"Rural Prairie Women" contains the work of two task forces: the Rural Social Work Task Force which looked at the forces active in North Dakota rural areas and the Rural Women Task Force which examined the position of women within those same rural communities. The relationship between the land, small towns, and sparse population is…
García-Mendizábal, María José; Carrasco, José Miguel; Pérez-Gómez, Beatriz; Aragonés, Nuria; Guallar-Castillón, Pilar; Rodríguez-Artalejo, Fernando; López-Abente, Gonzalo; Pollán, Marina
Background The impact of obesity on health-related quality of life (HRQL) has been little explored in rural areas. The goal of this study is to ascertain the association between obesity and HRQL among Spanish women living in a rural area, and the influence of their educational level. Methods Cross-sectional study with personal interview of 1298 women (aged 18 to 60) randomly selected from the electoral rolls of 14 towns in Galicia, a region in the north-west of Spain. HRQL was assessed using the SF-36 questionnaire. The association between body mass index (BMI) and suboptimal scores in the different HRQL dimensions was summarised using odds ratios (ORs), obtained from multivariate logistic regression models. Separate analyses were conducted for women who had finished their education younger than 16 years old and women with secondary education to assess differences in the relationship between BMI and HRQL according to educational level. Results Among women with primary or lower education, obesity was associated with a higher prevalence of suboptimal values in the following dimensions: Physical functioning (OR: 1.97; 95%CI: 1.22–3.18); Role-physical (OR: 1.81; 95%CI: 1.04–3.14); General health (OR: 1.76; 95%CI: 1.10–2.81); and Role-emotional (OR: 2.52; 95%CI: 1.27–5.03). In women with higher education, physical functioning was the only dimension associated with obesity (OR: 2.02: 95%CI 0.83–4.97). Conclusion The impact of obesity on women's HRQL is greater among those with a lower educational level. This group registered higher prevalence of obesity and poorer self-perceived health. PMID:19405963
Rural America, Inc., Washington, DC.
In rural America 34 million culturally and economically diverse women share the common problem of unfair treatment based on sex. Although in recent years women have begun to question the social attitudes limiting their aspirations, a formidable gap exists between their expectations and the archaic legal, social, and economic policies that continue…
Crosato, Kay E; Leipert, Beverly
Informal caregiving within rural contexts in Canada is increasing. This is due in part to a number of factors related to the restructuring of the Canadian health care system, the regionalization of services to urban locations, the increased population of people 65 years and older, and the desire of this population to age within their rural homes. Most often, the informal caregiving role is assumed by rural women. Women tend to fall into the role of informal caregiver to elders because of the many societal and gender expectations and values that are present within the rural culture. The purpose of this literature review is to identify the context in which women provide care for an elder in rural Canada. Illustrating these issues will help to uncover challenges and barriers rural women face when providing care and highlight recommendations and implications for rural women caregivers and nurses employed within rural settings. Many rural women share similar caregiving experiences as urban informal caregivers, but rural women are faced with additional challenges in providing quality care for an elder. Rural women caregivers are faced with such issues as limited access to adequate and appropriate healthcare services, culturally incongruent health care, geographical distance from regionalized centers and health services, transportation challenges, and social/geographical isolation. In addition to these issues, many rural women are faced with the multiple role demands that attend being a wife, mother, caregiver and employee. The pile up of these factors leaves rural women caregivers susceptible to additional stresses and burn out, with limited resources on which to depend. Through reviewing pertinent literature, appropriate implications and recommendations can be made that may assist rural women caregivers and rural nurses. Nurses working within rural communities are in ideal settings to work collaboratively in building supportive relationships with rural women in order to
Tower, Leslie E.; Fernandez, Maria Elena
This study analyzes variables related to the context and consequences of women's use of violence as well as a wide range of violent behaviors used and experienced by court-ordered English- and Spanish-speaking women. Data were derived from intake assessments of 125 court-ordered women over 24 months. Almost all of the women reported a history of…
Cornwell, Gretchen T.; Thorsen, Jenny S.
Data from the 1980, 1970, and 1960 censuses were used to describe Pennsylvania's rural women and to compare them with urban women and, in some instances, men. In Pennsylvania in 1980, just 1 rural woman in 25 lived on a farm. These women were more educated, more active in the labor force, and somewhat better paid than their counterparts in 1960…
Arrowsmith, Heather E.; Cole, Henry P.; Mazur, Joan M.
Objective: A Spanish language version of an exercise about adolescent horseback riders' exposure to traumatic brain injuries was integrated into the Spanish curriculum in a rural Kentucky high school. Design: An exploratory case study design with two groups of students. Setting and Method: Thirty-eight students, enrolled in intermediate Spanish IV…
34. View of the Women's lounge (Spanish room) looking northwest. A Mural by Merlin Hardy depicts a "Spanish dance theme in a 19th century setting." (removed 1997) - Fort Ord, Soldiers' Club, California State Highway 1 near Eighth Street, Seaside, Monterey County, CA
Although women are a crucial element in national rural development, their role continues to be neglected in plans and programs for change--especially in Third World countries. In addition to the burden faced by rural people generally in developing countries, women carry a double burden because of their low social status, high illiteracy rate, lack…
Buckheit, Caledonia; Pineros, Dwan; Olson, Ardis; Johnson, Deborah; Genereaux, Stephen
Dartmouth Geisel Migrant Health (DGMH) is a medical student group that provides on-site health services for Spanish-speaking dairy workers in rural Vermont and New Hampshire in conjunction with a federally qualified health center (FQHC). This project was undertaken to evaluate and improve the services provided by DGMH and the FQHC and to refine understanding of the target population. We surveyed 25 workers at 6 collaborating dairy farms to identify health priorities and concerns and perceived barriers and facilitators to health care for these workers. Surveys were administered over 2 weeks in July 2015. Interpreter-mediated appointment and sliding-fee-scale data from a period 7 months that spanned survey administration were also assessed. Diabetes and hypertension were the most common health concerns. Thirty-two percent of participants reported 10 or more days of depressed mood in the past month. Insurance and language were the most common barriers to health care and employers and on-site clinics were the most common facilitators. Appointments most often addressed women's health, gastrointestinal problems, health maintenance, diabetes, and back pain. Thirty FQHC sliding-fee-scale applications were completed by workers. These Spanish-speaking dairy-farm workers have many health concerns and perceive substantial barriers to health care. Collaboration between medical students, a rural FQHC, and farm employers provides important services that facilitate health care access among this population. © Copyright 2017 by the American Board of Family Medicine.
The Country Women's Association (CWA) is a nationwide Australian group that started in the 1920s in response to isolated women's need to socialize. The group's activities have expanded greatly over time. It distributes essential food and clothing to needy rural families, and its extensive involvement in incidental education for women includes…
Colle, Royal D.; Fernandez de Colle, Susana
Although not often considered in the past by planners because their economic contributions are not performed for money, rural women are contributors to the development of their countries. The urgency of reaching women with important information to break the cycle of poverty is now being recognized by the major development agencies. While there are…
Vaughn, Jennie; Harrell, Allen; Dayton, Amy E.
This qualitative study looks at how rural women in the American South have obtained access to digital technologies for reading and writing. Using the "life history" approach (Brandt; Hawisher and Selfe), we interviewed five women. We look at the challenges caused by the Digital Divide, at economies of access, including the financial…
Ugbomeh, George M. M.
Discusses the concepts of agricultural education, women empowerment, and sustainable rural development. Suggests that, because women make up more than half of Nigeria's population, their empowerment would assist the efforts for sustainable rural development. (Contains 48 references.) (JOW)
Grebner, Marythea; Mahaney Bud, Ed.
The handbook is comprised of eight chapters and nine appendixes which provide business management training and resource listings for rural women. Chapters cover aspects of financial planning, credit, recordkeeping, business regulations, personnel, federal taxes, estate planning, and property management. Appendixes include a will planning…
This study describes the status of 34 million rural women and analyzes how they and their families will be directly affected by cuts in the 1983 federal budget in the areas of legal services, vocational education, domestic violence intervention, energy assistance and alternative energy development, public housing, unemployment compensation, social…
Cornellana, M J; Harvey, X; Carballo, A; Khartchenko, E; Llaneza, P; Palacios, S; Mendoza, N
One of the most common complaints among postmenopausal women is a change in sexual drive. The aim of this study was to assess the current state of sexual health in Spanish postmenopausal women who present at outpatient gynecology clinics. In this multicenter, observational, cross-sectional, questionnaire-based study, a survey was conducted that included 3026 Spanish postmenopausal women in a routine clinical setting in outpatient gynecology clinics at public and private institutions throughout Spain. We used the Women's Sexual Function questionnaire, which has been validated in Spain. In the multivariate analysis, we found that the best indicators of sexual health in postmenopausal women were a higher education (p < 0.001), working or previously worked (p < 0.001), a stable partner (p < 0.001), living in an urban area (p < 0.01), healthy habits and received information about menopause (p < 0.001). These results indicate that it is important to provide health education and information about menopause and the complaints associated with this period in a woman's life.
Matthews, Hollie L.; Laya, Mary; DeWitt, Dawn E.
Context: Little is known about rural women's knowledge about osteoporosis. Purpose: To explore what women from high-prevalence rural communities know about osteoporosis and to assess their learning preferences. Methods: We surveyed 437 women in rural Washington and Oregon. Findings: The response rate was 93% (N = 406). The mean age of respondents…
Villareal, F L
This article describes the Women's Population and Development (WPD) program among rural women in 35 poor counties in 10 provinces in China in 1988. The provinces included Xinjiang, Gansu, Qinghai, Ningxia, Inner Mongolia, Shaanxi, Shanxi, Guizhou, Hubei, and Anhui, which are mostly located in the arid northwest or pastoral northeast China. The study area is inclined to have harsh agro-ecological conditions and environmental degradation. Women's income ranges from RMB 350 to 650 Yuan. About 35% were literate. 40-50% of the rural agricultural labor force and about 60% of all farm labor were women. Out migration of men was increasing. This WPD program was supported by the Ministry of Foreign Technical and Economic Cooperation, the UNFPA, and the UN Food and Agriculture Organization. The program aim is to use alternative family planning strategies, alleviate poverty, and improve rural women's status. Initial discussions revealed different goals among rural women and county leaders. Women wanted direct access and control over resources. County leaders desired increased productivity among a selected number of small scale enterprises. The project stipulated that 80% of funding was to be allocated as credit for rural women, that a revolving fund would give women direct access and control of resources, and that women would be recognized for their dual roles. Partnerships were formed between women's voluntary groups and project management. Prospective members of women's self-help groups received a 60-70 hour workshop. This workshop helped to identity the root causes of low status and feasible approaches to improving the status and to developed program activities. Counties were gradually included during 1990-93. This program evaluation pertains to analysis of 1994-95 data among 1300 respondents at four points in time. Impact indicators include 18 measures. The most important measure is that women gained control over their own lives and a partnership with husbands. The program
In 1998, a multidisciplinary group of researchers investigated women's reproductive health in two rural villages in Giza, Egypt using data from clinical examinations and laboratory tests. In addition, a questionnaire supplemented with in-depth interviews illuminated women's perceptions of illness and the sociocultural context of the community. Examining a random sample of 509 married, nonpregnant women, the researchers found that the vast majority of these women suffer from a spectrum of gynecological and related conditions. Beyond reproductive tract infections, which affect roughly half of the women, genital prolapse afflicts 56% and anemia 63%. Suspicious cervical cell changes (11%) and cervical erosion (22%) in women were noted. Moreover, related conditions were also highly prevalent: women suffered from urinary tract infections (14%), obesity (43%), and hypertension (18%). The team also discovered that two-thirds of women with symptoms had not sought care. Factors other than the physical accessibility, inadequacy in the quality and nature of available health services, and low priority that women place on their health have all contributed to women's lack of seeking treatment. This study suggests that a multidisciplinary approach to medical provision, taking women's perceptions into account is the most effective way to address reproductive health and ill health in communities of the developing world.
BARRETT, DONALD N.; SAMORA, JULIAN
THE ANALYSIS DEALS WITH--DEMOGRAPHIC, HISTORICAL, AND CULTURAL BACKGROUND FACTORS, AND THE HOUSING, FAMILY LIFE, AND EDUCATIONAL AND ECONOMIC PARTICIPATION OF SPANISH SURNAME, NON-PUERTO RICAN PEOPLE IN FIVE SOUTHWESTERN STATES. CONCLUSIONS ARE BASED ON AN EXAMINATION OF EXISTING LITERATURE, A SURVEY OF EXPERT OPINION, FIELD CHECKS OF SELECTED…
Vives-Cases, Carmen; La Parra Casado, Daniel
This study analyzes the discourse of some members of the Spanish parliament (MPs) in the 2 years before the Gender Violence Act was passed in 2004 to examine how gender-based violence is construed when legal measures are proposed. Ten members of six different parties of the Spanish parliament were interviewed between November 2002 and March 2003. Each interview was recorded and transcribed. A discourse analysis was performed with Atlas.ti 4.2. Analysis of the interviews showed a discourse that revolved around the victim's report as the main mechanism for the public authorities to intervene and try to end gender-based violence. The interviewees proposed the following steps to help victims to escape from violence: reporting violence to the police, the provision of victim protection, punishment of the perpetrator, and avoidance of problems and death through different measures (law, police, support services). Our analysis shows how a major social problem and the mobilization of women and mass media have had several effects. One of these effects is that lawmakers have turned their attention to this social concern. A solution to this phenomenon is being sought through the mechanisms of the Spanish parliament (promoting changes in the law) and government (making more economic resources available). The public action proposed by the MPs interviewed focuses on reporting; their discourse does not include alternative options (or includes only vague options) for victims not reporting violence.
Martínez Pérez, José Antonio; Palacios, Santiago; García, Felipe Chavida; Pérez, Maite
(1) To assess the prevalence of osteoporosis risk factors in Spanish menopausal women; (2) to detect medical and lifestyle risk factor differences between perimenopausal and postmenopausal women; (3) and to identify the main factors responsible for osteoporosis. Cross-sectional descriptive study encompassing women aged 45-65 across Spain. The study population sample was collected through random sampling and a total of 10,514 women were included. Socio-demographic, medical history, and lifestyle data were assessed. The prevalence of osteoporosis risk factors was 67.6%. The most common risk factors were physical inactivity (53.6%), use of medication related to osteoporosis risk (45.9%), and low calcium intake (30.1%). There were statistically significant differences between peri- and postmenopausal women in terms of smoking status, alcohol intake, personal history, poor dairy product intake, and medication use that could increase risk. Logistic regression analysis showed that osteoporosis was significantly associated with age, family history, age at onset of menopause, Kupperman Index, prolonged immobilization, weight loss, and other diseases that increase the probability of developing osteoporosis. A high prevalence of women taking osteoporosis risk-related medication was observed in our study. There was correlation between the menopausal symptoms' degree of severity and the risk of suffering from osteoporosis.
Tudiver, Fred; Edwards, Joellen Beckett; Pfortmiller, Deborah T.
Context: Rates and types of screening for depression in rural primary care practices are unknown. Purpose: To identify rates of depression screening among rural women in a sample of rural health clinics (RHCs). Methods: A chart review of 759 women's charts in 19 randomly selected RHCs across the nation. Data were collected from charts of female…
Watson-Johnson, Lisa C.; Bhagatwala, Jigar; Reyes-Garcia, Claudia; Hinojosa, Andrea; Mason, Mondi; Meade, Cathy D.; Luque, John S.
Summary Cervical cancer incidence and mortality continue to affect Hispanic women in the U.S. disproportionately. Our project sought to refine a cervical cancer intervention designed for use by community health workers, or promotoras, in rural southern Georgia. We collaborated with Hispanic promotoras to refine a Spanish language educational flipchart featuring cervical cancer topic areas for use in screening promotion. PMID:23698684
Lagro, Marieke; Liche, Agnes; Mumba, Theresa; Ntebeka, Ruth; van Roosmalen, Jos
Health problems after childbirth have received little attention compared to maternal morbidity in the antenatal period and during labour. We conducted a hospital-based study to investigate postpartum health problems in rural Zambian women. Health problems are very common: 84% of the 620 study participants reported at least one health problem. The majority of women who experienced a health problem took action to relieve the complaint. High vaginal swabs were used to diagnose a genital tract infection. Seventeen per cent of the swabs were abnormal; most women with abnormal result showed no symptoms of genital tract infection. Ninety three per cent of women with symptoms suggestive of a genital tract infection did not seek medical attention. Further research is needed to estimate the impact of self-reported health problems on women's daily lives. Women should be educated on specific conditions that require medical care. More information is also needed on the prevalence of sexually transmitted infections in antenatal and postpartum women including the feasibility of mass screening and treatment in this group of women.
Morrison, J; Colbourn, T; Budhathoki, B; Sen, A; Adhikari, D; Bamjan, J; Pathak, S; Basnet, A; Trani, J F; Costello, A; Manandhar, D; Groce, N
There is strong evidence that participatory approaches to health and participatory women's groups hold great potential to improve the health of women and children in resource poor settings. It is important to consider if interventions are reaching the most marginalized, and therefore we examined disabled women's participation in women's groups and other community groups in rural Nepal. People with disabilities constitute 15% of the world's population and face high levels of poverty, stigma, social marginalization and unequal access to health resources, and therefore their access to women's groups is particularly important. We used a mixed methods approach to describe attendance in groups among disabled and non-disabled women, considering different types and severities of disability. We found no significant differences in the percentage of women that had ever attended at least one of our women's groups, between non-disabled and disabled women. This was true for women with all severities and types of disability, except physically disabled women who were slightly less likely to have attended. Barriers such as poverty, lack of family support, lack of self-confidence and attendance in many groups prevented women from attending groups. Our findings are particularly significant because disabled people's participation in broader community groups, not focused on disability, has been little studied. We conclude that women's groups are an important way to reach disabled women in resource poor communities. We recommend that disabled persons organizations help to increase awareness of disability issues among organizations running community groups to further increase their effectiveness in reaching disabled women. © The Author 2015. Published by Oxford University Press.
Colbourn, T.; Budhathoki, B.; Sen, A.; Adhikari, D.; Bamjan, J.; Pathak, S.; Basnet, A.; Trani, J. F.; Costello, A.; Manandhar, D.; Groce, N.
Abstract There is strong evidence that participatory approaches to health and participatory women's groups hold great potential to improve the health of women and children in resource poor settings. It is important to consider if interventions are reaching the most marginalized, and therefore we examined disabled women's participation in women's groups and other community groups in rural Nepal. People with disabilities constitute 15% of the world's population and face high levels of poverty, stigma, social marginalization and unequal access to health resources, and therefore their access to women's groups is particularly important. We used a mixed methods approach to describe attendance in groups among disabled and non-disabled women, considering different types and severities of disability. We found no significant differences in the percentage of women that had ever attended at least one of our women's groups, between non-disabled and disabled women. This was true for women with all severities and types of disability, except physically disabled women who were slightly less likely to have attended. Barriers such as poverty, lack of family support, lack of self-confidence and attendance in many groups prevented women from attending groups. Our findings are particularly significant because disabled people's participation in broader community groups, not focused on disability, has been little studied. We conclude that women's groups are an important way to reach disabled women in resource poor communities. We recommend that disabled persons organizations help to increase awareness of disability issues among organizations running community groups to further increase their effectiveness in reaching disabled women. PMID:26519006
Deere, C D; León de Leal, M
On the basis of experience gained in researching the economic roles of rural women in a national level study in Colombia and in a regional level study in Peru, some of the methodological problems of measuring rural women's economic participation by sample survey are considered. The specific objective of the sample surveys was to quantify the existing sexual division of labor among the peasant population. The rural household was the unit of analysis, and the focus of measurement was the division of labor by sex in such activities as daily maintenance, household production, and income-generating activitives pursued outside the household. The focus of the survey questionnaire is on the sexual division of labor, but it necessarily must be related to another series of socioeconomic or cultural variables for analysis. The selection of these variables needs to be derived from the hypotheses guiding the study, yet much attention must be given to narrowing the range of inquiry. The time constraint on the length of the questionnaire requires that certain choices be made in terms of the complementary variables to be included. The most important problem in the design of a representative sample survey is the selection of the population to be sampled. The choice of population needs to be compatible with the theoretical framework. Since the interest was to measure the sexual division of labor in terms of class formation, the sample had to be representative of the different class strata in the rural areas. The measurement of access to means of production ideally should be quantitative and qualitative. The choice of the population to be sampled is also constrained by the available data base, a particular problem in rural areas.
Background While the timing of reproductive events varies across populations, a downward trend in age at menarche has nevertheless been reported in most of the developed world over the past century. Given the impact of change in age at menarche on health conditions, this study sought to examine secular trends in age at menarche among women living in Navarre (Northern Spain) who participated in a population-based breast cancer screening programme. Methods The study was based on 110545 women born from 1925 to 1962. Trends were tested using a linear regression model, in which year of birth was entered continuously as the predictor and age at menarche (years) as the response variable, using size of town and region of birth as covariates. Results Among women born in Navarre between 1925 and 1962, age at menarche declined steadily from an average of 13.72 years in the 1925-1929 birth-cohorts to 12.83 years in the 1958-1962 birth-cohorts. Controlling for size of town or city of birth, age at menarche declined by an average of 0.132 years every 5 years over the period 1925-1962. This decline was greater in women born in rural versus urban settings. Trends were also different among regions of birth. Conclusion We report a population-based study showing a downward trend in age of onset of menarche among Spanish women born in the period 1925-1962, something that is more pronounced among women born in rural settings and varies geographically. PMID:19961593
Moore-West, Maggi; Lucero, Susan
Personality and a social support system are two factors that may influence women medical students' choice of a rural primary care specialty. The 2-year study of 11 University of New Mexico School of Medicine women students engaged in 4-month rural primary care preceptorships included interviews and a personality inventory. Three women had…
Brooks, Elizabeth; Dailey, Nancy; Bair, Byron; Shore, Jay
While many women choose to live in rural areas after retiring from active military duty, a paucity of studies examine rural women veterans' health care needs. This report is the first of its kind to describe the population demographics and health care utilization of rural female veteran patients enrolled in the Department of Veterans Affairs (VA). Using the National Patient Care Datasets (n = 327,785), we ran adjusted regression analyses to examine service utilization between (1) urban and rural and (2) urban and highly rural women veterans. Rural and highly rural women veterans were older and more likely to be married than their urban counterparts. Diagnostic rates were generally similar between groups for several mental health disorders, hypertension, and diabetes, with the exception of nonposttraumatic stress anxiety that was significantly lower for highly rural women veterans. Rural and highly rural women veterans were less likely to present to the VA for women's specific care than urban women veterans; highly rural women veterans were less likely to present for mental health care compared to urban women veterans. Among the users of primary care, mental health, women's specific, and all outpatient services, patients' annual utilization rates were similar. Improved service options for women's specific care and mental health visits may help rural women veterans access care. Telehealth technologies and increased outreach, perhaps peer-based, should be considered. Other recommendations for VA policy and planning include increasing caregiver support options, providing consistency for mental health services, and revising medical encounter coding procedures. © 2013 National Rural Health Association.
Sinharoy, Sheela S; Waid, Jillian L; Haardörfer, Regine; Wendt, Amanda; Gabrysch, Sabine; Yount, Kathryn M
The relationship between women's empowerment and women's nutrition is understudied. We aimed to elucidate this relationship by quantifying possible pathways between empowerment and dietary diversity among women in rural Bangladesh. In 2015, we conducted a cross-sectional survey of 2,599 married women ages 15-40 (median: 25) living in 96 settlements of Habiganj District, Bangladesh, as a baseline for the Food and Agricultural Approaches to Reducing Malnutrition trial. We collected data on women's empowerment (highest completed grade of schooling and agency), dietary diversity, and demographic factors, including household wealth. We used exploratory factor analysis and confirmatory factor analysis on random split-half samples, followed by structural equation modelling, to test pathways from schooling, through domains of women's agency, to dietary diversity. Factor analysis revealed 3 latent domains of women's agency: social solidarity, decision-making, and voice with husband. In the adjusted mediation model, having any postprimary schooling was positively associated with voice with husband (β 41 = .051, p = .010), which was positively associated with dietary diversity (β 54 = .39, p = .002). Schooling also had a direct positive association with women's dietary diversity (β 51 = .22, p < .001). Neither women's social solidarity nor decision-making mediated the relationship between schooling and dietary diversity. The link between schooling and dietary diversity was direct and indirect, through women's voice with husband but not through women's social solidarity or decision-making. In this population, women with postprimary schooling seem to be better able to negotiate improved diets for themselves. © 2017 John Wiley & Sons Ltd.
McCulloch, B Jan; Jackson, Melanie N G; Lassig, Sara L
This exploratory study examined older rural women's health decision making. Thirty-three rural women were recruited to participate in semistructured qualitative interviews. Major themes emerged that focused on rural women's comments regarding their concerns about not worrying or bothering their children with personal health matters. Themes were discussed in the context of an ethic of care. Results suggest that it is important for mental health professionals, family physicians, social workers, and other practitioners to be aware of the sense of worry and concern for others that older rural women bring to bear in decision making about personal health issues.
Bove, Riley M; Vala-Haynes, Emily; Valeggia, Claudia
Women's social networks and social power are increasingly seen as important factors modulating their health in sub-Saharan Africa. Polygyny, a common marital structure in many societies, mediates important intra-household relationships by requiring both competition and cooperation among co-wives. Using mixed methods, semi-structured questionnaires were administered to 298 women aged 15 to 84 living in the Kolondiéba region of rural Mali in 1999, and supplemented by detailed interviews with 40 women. Three categories of outcome were explored: illness experience, therapeutic itinerary, and social support received. Quantitative data were analyzed using regression analysis and qualitative data using a grounded theory approach. In quantitative analyses, controlling for age and household wealth index, senior wives were less likely to be escorted to a healer by their husbands during illness than were junior wives or monogamous women. Polygynous women were also less likely to obtain a treatment for which there was a monetary fee. Fewer than one third of polygynous women reported the assistance of a co-wife during illness in any given task. In qualitative analyses, women further related varied mechanisms through which polygyny impacted their health trajectories. These ranged from strongly supportive relationships, to jealousy because of unequal health or fertility, bias in emotional and material support provided by husbands, and accusations of wrong-doing and witchcraft. This study highlights the need for more prospective mixed methods analyses to further clarify the impact of polygyny on women's health-related experiences and behaviors in sub-Saharan Africa. PMID:23480408
This presentation examines the history of women teachers in the rural United States. The earliest classrooms in America were a male environment modeled after European schools. But in the mid-19th century, the Civil War and westward expansion depleted the number of male teachers and brought rural women teachers to the helm of American education.…
Ely, Andrea C.; Befort, Christie; Banitt, Angela; Gibson, Cheryl; Sullivan, Debra
Objective: To explore weight control beliefs, attitudes, knowledge, and practices among rural Kansas women, and to characterize the relationship of these women with their primary-care providers around weight control. Design: Qualitative research using focus groups. Setting: Three separate communities of rural Kansas. Participants: Six focus groups…
Fernández Niño, Julián Alfredo; Pinzón Flórez, Carlos Eduardo; Moreno Montoya, José; Cepeda Gil, Magda Cristiana; Idrovo Velandia, Alvaro Javier
Social capital is considered a structural determinant of social development and wellbeing. Its cognitive component assesses the degree of confidence of the population in their systems for social organization, as well as community interactions to coordinate social responses to social problems. There are few available scales for measuring this construct. This work presents the adaptation to Spanish and psychometric validation of a scale for measuring social capital in a rural setting. The Wang Social Cognitive Scale was also adapted to Spanish. 1200 questionnaires were applied to adults in 12 villages of the municipality of Tierra Alta, (Colombia) recruited by random sampling. Factor analysis of the scale was performed based on a polychoric correlation matrix. Exploratory factor analysis suggests the existence of two principal factors distributed as follows: 7 items for factor 1, trust (eigenvalue 3.23) and 2 items, for factor 2, distrust (eigenvalue 1.40). As observed by Wang, Q9 and Q10 could be ambiguous questions which do not contribute enough to either of the factors. The first factor validation to Spanish language of the Wang Social Capital Scale is presented in the social context of rural Colombia.
Jimenez, T.; Olson, K.
Esta es la primera de una serie de guias de aplicaciones que el Programa de Energia de Villas de NREL esta comisionando para acoplar sistemas comerciales renovables con aplicaciones rurales, incluyendo agua, escuelas rurales y micro empresas. La guia esta complementada por las actividades de desarrollo del Programa de Energia de Villas de NREL, proyectos pilotos internacionales y programas de visitas profesionales.
Lope, Virginia; García-Pérez, Javier; Pérez-Gómez, Beatriz; Pedraza-Flechas, Ana María; Alguacil, Juan; González-Galarzo, Mª Carmen; Alba, Miguel Angel; van der Haar, Rudolf; Cortés-Barragán, Rosa Ana; Pedraz-Pingarrón, Carmen; Moreo, Pilar; Santamariña, Carmen; Ederra, María; Vidal, Carmen; Salas-Trejo, Dolores; Sánchez-Contador, Carmen; Llobet, Rafael; Pollán, Marina
The association between occupational exposures and mammographic density (MD), a marker of breast cancer risk, has not been previously explored. Our objective was to investigate the influence of occupational exposure to chemical, physical and microbiological agents on MD in adult women. This is a population-based cross-sectional study based on 1476 female workers aged 45-65 years from seven Spanish breast cancer screening programmes. Occupational history was surveyed by trained staff. Exposure to occupational agents was assessed using the Spanish job-exposure matrix MatEmESp. Percentage of MD was measured by two radiologists using a semiautomatic computer tool. The association was estimated using mixed log-linear regression models adjusting for age, education, body mass index, menopausal status, parity, smoking, alcohol intake, type of mammography, family history of breast cancer and hormonal therapy use, and including screening centre and professional reader as random effects terms. Although no association was found with most of the agents, women occupationally exposed to perchloroethylene (e β =1.51; 95% CI 1.04 to 2.19), ionising radiation (e β =1.23; 95% CI 0.99 to 1.52) and mould spores (e β =1.44; 95% CI 1.01 to 2.04) tended to have higher MD. The percentage of density increased 12% for every 5 years exposure to perchloroethylene or mould spores, 11% for every 5 years exposure to aliphatic/alicyclic hydrocarbon solvents and 3% for each 5 years exposure to ionising radiation. Exposure to perchloroethylene, ionising radiation, mould spores or aliphatic/alicyclic hydrocarbon solvents in occupational settings could be associated with higher MD. Further studies are needed to clarify the accuracy and the reasons for these findings. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Zimmermann, Kristine; Khare, Manorama M.; Huber, Rachel; Moehring, Patricia A.; Koch, Abby; Geller, Stacie E.
Background: Cardiovascular disease is the leading cause of death in women in the United States. Rural women have an increased risk of cardiovascular disease due to both behavioral and environmental factors. Models of prevention that are tailored to community needs and build on existing resources are essential for effective outreach to rural women.…
Crosby, Richard A.; Casey, Baretta R.; Vanderpool, Robin; Collins, Tom; Moore, Gregory R.
Purpose: To contrast rates of initial HPV vaccine uptake, offered at no cost, between a rural clinic, a rural community college, and an urban college clinic and to identify rural versus urban differences in uptake of free booster doses. Methods: Young rural women attending rural clinics (n = 246), young women attending a rural community college (n…
Howard, David L; Soulli, Beth; Johnson, Nicole; Cooper, Saladin
Objective To compare the understanding of the term 'Pap smear' among Spanish-speaking women, as compared to their English-speaking counterparts. Methods Surveys were distributed to English and Spanish speaking female patients in an urban Obstetrics and Gynecology clinic. Patients were at least 18 years old or they were less than 18 years old and pregnant. Results A majority of participants (77.3 % English-speaking vs. 74.1 % Spanish-speaking, respectively) were able to identify at least one correct descriptor for the term Pap smear. However, Spanish-speaking women were significantly less likely to choose incorrect descriptors. Spanish-speaking women were much less likely to say that a Pap smear was the same as a Pelvic exam (45.7 vs. 78.8 %; p = 0.001), or a test for a sexually transmitted disease (25 vs. 60.6 %; p = 0.001). Conclusions for Practice Compared to English-speaking women, Spanish-speaking women are much less likely to conflate a pelvic exam with a Pap smear. Overall understanding was suboptimal, regardless of primary language, indicating that major efforts are still needed to improve functional health literacy with respect to cervical cancer screening.
Nagarajan, P.; Jiji, G. Wiselin
This paper is intended as a gender issue to the rural finance practitioners. It highlights the questions that need to be asked and addressed to the gender mainstream. It will also be useful to gender experts to wish to increase their understanding on specific gender issues in rural finance through mobile services. It focuses on rural microfinance…
Suicides by young females in rural China contribute substantially to the high rate of suicide and the total number of suicides in China. Given the traditional familial structure that remains largely intact in rural China, this research focuses on whether being married is a risk or protective factor for suicide by young women. I examined 168 rural…
Sánchez-López, Maria Pilar; López-García, Juan José; Dresch, Virginia; Corbalán, Javier
The purpose of this work was to examine the sociodemographic, psychological, and health-related factors (considered jointly) associated with poor mental health in midlife and to analyze whether risk and protective factors differed in men and women. A cross-sectional study was conducted with a middle-class sample of 252 women and 189 men between 45 and 65 years of age from Spanish rural areas. Mental health status was measured with the 12-Item General Health Questionnaire (GHQ-12; Goldberg & Williams, 1988). Multiple logistic regression models were used to calculate odds ratios with confidence intervals of 95%, adjusting for confounding variables. The percentage of women (14.3%) with poor mental health was twice that of the men (7.4%). In women, the following variables were significantly and positively related to poor mental health: consumption of psychoactive drugs, physiological and cognitive anxiety; self-esteem and family satisfaction were protective factors. For men, physical complaints and cognitive anxiety were significant risk factors, and job satisfaction was a protective factor. In general, the psychological variables were more clearly related to poor mental health. Women had a more unfavorable profile, and the variables related to poor mental health differed for men and women, perhaps due to social roles associated with gender. To facilitate diagnosis and take preventive measures, men's and women's risk factors for poor mental health should be differentiated.
Wendt, Sarah; Hornosty, Jennie
Research on family violence in rural communities in Australia and Canada has shown that women's experience of family violence is shaped by social and cultural factors. Concern for economic security and inheritance for children, closeness and belonging, and values of family unity and traditional gender roles are factors in rural communities that…
RESPIRATORY HEALTH OF RURAL AND FARM WOMEN IN THE KEOKUK COUNTY RURAL HEALTH STUDY
Allison L. Naleway*, Nancy L. Sprince?, Erik R. Svendsen?, Ann M. Stromquist?, James A. Merchant?
*Marshfield Medical Research and Education Foundation, Marshfield, WI; ?University of Iowa Co...
Escribà-Agüir, Vicenta; Ruiz-Pérez, Isabel; Artazcoz, Lucía; Martín-Baena, David; Royo-Marqués, Manuela; Vanaclocha-Espí, Mercedes
To assess the reliability, accuracy, and construct validity of the Spanish Abuse Assessment Screen (AAS) among pregnant women using the Spanish version of Index of Spouse Abuse (ISA) as a reference standard. Cross-sectional survey. A total of 1,329 pregnant women were selected in nine primary care centers during 2008-2009. The Spanish ISA was self-administered first, followed by the AAS, administered by the midwife. Sensitivity, specificity, and predictive values of the Spanish AAS were compared with the Spanish version of the ISA as a reference standard. Percentage of agreement between initial and retest administration of the Spanish AAS was high, from 96.4% to 100%. Specificity was for all types of abuse above 97%, but sensitivity values were much lower (33.3%, 22.9%, 6.9%, for severe physical abuse, minor psychological abuse, and minor physical abuse, respectively). The sensitivity of severe psychological abuse was perfect. Construct validity was good. The Spanish AAS has good test-retest reliability, specificity, and construct validity. The sensitivity was good for severe psychological abuse and moderate for severe physical abuse. Further formal psychometric evaluations, in other languages from countries with low prevalence of abuse, remains a priority for clinical and research efforts in pregnancy domestic violence screening. © 2015 Wiley Periodicals, Inc.
With much discussion about health disparities in Minnesota in recent years, there has been growing awareness about the inequities between rich and poor and between majority and minority groups. Attention also needs to be paid to the disparities between women who live in rural areas and those who live in urban parts of the state. Rural women are poorer, older and less likely to have adequate health insurance than their urban counterparts, which can compromise their health status. They also fare worse on a number of health indicators and face barriers to adequate health care that can exacerbate disparities. This article describes the root causes of health disparities between women living in rural and urban parts of the state and explores strategies to mitigate them that include increasing the rural physician workforce, improving access to primary and specialty care through telehealth services, and expanding health insurance options.
Borda-Olivas, Alfredo; Fernández-Navarro, Pablo; Otero-García, Laura; Sanz-Barbero, Belén
This study analyses the association between rurality and local rate of avoidable hospitalizations in a Spanish region with high population dispersion. Ecological study using a municipality in the region of Castile and Leon (Spain) as the spatial unit of analysis. The variables used to operationalize rurality included the following: distance to hospital, population density, mean socio-economic level and percentage of the population aged >65 years. We calculated relative risk (RR) and 95% confidence intervals (CI) using the conditional autoregressive spatial model proposed by Besag, York and Mollié, with explanatory variables. The number of avoidable hospitalizations was 9923 or 4.5% of all admissions. The age- and gender-adjusted avoidable hospitalization rate was 4.06 per 1000 persons. Spatial analysis showed that two variables, distance from municipality of residence to reference hospital and percentage of population aged >65 years were inversely associated with risk for avoidable hospitalization [RR=0.996 (95% CI 0.993-0.999) and RR=0.989 (95% CI 0.982-0.996), respectively]. It is important to determine whether these lower avoidable hospitalization rates reflect an adequate level of accessibility and quality of primary care health services for rural populations or, in the contrary, they reveal access barriers to hospital care.
Navarro, Raúl; Serna, Cristina; Martínez, Verónica; Ruiz-Oliva, Roberto
Cyberbullying victimization research on individual and familial correlates is scarce in Spain. By building upon previous studies, this research examines the role of Internet usage and parental mediation in online victimization. Spanish children from rural public schools (10-12 years; n?=?1068) completed a self-report questionnaire which measured…
Mutanyatta, J. N. S.
Despite their significant role in African economies, women are still the victims of poverty, illiteracy, discrimination, and powerlessness. Most African countries are classified as "low" on the Human Development Index and exhibit a relationship between per capita gross domestic product and the adult literacy rate. Rural women appear to…
Williams, Armenia; Wold, Judith; Dunkin, Jeri; Idleman, Lynda; Jackson, Cennette
Using Pender's Health Promotion Model, this study tested a work site cardiovascular disease (CVD) risk factor reduction intervention among low-income African American (LAAW) women. Individual CVD risk profiles were identified at the work site through (1) health risk appraisal, (2) blood pressure measurement, (3) body mass index calculation, (4) individual interviews about diet and exercise behaviors, and (5) total cholesterol analysis. Two LAAW groups, one urban and one rural, exhibited higher or similar pretest CVD relative risks (RR) when statistically compared with a national sample of African American women. The LAAW study samples were younger and more educated. Pretest cholesterol and fat intake for the rural women were higher than for the urban women (<.05). Posttest changes in cholesterol and fat intake risks were more significant in rural LAAW than in urban LAAW (<.05).
Chikani, Vatsal; Reding, Douglas; Gunderson, Paul; McCarty, Catherine A.
Background: The aim of the present study is to investigate the association between psychosocial work characteristics and health functioning and cardiovascular disease risk factors among rural women of central Wisconsin and compare psychosocial work characteristics between farm and nonfarm women. Methods: Stratified sampling was used to select a…
Angell, Karyn L; Kreshka, Mary Anne; McCoy, Rebecca; Donnelly, Patricia; Turner-Cobb, Julie M; Graddy, Kathy; Kraemer, Helena C; Koopman, Cheryl
OBJECTIVE This study was initiated by breast cancer survivors living in a rural community in California. They formed a partnership with academic researchers to develop and evaluate a low-cost, community-based Workbook-Journal (WBJ) for improving psychosocial functioning in geographically and economically isolated women with primary breast cancer. DESIGN A randomized controlled trial was used to compare the WBJ intervention plus educational materials to educational materials alone (usual care). SETTING One rural cancer center and several private medical, surgical, and radiation oncology practices in 7 rural counties in the Sierra Nevada Foothills of California. PARTICIPANTS One hundred women with primary breast cancer who were either within 3 months of diagnosis or within 3 months of completing treatment. INTERVENTION A community-initiated, theoretically-based Workbook-Journal, designed by rural breast cancer survivors and providers as a support group alternative. It included compelling personal stories, local rural resources, coping strategies, and messages of hope. RESULTS Community recruiters enrolled 83% of the women referred to the study. Retention at 3-month follow-up was 98%. There were no main effects for the WBJ. However, 3 significant interactions suggested that women who were treated in rural practices reported decreased fighting spirit and increased emotional venting and posttraumatic stress disorder symptoms if they did not receive the WBJ. Among women who receive the WBJ, 74% felt emotionally supported. CONCLUSIONS This community-based Workbook-Journal may be an effective psychosocial intervention for rural, isolated, and low-income women with breast cancer. Community involvement was essential to the success of this project. PMID:12848832
Cochrane, Hortence S., Comp.
The 1976 Rural New York Conference focused on unresolved social problems in rural America, with particular attention to needs of rural women in New York. Growing out of a course on rural poverty and social change at Syracuse University, the conference was initiated and planned primarily by students. Proceedings include "Commentaries" by:…
Wieslander, Cecilia K; Alas, Alexandriah; Dunivan, Gena C; Sevilla, Claudia; Cichowski, Sara; Maliski, Sally; Eilber, Karyn; Rogers, Rebecca G; Anger, Jennifer T
Limited data exist on women's experience with pelvic organ prolapse (POP) symptoms. We aimed to describe factors that prevent disease understanding among Spanish-speaking and English-speaking women. Women with POP were recruited from female urology and urogynecology clinics in Los Angeles, California, and Albuquerque, New Mexico. Eight focus groups were conducted, four in Spanish and four in English. Topics addressed patients' emotional responses when noticing their prolapse, how they sought support, what verbal and written information was given, and their overall feelings of the process. Additionally, patients were asked about their experience with their treating physician. All interview transcripts were analyzed using grounded theory qualitative methods. Qualitative analysis yielded two preliminary themes. First, women had misconceptions about what POP is as well as its causes and treatments. Second, there was a great deal of miscommunication between patient and physician which led to decreased understanding about the diagnosis and treatment options. This included the fact that women were often overwhelmed with information which they did not understand. The concept emerged that there is a strong need for better methods to achieve disease and treatment understanding for women with POP. Our findings emphasize that women with POP have considerable misconceptions about their disease. In addition, there is miscommunication during the patient-physician interaction that leads to further confusion among Spanish-speaking and English-speaking women. Spending more time explaining the diagnosis of POP, rather than focusing solely on treatment options, may reduce miscommunication and increase patient understanding.
Ortega, M; Elena-Roselló, R; García del Barrio, J M
Approaches linking biodiversity assessment with landscape structure are necessary in the framework of sustainable rural development. The present paper describes a methodology to estimate plant diversity involving landscape structure as a proportional weight associated with different plant communities found in the landscape mosaic. The area occupied by a plant community, its patch number or its spatial distribution of patches are variables that could be expressed in gamma plant diversity of a territory. The methodology applies (1) remote sensing information, to identify land cover and land use types; (2) aspect, to discriminate composition of plant communities in each land cover type; (3) multi-scale field techniques, to asses plant diversity; (4) affinity analysis of plant community composition, to validate the stratified random sampling design and (5) the additive model that partitions gamma diversity into its alpha and beta components. The method was applied to three Spanish rural areas and was able to record 150-260 species per ha. Species richness, Shannon information index and Simpson concentration index were used to measure diversity in each area. The estimation using Shannon diversity index and the product of patch number and patch interspersion as weighting of plant community diversity was found to be the most appropriate method of measuring plant diversity at the landscape level.
Patterson, Jean; Foureur, Maralyn; Skinner, Joan
Birth in primary midwife-led maternity units has been demonstrated to be a safe choice for well women anticipating a normal birth. The incidence of serious perinatal outcomes for these women is comparable to similarly low risk women, who choose to birth in hospital. New Zealand women have a choice of Lead Maternity Carer (LMC) and birthplace; home, primary birthing unit, or a base hospital, though not all women may have all these choices available locally. Women in rural and rural remote areas can also choose to birth in their rural primary maternity unit. A percentage of these women (approx. 15-17%) will require transfer during labour, an event which can cause distress and often loss of midwifery continuity of care. To explore retrospectively the choice of birth place decisions and the labour and birth experiences of a sample of women resident in remotely zoned, rural areas of the lower South Island of New Zealand. A purposive sample of women living in remote rural areas, recruited by advertising in local newspapers and flyers. Individual semi-structured interviews were digitally recorded using a pragmatic interpretive approach. The data (transcripts and field notes) were analysed using thematic and content analysis. Ethical approval was obtained from the Health and Disability Ethics Committee (HEDC) MEC/06/05/045. Thirteen women consented to participate. Each was resident in a remote rural area having given birth in the previous 18 months. The women had been well during their pregnancies and at the onset of labour had anticipated a spontaneous vaginal birth. Rural remote zoned areas in Otago and Southland in the South Island of New Zealand FINDINGS: Five women planned to birth in a regional hospital and eight chose their nearest rural primary maternity unit. All of the women were aware of the possibility of transfer and had made their decision about their birthplace based on their perception of their personal safety, and in consideration of their distance from
Wooller, Judith; Warner, Lesley
Central Queensland University's Women into Science and Technology program aimed to broaden the access of women to higher education, improve their career opportunities and employment prospects, and address the personnel shortage in engineering and technology by encouraging mature age women to consider these fields. The distance learning program was…
Fagley, R M
Women are the 2nd-class citizens of the developing countries, especially in the rural areas. Not until the status of women is upgraded in these areas will the struggle for better nutrition, for smaller families, and for general social development be successful. The reasons why women have been neglected so far are discussed. Women in developing countries suffer from a lack of power. They can be helped by women in affluent societies. Information on the status of women in various Asian, African, and Latin American countries was solicited and is presented. Obstacles to improvement in the condition of women include: 1) continual childbearing 2) traditional values, 3) social pressures, and 4) the machismo philosophy. Recommendations are made for ways in which to aid the situation of women in Africa, Asia, and Latin America. Some beginning efforts in this direction are mentioned.
Jiménez-Muro, Adriana; Samper, M Pilar; Marqueta, Adriana; Rodríguez, Gerardo; Nerín, Isabel
To identify differences in the prevalence of smoking and second-hand smoke exposure between Spanish and immigrant pregnant women, as well as the factors associated with continued smoking during pregnancy. An epidemiologic cross-sectional study was carried out in women attended at delivery in Zaragoza (Spain). A smoking questionnaire was used to collect the following variables: the women's and partners' sociodemographic factors and smoking behavior, second-hand smoke exposure and perception of the risks of this exposure. We included 2440 women (35% immigrants). A total of 31.1% smoked before becoming pregnant and 18.2% during pregnancy, with significant differences between Spanish and immigrant women (21.9% versus 8.7%; p<0.001). Immigrant women lived with a greater number of smokers, smoked more inside the home, were exposed to second-hand smoke for a greater number of hours per day, avoided public places with second-hand smoke less, and more often worked in bars and restaurants. The following factors were associated with smoking during pregnancy: being Spanish, smoking a greater number of cigarettes before pregnancy, being exposed to second-hand smoke at home for a greater number of hours, having a low perception of risks and having a partner with lower educational attainment. The prevalence of smoking is higher among Spanish pregnant women than immigrant women, although the immigrant population is more exposed to second-hand smoke at home and at work. There are socio-cultural differences that should be taken into account when carrying out interventions in women of reproductive age. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.
Anderson, Kim M; Renner, Lynette M; Bloom, Tina S
In this study we explored rural women's (N = 37) perceptions of strategy use and effectiveness in dealing with intimate partner violence (IPV). We used all six categories of the IPV Strategies Index (Goodman, Dutton, Weinfurt, & Cook, 2003 ) to assess the strategic responses used by women in the sample and the level of helpfulness associated with each strategy. The strategy category used most often was resistance, and the category deemed most helpful was safety planning. Implications include finding ways for practitioners, advocates, and researchers to support and highlight the resourcefulness of rural survivors of IPV residing in the United States.
Sullivan, Therese; Weinert, Clarann; Cudney, Shirley
The prevalence and cost of chronic illness globally and in the United States of America continue to escalate and the day-to-day management of these conditions presents a major challenge. The burden of chronic illness disproportionately affects vulnerable populations such as women and those living in rural areas. To add to the knowledge base of illness management by chronically ill rural women through examining their individual perceptions of the illness experience. The Women to Women project provided a nursing research-based computer intervention model for conducting support groups, providing health education, and fostering self-care, via personal computers and evaluated its effect on the women's psychosocial health. Fatigue and pain were the major physical symptoms that impacted the women's quality of life, with depression and stress being the primary emotions they experienced. The characteristics of humour, hope, and courage were key in their successful adaptation to living with chronic illness. The women's voices relate how they manage their illness responses and adaptation mechanisms. The data provide nurses with information to heighten their sensitivity to clients' day-to-day needs and experiences. It will assist them in their designing and planning of interventions that will enable clients to adapt and to have the best quality of life possible within the limitations of their chronic illnesses. The data are also important to nurses involved in rural research and theory development concerning self-management and adaptation to chronic illnesses.
Plazaola-Castano, Juncal; Ruiz-Perez, Isabel; Escriba-Aguir, Vicenta; Montero-Pinar, Isabel; Vives-Cases, Carmen
We aimed to analyze the internal consistency and construct validity of the Spanish version of the Index of Spouse Abuse (ISA) in a representative sample of 8,995 women attending general practice in Spain in 2006-2007. The factor structure analysis shows that the ISA measures four intimate partner violence (IPV) dimensions: emotional, physical, and…
Khan, Aqsa A; Sevilla, Claudia; Wieslander, Cecilia K; Moran, Meghan B; Rashid, Rezoana; Mittal, Brita; Maliski, Sally L; Rogers, Rebecca G; Anger, Jennifer T
The purpose of our study was to evaluate barriers in communication and disease understanding among office staff and interpreters when communicating with Spanish-speaking women with pelvic floor disorders. We conducted a qualitative study to evaluate barriers to communication with Spanish-speaking women with pelvic floor disorders among office staff and interpreters. Sixteen office staff and interpreters were interviewed; interview questions focused on experiences with Spanish-speaking patients with pelvic floor disorders in the clinic setting. Interview transcripts were analyzed qualitatively using grounded theory methodology. Analysis of the interview transcripts revealed several barriers in communication as identified by office staff and interpreters. Three major classes were predominant: patient, interpreter, and system-related barriers. Patient-related barriers included a lack of understanding of anatomy and medical terminology and inhibited discussions due to embarrassment. Provider-related barriers included poor interpreter knowledge of pelvic floor vocabulary and the use of office staff without interpreting credentials. System-related barriers included poor access to information. From these preliminary themes, an emergent concept was revealed: it is highly likely that Spanish-speaking women with pelvic floor disorders have poor understanding of their condition owing to multiple obstacles in communication. There are many levels of barriers to communications with Latin women treated for pelvic floor disorders, arising from the patient, interpreter, and the system itself. These barriers contribute to a low level of understanding of their diagnosis, treatment options, and administered therapies.
Elter, Prangthip Thasanoh; Kennedy, Holly Powell; Chesla, Catherine A; Yimyam, Susanha
Postpartum Thai women follow family instructions to recover health at home. This study explores first-time mothers' experiences with postpartum family practices. This article presents the experiences with spiritual healing, one of the three essences of Thai traditional medicine. An interpretive phenomenological study was conducted in rural Thailand. Participants were 16 pregnant women purposively recruited. Data were collected using in-depth interviews, participant observations, and a demographic record and were analyzed using thematic and exemplar analysis. The women adhered to practices and rituals related to beliefs about three essences (the body, mind-heart, and energy). Spiritual healing works on mind-heart essences. A new mother healed her spirit through traditional postpartum practices. The findings provide an understanding of the practices within the context of rural Thai women's families. This information can guide future implementation of postpartum care, with awareness of and respect for cultural practices in fulfilling spiritual needs. © The Author(s) 2014.
Lim, Kuang Kuay; Chan, Ying Ying; Teh, Chien Huey; Ismail, Hasimah; Yusof, Rafidah; Muhi, Jamail; Lim, Kuang Hock; Foo, Leng Huat
In 2000, legislation on mandatory universal salt iodisation was enacted in Sabah, Malaysia, to reduce the incidence of iodine deficiency disorders among its population. To evaluate the iodine levels among pregnant women from selected rural divisions in Sabah 13 years after the enactment of the universal salt iodisation programme. This cross-sectional study was conducted from 1 May to 30 June, 2013, in three rural divisions of Sabah (the Interior, the West Coast, and Kudat). Data regarding domestic iodised salt use and iodine-containing supplement consumption were obtained from respondents through face-to-face interviews; goitre enlargement was examined through palpation and graded according to the World Health Organization classification. Spot urine samples were also obtained to assess urinary iodine levels by using an in-house modified micromethod. In total, 534 pregnant women participated. The prevalence of goitre was 1.0% (n=5), noted only in the West Coast and Kudat divisions. Although all pregnant women consumed iodised salt, overall median urinary iodine concentration was only 106 μg/L, indicating insufficient iodine intake, with nearly two-thirds of the women (60%) having a median urinary iodine concentrations of <150 μg/L. Pregnant women from the rural divisions in Sabah still exhibit iodine deficiency disorder despite the mandatory universal salt iodisation programme. Iodine supplementation programmes targeting pregnant women are warranted.
Mbah, Blessing Akaraka
This study assessed the functional impacts of adult literacy programme among rural women participants in Ishielu Local Government Area (LGA) of Ebonyi State, Nigeria. Descriptive survey design was used for the study. The population of the study was made up of 115 adult instructors and 2,408 adult learners giving a total of 2,623. The sample…
Mayes, Robyn; McAreavey, Ruth
This paper explores migrant women's encounters with formal and informal education in what can be termed new immigration rural destinations. We ask to what extent educational opportunities are realized in these new destinations. We show that education aspirations may be jeopardized because of the desire to achieve economic goals and thus require…
Background The combination of eHealth applications and/or services with cloud technology provides health care staff—with sufficient mobility and accessibility for them—to be able to transparently check any data they may need without having to worry about its physical location. Objective The main aim of this paper is to put forward secure cloud-based solutions for a range of eHealth services such as electronic health records (EHRs), telecardiology, teleconsultation, and telediagnosis. Methods The scenario chosen for introducing the services is a set of four rural health centers located within the same Spanish region. iCanCloud software was used to perform simulations in the proposed scenario. We chose online traffic and the cost per unit in terms of time as the parameters for choosing the secure solution on the most optimum cloud for each service. Results We suggest that load balancers always be fitted for all solutions in communication together with several Internet service providers and that smartcards be used to maintain identity to an appropriate extent. The solutions offered via private cloud for EHRs, teleconsultation, and telediagnosis services require a volume of online traffic calculated at being able to reach 2 Gbps per consultation. This may entail an average cost of €500/month. Conclusions The security solutions put forward for each eHealth service constitute an attempt to centralize all information on the cloud, thus offering greater accessibility to medical information in the case of EHRs alongside more reliable diagnoses and treatment for telecardiology, telediagnosis, and teleconsultation services. Therefore, better health care for the rural patient can be obtained at a reasonable cost. PMID:26215155
de la Torre-Díez, Isabel; Lopez-Coronado, Miguel; Garcia-Zapirain Soto, Begonya; Mendez-Zorrilla, Amaia
The combination of eHealth applications and/or services with cloud technology provides health care staff—with sufficient mobility and accessibility for them—to be able to transparently check any data they may need without having to worry about its physical location. The main aim of this paper is to put forward secure cloud-based solutions for a range of eHealth services such as electronic health records (EHRs), telecardiology, teleconsultation, and telediagnosis. The scenario chosen for introducing the services is a set of four rural health centers located within the same Spanish region. iCanCloud software was used to perform simulations in the proposed scenario. We chose online traffic and the cost per unit in terms of time as the parameters for choosing the secure solution on the most optimum cloud for each service. We suggest that load balancers always be fitted for all solutions in communication together with several Internet service providers and that smartcards be used to maintain identity to an appropriate extent. The solutions offered via private cloud for EHRs, teleconsultation, and telediagnosis services require a volume of online traffic calculated at being able to reach 2 Gbps per consultation. This may entail an average cost of €500/month. The security solutions put forward for each eHealth service constitute an attempt to centralize all information on the cloud, thus offering greater accessibility to medical information in the case of EHRs alongside more reliable diagnoses and treatment for telecardiology, telediagnosis, and teleconsultation services. Therefore, better health care for the rural patient can be obtained at a reasonable cost.
Mustafa, Rozina; Afreen, Uzma; Hashmi, Haleema A
To assess the knowledge, attitude regarding family planning and the practice of contraceptives among rural women. A cross-sectional observational study. The gynaecological outpatient clinic of Fatima Hospital, Baqai Medical University, Karachi, from July to December 2005. One-hundred women between the ages 15-45, living with their husbands and coming from rural area (villages) were interviewed. Women who were pregnant, had a child younger than 2 years, or had any medical disorder were excluded. Their knowledge, attitude and practice on contraceptives were evaluated with the help of a predesigned questionnaire. The other variables used were the age of women, parity and educational status. Descriptive analysis was conducted to obtain percentages. Out of 100 interviewed women with mean age of 29.7 years, 81(81%) had some knowledge about family planning methods. The media provided information of contraceptives in 52 out of 81 (64%) women. Regarding the usage of contraceptive methods, only 53 (53%) of the respondents were using some sort of contraception. Barrier method (condoms) was in practice by 18 (33.9%) and 12 (22.6%) of women had already undergone tubal ligation. The women using injectables and intrauterine contraceptive devices were 10 (18.8%) and 7 (13.2%) respectively. Six were using oral contraceptive pills (11.3%). Positive attitude towards contraception was shown by 76 (76%) of them, while 41(41%) stated their husbands' positive attitude towards contraception. In the present study, there was a low contraceptive use among women of rural origin despite good knowledge. Motivation of couples through media and health personnel can help to achieve positive attitude of husbands for effective use of contraceptives.
This paper evaluates effects of community-level women's property and inheritance rights on women's economic outcomes using a 13 year longitudinal panel from rural Tanzania. In the preferred model specification, inverse probability weighting is applied to a woman-level fixed effects model to control for individual-level time invariant heterogeneity and attrition. Results indicate that changes in women's property and inheritance rights are significantly associated with women's employment outside the home, self-employment and earnings. Results are not limited to sub-groups of marginalised women. Findings indicate lack of gender equity in sub-Saharan Africa may inhibit economic development for women and society as a whole.
Schuler, S R; Hashemi, S M
This article presents findings of research addressing the question of how women's status affects fertility. The effects on contraceptive use of women's participation in rural credit programs and on their status or level of empowerment were examined. A woman's level of empowerment is defined here as a function of her relative physical mobility, economic security, ability to make various purchases on her own, freedom from domination and violence within her family, political and legal awareness, and participation in public protests and political campaigning. The main finding is that participation in both of the credit programs studied, those of Grameen Bank and Bangladesh Rural Advancement Committee (BRAC), is positively associated with women's level of empowerment. A positive effect on contraceptive use is discernible among both participants and nonparticipants in Grameen Bank villages. Participation in BRAC does not appear to affect contraceptive use.
Moral, E; Delgado, J L; Carmona, F; Caballero, B; Guillán, C; González, P M; Suárez-Almarza, J; Velasco-Ortega, S; Nieto, C
To determine the prevalence of genitourinary syndrome of menopause (GSM) and urogynecological conditions associated with menopause, and to evaluate the impact of GSM on quality of life in a cohort of Spanish postmenopausal women. Multicenter, cross-sectional, and observational study involving 430 women. The prevalence of GSM was 70%. GSM was diagnosed in 60.2% of women with no known diagnosis of vulvovaginal atrophy or GSM. Most prevalent symptoms were vaginal dryness (93.3%) and reduced lubrication with sexual activity (90.0%). Most prevalent signs were decreased moisture (93.7%) and loss of vaginal rugae (78.4%). GSM was significantly associated with stress or mixed urinary incontinence, overactive bladder, and vaginal prolapse. Symptoms showed a low-moderate impact on quality of life, mainly in sexual functioning and self-concept and body image. The GSM is very prevalent in Spanish postmenopausal women, affecting up to 70% of those consulting the gynecologist. Despite the high prevalence of symptoms and signs and its impact on the women's well-being, GSM remains underdiagnosed and undertreated. Given its relationship with urogynecological conditions, it seems necessary to provide an adequate evaluation of postmenopausal women for identifying potential co-morbidities and providing most adequate treatments. An adequate management of GSM will contribute to an improvement in the quality of life of these women.
Ibraz, T S
The roles of rural Pakistani women in agricultural production are described with numerous examples from a village study by Anwar and Bilquees, and the author's research in a Punjabi village (Rajpur) to show cultural perceptions of women and their work, and the nature of productive activities inside the house and outside on the farm. The cultural perceptions are related to the image of women as dependent/private wives and mothers. A broad definition of production is used to include activities, such as churning milk which generates income and saves expenditures and making butter which fulfills household needs and is sold in the market for cash. Rajpur is a village engaged in social change. Men seek work outside the villages, and women take on work previously assumed by men. Women contribute considerably to the year-round production and processing of major crops. The productive labor of women by major crop type and activity type are described and charted. Tending livestock is performed exclusively by men. Handicraft activity at home reduces expenditure for buying these items in the local markets. Most women were unaware of the savings and "indirect" income their work contributed to the household. Work for wages is viewed as men's work. Women's mobility beyond the fields and home is still limited; market activity must be conducted with a male present and women do not earn cash. The division of labor is conceived by men for women because of women's cultural identity. Women are perceived as "chase daughters/sisters, fertile wives, and nurturing mothers." There are punishments or social rewards for proper behavior. Women in their private domain are expected to "look good within the house," which is viewed as a feminine world. The outside world is masculine. Women are also seen as lacking reasoning ability and their motherhood roles limit their capability to cope with external affairs. There is great value attached to the invisibility of women physically, socially, and
Del Río, Francisco Javier; Cabello-Santamaría, Francisco; Cabello-García, Marina A; Aragón-Vela, Jerónimo
The impact of pain in sexuality, couple relationships and the quality of life is very well known. The relationship between substance abuse and the presence of sexual pain disorder is assessed, together with anxiety and sexual attitudes . Two samples were selected. One sample for women with a history of substance abuse (n = 129), and another one of women nonconsumers (n = 129). The Golombok Rust Inventory of Sexual Satisfaction (GRISS), the Sexual Opinion Survey (SOS) and the State Trait Anxiety Inventory (STAI) questionnaires were used. The results indicate that women consumers obtained a higher mean scores in sexual pain disorder (4.88 > 2.89, that is 65.12%), plus higher mean scores on state anxiety (23.82 > 14.56) and trait anxiety (30.93 > 16.95), and lower average figure in erotophilia (84.93 < 95.81). It was also verified that the period of abstinence does not improve sexual response. Substance consumption affects sexual response in women negatively. Sexual response does not improve with abstinence period.
Morrison, Joanna; Basnet, Machhindra; Budhathoki, Bharat; Adhikari, Dhruba; Tumbahangphe, Kirti; Manandhar, Dharma; Costello, Anthony; Groce, Nora
Objective there is little evidence about disabled women׳s access to maternal and newborn health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and care seeking. Our study explores disabled women׳s experiences of maternal and newborn care in rural Nepal. Design we used a qualitative methodology, using semi-structured interviews. Setting rural Makwanpur District of central Nepal. Participants we purposively sampled married women with different impairments who had delivered a baby in the past 10 years from different topographical areas of the district. We also interviewed maternal health workers. We compared our findings with a recent qualitative study of non-disabled women in the same district to explore the differences between disabled and non-disabled women. Findings married disabled women considered pregnancy and childbirth to be normal and preferred to deliver at home. Issues of quality, cost and lack of family support were as pertinent for disabled women as they were for their non-disabled peers. Health workers felt unprepared to meet the maternal health needs of disabled women. Key conclusions and implications for practice integration of disability into existing Skilled Birth Attendant training curricula may improve maternal health care for disabled women. There is a need to monitor progress of interventions that encourage institutional delivery through the use of disaggregated data, to check that disabled women are benefiting equally in efforts to improve access to maternal health care. PMID:24768318
Morrison, Joanna; Basnet, Machhindra; Budhathoki, Bharat; Adhikari, Dhruba; Tumbahangphe, Kirti; Manandhar, Dharma; Costello, Anthony; Groce, Nora
there is little evidence about disabled women׳s access to maternal and newborn health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and care seeking. Our study explores disabled women׳s experiences of maternal and newborn care in rural Nepal. we used a qualitative methodology, using semi-structured interviews. rural Makwanpur District of central Nepal. we purposively sampled married women with different impairments who had delivered a baby in the past 10 years from different topographical areas of the district. We also interviewed maternal health workers. We compared our findings with a recent qualitative study of non-disabled women in the same district to explore the differences between disabled and non-disabled women. married disabled women considered pregnancy and childbirth to be normal and preferred to deliver at home. Issues of quality, cost and lack of family support were as pertinent for disabled women as they were for their non-disabled peers. Health workers felt unprepared to meet the maternal health needs of disabled women. integration of disability into existing Skilled Birth Attendant training curricula may improve maternal health care for disabled women. There is a need to monitor progress of interventions that encourage institutional delivery through the use of disaggregated data, to check that disabled women are benefiting equally in efforts to improve access to maternal health care. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.
Sri, B Subha; Ravindran, T K Sundari
To understand how rural and other groups of marginalized women define safe abortion; their perspectives and concerns regarding medical abortion (MA); and what factors affect their access to safe abortion. Focus group discussions were held with various groups of rural and marginalized women in Tamil Nadu to understand their perspectives and concerns on abortion, especially MA. Nearly a decade after mifepristone was approved for abortion in India, most study participants had never heard of MA. When they learned of the method, most preferred it over other methods of abortion. The women also had questions and concerns about the method and recommendations on how services should be provided. Their definition of a "safe abortion" included criteria beyond medical safety. They placed a high priority on "social safety," including confidentiality and privacy. In their view, factors affecting access to safe abortion and choice of provider included cost, assurance of secrecy, promptness of service provision, and absence of provider gatekeeping and provider-imposed conditions for receiving services. Women's preference for MA shows the potential of this technology to address the problem of unsafe abortion in India. Women need better access to information and services to realize this potential, however. Women's preferences regarding information dissemination and service provision need to be taken into account if policies and programs are to be truly responsive to the needs of marginalized women. Copyright © 2012. Published by Elsevier Ireland Ltd.
Using data from parish and civil registers in a rural community in northwest Spain (Los Nogales), family reconstitution provided 1502 complete reproductive histories, of which 584 corresponded to first marriages of women dying after their 50th birthday. A homogeneous sample consisting of women married in the period 1877-1899 (N=311) provided information concerning their reproductive performance, including ages at first and last maternity and number of children born alive and surviving, which was related to the mother's post-menopausal longevity, also considering premarital fertility and her marital status (widow/married). The results obtained indicate that mothers with a lower proportion of children dying before the first birthday and the age of 15 (mainly males) have a greater post-reproductive longevity. Moreover, women with a more protracted end to their reproductive period and greater fertility live for more years beyond their 50th birthday. These results do not prove a causality between maternal longevity and more successful reproduction; instead, they are indicative of a holistic condition of health. A wide spectrum of favorable biological and environmental factors will have positive consequences for a woman's life trajectory, affecting both her reproductive performance and her own likelihood of surviving. Copyright © 2011 Elsevier GmbH. All rights reserved.
Cuervo, Marta; Sayon-Orea, Carmen; Santiago, Susana; Martínez, Jose Alfredo
The nutritional status and lifestyle of women in preconception, pregnancy and lactation determine maternal, fetal and child health. The aim of this cross-sectional study was to evaluate dietary patterns and lifestyles according the perinatal physiological status in a large sample of Spanish women. Community pharmacists that were previously trained to collect the data recruited 13,845 women. General information, anthropometric measurements, physical activity, unhealthy habits and dietary data were assessed using a validated questionnaire. Mean values and percentages were used as descriptive statistics. The t-test, ANOVA or chi-squared test were used to compare groups. A score that included dietary and behavioral characteristics was generated to compare lifestyles in the three physiological situations. The analysis revealed that diet quality should be improved in the three stages, but in a different manner. While women seeking a pregnancy only met dairy recommendations, those who were pregnant only fulfilled fresh fruits servings and lactating women only covered protein group requirements. In all cases, the consumption allowances of sausages, buns and pastries were exceeded. Food patterns and unhealthy behaviors of Spanish women in preconception, pregnancy and lactation should be improved, particularly in preconception. This information might be useful in order to implement educational programs for each population group. PMID:25333199
Brown, Emma J; Trujillo, Teresa Henehan
Studies have explored the spiraling-down effect of losing individual, familial, and social resources among African Americans who use drugs, but there is a gap in knowledge about this "bottoming-out" phenomenon among rural African American women. The study was conducted to better understand the phenomenon of bottoming out among rural African American women who use cocaine. Using an ethnographic approach, researchers drew on multiple qualitative and quantitative data collection methods. Data derived from qualitative interviews, field notes, and demographic profiles describe the phenomenon or lack thereof of bottoming out among 25 southeastern rural African American women who use cocaine. Data collection took place in a rural county of north Florida with a population between 11,000 and 15,000. Twenty-five African American females 18 years or older who used either powder or crack cocaine at the time of enrollment and resided in the rural county participated in the study. Respondents used 6 major strategies that delayed or prevented them from bottoming out: (1) taking advantage of their social environment and community ties, (2) utilizing various sources of income, (3) accessing family resources, (4) maintaining some degree of discipline over spending for drugs, (5) maintaining routine drug use locations, and (6) renting cheap housing and/or house pooling. Unlike studies of similar populations in urban settings, most respondents continued to work after numerous years of drug use, tended not to lose legal custody of their children, maintained a support system of nonusers as well as users over time, and securred food, clothing, and shelter for themselves and in many instances their children using legal or illegal means.
Weinert, Clarann; Cudney, Shirley; Hill, Wade G
The objective of this study was to determine the differences in the psychosocial status of 3 groups of chronically ill rural women participating in a computer intervention. The 3 groups were: intense intervention, less-intense intervention, and control. At baseline and following the intervention, measures were taken for social support, self-esteem, empowerment, self-efficacy, depression, stress, and loneliness. ANCOVA results showed group differences for social support and self-efficacy among the overall group. The findings differed for a vulnerable subgroup, with significant between-group differences for social support and loneliness. It was concluded that a computer-delivered intervention can improve social support and self-efficacy and reduce loneliness in rural women, enhancing their ability to self-manage and adapt to chronic illness.
Background Thyroid function changes during pregnancy and maternal thyroid dysfunction have been associated with adverse outcomes. Our aim was to evaluate thyroid hormones levels in pregnant women resident in Aragon, Spain. Findings Samples for 1198 pregnant women with no apparent thyroid disorders were analyzed, using paramagnetic microparticle and chemiluminescent detection technologies, in order to determine levels of thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), thyroid peroxidase antibodies (TPO-Ab), and thyroglobulin antibodies (Tg-Ab). Of the women in our sample, 85.22% had normal values for TPO-Ab and Tg-Ab and 14.77% had results revealing the presence of autoimmune diseases of the thyroid. The thyroid hormone reference values obtained according to gestational age (in brackets) were as follows: for free T3, values were 3.38 ± 0.52 pg/mL (<11 weeks), 3.45 ± 0.54 pg/mL (11-20 weeks), 3.32 ± 0.43 pg/mL (21-30 weeks), 3.21 ± 0.53 pg/mL (31-36 weeks), and 3.23 ± 0.41 pg/mL (>36 weeks); for free T4, values were 1.10 ± 0.14 ng/dL (<10 weeks), 1.04 ± 0.14 ng/dL (11-20 weeks), 0.93 ± 0.12 ng/dL (21-30 weeks), 0.90 ± 0.13 ng/dL (31-36 weeks), and 0.80 ± 0.21 ng/dL (>36 weeks); and for TSH, values were (μIU/mL): 1.12 ± 0.69 (<10 weeks), 1.05 ± 0.67 (11-20 weeks), 1.19 ± 0.60 (21-30 weeks), 1.38 ± 0.76 (31-36 weeks), and 1.46 ± 0.72 (>36 weeks). Conclusion Pregnant women with normal antibody values according to gestational age had values for FT4 and TSH, but not for FT3, that differed to a statistically significant degree. The values we describe can be used as reference values for the Aragon region of Spain. PMID:19939287
Bocos-Terraz, Julia Pilar; Izquierdo-Alvarez, Silvia; Bancalero-Flores, Jose Luís; Alvarez-Lahuerta, Rosa; Aznar-Sauca, Ana; Real-López, Elisabet; Ibáñez-Marco, Raquel; Bocanegra-García, Virgilio; Rivera-Sánchez, Gildardo
Thyroid function changes during pregnancy and maternal thyroid dysfunction have been associated with adverse outcomes. Our aim was to evaluate thyroid hormones levels in pregnant women resident in Aragon, Spain. Samples for 1198 pregnant women with no apparent thyroid disorders were analyzed, using paramagnetic microparticle and chemiluminescent detection technologies, in order to determine levels of thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), thyroid peroxidase antibodies (TPO-Ab), and thyroglobulin antibodies (Tg-Ab). Of the women in our sample, 85.22% had normal values for TPO-Ab and Tg-Ab and 14.77% had results revealing the presence of autoimmune diseases of the thyroid. The thyroid hormone reference values obtained according to gestational age (in brackets) were as follows: for free T3, values were 3.38 +/- 0.52 pg/mL (<11 weeks), 3.45 +/- 0.54 pg/mL (11-20 weeks), 3.32 +/- 0.43 pg/mL (21-30 weeks), 3.21 +/- 0.53 pg/mL (31-36 weeks), and 3.23 +/- 0.41 pg/mL (>36 weeks); for free T4, values were 1.10 +/- 0.14 ng/dL (<10 weeks), 1.04 +/- 0.14 ng/dL (11-20 weeks), 0.93 +/- 0.12 ng/dL (21-30 weeks), 0.90 +/- 0.13 ng/dL (31-36 weeks), and 0.80 +/- 0.21 ng/dL (>36 weeks); and for TSH, values were (muIU/mL): 1.12 +/- 0.69 (<10 weeks), 1.05 +/- 0.67 (11-20 weeks), 1.19 +/- 0.60 (21-30 weeks), 1.38 +/- 0.76 (31-36 weeks), and 1.46 +/- 0.72 (>36 weeks). Pregnant women with normal antibody values according to gestational age had values for FT4 and TSH, but not for FT3, that differed to a statistically significant degree. The values we describe can be used as reference values for the Aragon region of Spain.
Hoang, Ha; Le, Quynh; Terry, Daniel
This study investigates (i) maternity care access issues in rural Tasmania, (ii) rural women's challenges in accessing maternity services and (iii) rural women's access needs in maternity services. A mixed-method approach using a survey and semi-structured interviews was conducted. The survey explored women's views of rural maternity services from antenatal to postnatal care, while interviews reinforced the survey results and provided insights into the access issues and needs of women in maternity care. The survey was completed by n=210 women, with a response rate of 35%, with n=22 follow-up interviews being conducted. The survey indicated the majority of rural women believed antenatal education and check-ups and postnatal check-ups should be provided locally. The majority of women surveyed also believed in the importance of having a maternity unit in the local hospital, which was further iterated and clarified within the interviews. Three main themes emerged from the interview data, namely (i) lack of access to maternity services, (ii) difficulties in accessing maternity services, and (iii) rural women's access needs. The study suggested that women's access needs are not fully met in some rural areas of Tasmania. Rural women face many challenges when accessing maternity services, including financial burden and risk of labouring en route. The study supports the claim that the closure of rural maternity units shifts cost and risk from the health care system to rural women and their families. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
García, M Angeles; Sánchez, M Luisa; Pérez, Isidro A; de Torre, Beatriz
Continuous carbon dioxide (CO2) measurements over the period 2004-2005 for a rural area in the upper Spanish plateau were examined to characterize the influence of sources and sinks. The diurnal pattern and the annual cycle are presented. The baseline CO2 levels over the time frames researched are determined so as to achieve a more accurate verification of the ambient conditions when uptake is deployed at the site. The results reveal a mean concentration of 384.2 ppm, with 9.8-ppm variability. The mean maximum concentration levels at night, 4:00 a.m. Greenwich Mean Time (GMT), are 390.7 ppm, mainly when atmospheric stability increased. Moreover, mean CO2 levels increase in spring, peaking in May at 388.5 ppm. Concentrations then decline in summer and again increase in autumn, reaching a similar mean value in December. The results also show consistency with vegetation and crop growth, as well as the influence of meteorological conditions, soil features, and human activity in the area. Minimum and maximum CO2 concentrations present a similar but opposite variation, 4.4 ppm x yr(-1), with values decreasing in the latter. Diurnal variation is more pronounced during the growing season and higher in 2004, partly because of abundant rainfall. The lower daily amplitudes in the remaining months are attributed to the reduction in plant and soil respiration processes. The influence of wind on CO2 concentrations has enabled us to identify the contribution of emissions from the cities of Valladolid and Palencia. An increase in mean CO2 concentrations was observed in the, east-southeast, southeast, south-southeast, and south sectors for the former city, and north and east for the latter. The ratio of CO2 increase in the wind sectors influenced by these sources yielded a factor of 1.2 with respect to the relationship between the populations of the two cities.
Schuler, Sidney Ruth; Bates, Lisa M; Islam, Farzana
This article seeks to deepen understanding of the reasons that abused women in a resource-poor rural setting seek recourse so seldom and with so little success. Data from in-depth interviews and group discussions are used to explore the range of responses to domestic violence and to examine barriers to recourse seeking. Findings illustrate how the combination of poverty and gender inequality, inequities in the legal framework, and patriarchal attitudes and corruption in both formal and informal institutions at the local level discourage abused women from seeking recourse and decrease the likelihood of a favorable outcome when they do.
Gan, C Y
A survey was conducted to document and bring attention to the use of smokeless tobacco among rural Kadazan women in Sabah, East Malaysia. Of the 472 women interviewed, 59.5% had used tobacco among the ingredients that they habitually chewed. Women with low education were more likely to be chewers. The chewing habit was usually acquired during the teenage years and the practice was perceived mainly as a cultural norm. 73.3% of these smokeless tobacco users were unaware of any adverse health effect of this type of tobacco use as compared to 53.9% of the non-tobacco users. The high prevalence of smokeless tobacco use is easily maintained as tobacco is cheap, locally produced and its use is socially accepted. The low level educational status of the women compounds the problem and intervention programs to curb this form of tobacco use is warranted.
Gracia, Enrique; Tomás, José M
This article analyzes correlates of victim-blaming attitudes regarding partner violence against women (PVAW) among the Spanish general population (N = 1,006). Results showed that victim-blaming attitudes were more common among respondents who were older, less educated, and who placed themselves at the bottom of the social scale. Furthermore, the odds of expressing victim-blaming attitudes were higher among respondents who thought that PVAW was common in society, considered it more acceptable, and knew women victims of partner violence in their circle of friends and family. Implications for public education are discussed.
Cepeda-Benito, A; Doogan, N J; Redner, R; Roberts, M E; Kurti, A N; Villanti, A C; Lopez, A A; Quisenberry, A J; Stanton, C A; Gaalema, D E; Keith, D R; Parker, M A; Higgins, S T
Smoking prevalence is declining at a slower rate in rural than urban settings in the United States (U.S.), and known predictors of smoking do not readily account for this trend difference. Given that socioeconomic and psychosocial determinants of health disparities accumulate in rural settings and that life-course disadvantages are often greater in women than men, we examined whether smoking trends are different for rural and urban men and women. We used yearly cross-sectional data (n = 303,311) from the U.S. National Survey on Drug Use and Health (NSDUH) from 2007 through 2014 to compare cigarette smoking trends in men and women across rural and urban areas. Current smoking status was modelled using logistic regression controlling for confounding risk factors. Regression derived graphs predicting unadjusted prevalence estimates and 95% confidence bands revealed that whereas the smoking trends of rural men, urban men, and urban women significantly declined from 2007 to 2014, the trend for rural women was flat. Controlling for demographic, socioeconomic and psychosocial predictors of smoking did not explain rural women's significantly different trend from those of the other three groups. Rural women lag behind rural men, urban men and urban women in decreasing smoking, a health disparity finding that supports the need for tobacco control and regulatory policies and interventions that are more effective in reducing smoking among rural women. Copyright © 2018 Elsevier Inc. All rights reserved.
Today, obesity is one of the most evident public health problems in many parts of the World and it is more common among women. Several factors are affecting women's obesity, among these short term weight fluctuations, either gain or loss, cause severe health disorders, particularly in rural areas where seasonal activity differs significantly throughout the year. Since this case has not been studied in detail, our research focused on prevalence and probable causes of seasonal rural obesity among women in two rural areas of Turkey. The study was undertaken with 100 participants. One-way ANOVA and one-way repeated ANOVA tests were utilized for categorical, continuous and repeated variables as study contains groups with more than one and repeated variables. Overweight is more common in the 18-30 years and 50+ years groups, whereas the absence of obesity, except during winter of 2010 in the 50+ years of age group, is most probably due to the widespread occurrence of diabetes for this age group. The highest BMI values for all groups, which were 25.2 ± 3.39 for 2009 and 26.1 ± 3.40 for 2010, were determined in winter, because of minimum physical activity, while summer BMIs were 24.1 ± 3.39 in 2009 and 25.1 ± 3.35 in 2010. This decrease was most probably due to intense agricultural field work in both regions. The majority of the women claimed that their weight is balanced in summer but results revealed that participants did not lose all the weight which was gained during winter months although BMI showed a significant fall from spring to autumn.
Chigbu, B; Onwere, S; Aluka, C; Kamanu, C; Okoro, O; Feyi-Waboso, P
To evaluate the contraceptive choices and usage of women in rural Aba, Southeastern Nigeria, and identify factors influencing their choice and usage of modern contraceptive methods. The records of new and old acceptors of family planning methods between 1 November 2005 and 31 October 2007 at the reproductive health clinic of a primary health care center in Osisioma Ngwa local government area in the suburb ofAba, were reviewed and analyzed. Qualitative data was collected by in-depth interviews (IDIs) of 88 out of 188 clients whose records were analyzed. Majority of the clients (71.8%) accepted injectable hormonal contraceptives followed by the intrauterine contraceptive devices (IUDs) (14.4%). Sub-dermal contraceptive implants were accepted by 6.9% of the women and female sterilization by 3.2%. The oral contraceptive pills and the male condom were the least accepted by the clients. Only 2.1% of the contraceptive acceptors were adolescents. The modal age of the acceptors was 30 years and the average age 33.4 years while the age range was 18-51 years. The average parity was 4.7 while the modal parity was 5. The indication for contraception was child spacing in 30% of the clients and permanent limitation of the family size in 70% of the clients. Attitude of the women to the various methods of contraception was an important factor influencing contraceptive choices of the women interviewed. The study has shown that the most commonly used contraceptive method in rural Southeastern Nigeria is the injectable hormonal contraceptives. Strategies to increase contraceptive use in rural Nigeria must include improving delivery of correct and adequate information about the available contraceptive methods.
Haynes, Deborah C.; Haynes, George W.; Weinert, Clarann
This research was part of a larger longitudinal study of chronically ill rural women to determine if computer technology could be effective in allowing the women to take control of their own well-being, including finances. The current study examined whether chronically ill rural women can effectively use on-line personal finance educational…
This article deepens the understanding of the impact empowerment programs have for women on their social environment, and more specifically on the men in the community, who may or may not be supportive of such endeavors. Gathering evidence from one case in rural India, it addresses how powerholders and gatekeepers reacted to the increased use of…
Examines 21 female administrators' accounts of their experience in a rural Nova Scotia school district. Presents preliminary findings of these women's own responses, resistances, and initiatives while attempting to legitimize and implement their preferred leadership styles, which stressed relationships, instructional leadership, communication, and…
Roberto, Karen A; Brossoie, Nancy; McPherson, Marya C; Pulsifer, Mary Beth; Brown, Patricia N
To identify opportunities and challenges in promoting community support for rural older women experiencing intimate partner violence (IPV). Using community-based participatory research principles, we engaged in an academic-community partnership to analyse the research literature, estimate IPV incidence and prevalence, ascertain professional and older IPV victim perspectives through focus groups and interviews, and develop a collaborative community response plan. This study took place from 2008 to 2010 in the USA. IPV in late life is underreported by victims and often unrecognised by the academic and service community. Professionals, while agreeable to collaborating to support older IPV victims, sought coordination and leadership from domestic violence agencies. Older victims stressed the need for improved professional sensitivity to their unique needs and more service options. The insights generated during this project produced a framework on which rural communities can build to address the hidden and growing problem of late life IPV. © 2013 The Authors. Australasian Journal on Ageing © 2013 ACOTA.
Members of Women, Population and Development groups, which aim to improve women's status in rural areas of China, will use their embroidery and tapestries to tell their stories at the Fourth World Conference on Women in Beijing in September 1995. Contests were held at the county and provincial levels to decide whose artwork, from over a 1000 groups, would go to the conference. 35 pieces (one group tapestry or embroidery from each county) were judged at the provincial level based on how the artwork and the stories of the women who made it demonstrated the achievements of the women as a result of their group involvement. The criteria included: 1) higher self image, confidence, and desire for personal growth; 2) increased social mobility and creativity; 3) more independence and self-reliance in income generation and other activities; 4) increased ability to make decisions for self; 5) increased respect within family and community; 6) more consciousness of maternal and child health and family planning needs; and 7) more awareness of the need for literacy. The Women, Population and Development Project is funded by the United Nations Population Fund (UNFPA), executed by FAO, and implemented by MOFTEC¿DIR.
Gibbons, Veronique; Lancaster, Gytha; Gosman, Kim; Lawrenson, Ross
INTRODUCTION Rural women face many challenges with regards to maternity services. Many rural primary birthing facilities in New Zealand have closed. The Lead Maternity Carer (LMC) model of maternity care, introduced in 1990, has moved provision of rural maternity care from doctors to independent midwifery services. Shortages of rural midwives in the Midland region led to rural maternity care being seen as a vulnerable service. AIM To understand the views and experiences of rural women concerning maternity care, to inform the future design and provision of rural maternity services. METHODS Participants were drawn from areas purposively selected to represent the five District Health Boards comprising the Midland health region. A demographic questionnaire, focus groups and individual interviews explored rural women's perspectives of antenatal care provision. These were analysed thematically. RESULTS Sixty-two women were recruited. Key themes emerging from focus groups and interviews included: access to services, the importance of safety and quality of care, the need for appropriate information at different stages, and the role of partners, family and friends in the birthing journey. While most women were happy with access to services, quality of care, provision of information, and the role of family in their care, for some women, this experience could be enhanced. CONCLUSION Midwives are the frontline service for women seeking antenatal services. Support for rural midwives and for local birthing units is needed to ensure rural women receive services equal to that of their urban counterparts.
Simmons, Leigh Ann; Wu, Qishan; Yang, Nancy; Bush, Heather M; Crofford, Leslie J
To identify sources of general and mental health information for rural women to inform the development of public health nursing interventions that consider preferences for obtaining information. One thousand women (mean age = 57 years; 96.9% White) living in primarily nonmetropolitan areas of Western Kentucky participated via a random-digit-dial survey. Data were collected on demographics, sources of health information, depression, and stigma. Most participants preferred anonymous versus interpersonal sources for both general (68.1%) and mental health (69.4%) information. All participants reported at least one source of general health information, but 20.8% indicated not seeking or not knowing where to seek mental health information. The Internet was the most preferred anonymous source. Few women cited health professionals as the primary information source for general (11.4%) or mental (9.9%) health. Public stigma was associated with preferring anonymous sources and not seeking information. Public health nurses should understand the high utilization of anonymous sources, particularly for mental health information, and focus efforts on helping individuals to navigate resources to ensure they obtain accurate information about symptoms, effective treatments, and obtaining care. Reducing stigma should remain a central focus of prevention and education in rural areas. © 2014 Wiley Periodicals, Inc.
Hustedde, Carol; Paladine, Heather; Wendling, Andrea; Prasad, Rupa; Sola, Orlando; Bjorkman, Sarah; Phillips, Julie
The USA needs more rural physicians. Although women represent half of all US trained medical students, the rural physician workforce has remained predominantly male. Insight is needed into what makes rural practice attractive for women and which practice characteristics allow women physicians to practice successfully in rural areas. This study's purpose was to examine aspects of the practice environment that impact women physicians' professional satisfaction and commitment to rural medicine. Twenty-five women family physicians practicing in rural areas of the USA were interviewed by phone using a semi-structured format. Transcribed interviews were analyzed using an immersion and crystallization approach. Emergent themes were identified, coded, and discussed until team consensus was attained. Interviews continued until saturation of themes was reached. Three themes emerged from the data, in relationship to practice and employment attributes that contribute to US women physicians' professional satisfaction and willingness to remain in a rural setting: professional relationships, practice characteristics, and support during times of transition. Participants placed high importance on professional relationships, both within and outside of their rural practice. Rural women physicians enjoyed practicing an expanded scope of care, valued loan repayment opportunities, and appreciated supportive practice partners. Importantly, women physicians who found themselves struggling to maintain rural careers often had experienced difficulty during times of practice transition, including maternity leaves. Understanding practice attributes valued by successful rural women family physicians in the USA will help rural health systems, practices, and physicians-in-training to develop and evaluate opportunities that will best contribute to successful rural practice. Supporting women physicians during periods of practice transition may improve retention.
Cepeda, Isabel; Lacalle-Calderon, Maricruz; Torralba, Miguel
Violence against Women (VaW) has come to be recognized as a serious human rights abuse with important consequences not only for women but for whole societies. Since VaW has several manifestations, it is possible to differentiate among different types of violence. In this article, a broad theoretical framework with different dimensions of gender violence was adapted to a Latin American social and cultural context to measure three out of the five main types of violence: economic violence, emotional psychological violence, and coercive control. The goal of this article is to provide empirical evidence to determine whether access to microfinance services plays a role in reducing VaW. To this end, we designed and performed a cross-sectional study with a treatment and a control group in rural Guatemala. A sample of 883 rural women in the "Altiplano" area of Guatemala (448 women with microfinance services and 435 without) was surveyed from May to November 2012. The results of the bivariate logistic regression showed evidence of association between access to microfinance services and reduction of VaW. After adjusting for covariates, global, economic, and emotional psychological violence maintained a negative and statistically significant association with microfinance, while only coercive control showed no statistical association with microfinance services. Access to microcredits showed a very clear relationship to reducing economic and emotional violence but not coercive control, a factor that may be determined by social and cultural norms. In contrast to Status Inconsistency Theory, which has been tested primarily in Asia, our study of Guatemala showed that increased status and economic independence of women due to their participation in microfinance services reduced VaW.
Chhabra, S; Palaparthy, S; Mishra, S
This study covers issues on advanced unwanted pregnancies in rural single women in South-east Asia, with reference to age, education, occupation, person responsible (i.e. baby's father) and reasons for delay in seeking assistance. It describes single women with pregnancy beyond the time for abortion, as set by the Indian abortion law. The study involved 314 girls/women and was set in the Mahatma Gandhi Institute of Medical Sciences, Sevagram, India. The girls/women were admitted, provided with free facilities and had their babies looked after by hospital staff until given up for adoption, or otherwise. The outcomes of the study showed that most individuals (71.01%) were rural, less-literate, working girls. In 94.26% of cases, the baby's father was known; 24 (7.64%) reported rape (13 by a known person). A total of 66 individuals (21.02%) did not inform their parents about the pregnancy for up to 5 months. Five (1.59%) went to unqualified medical practitioners and 16.56% to private practitioners who did not give their services. A total of 47 (14.96%) had waited for the person responsible for their pregnancy before seeking assistance. There was a total of 315 babies born to 310 mothers (five twins); four absconded undelivered; 13 absconded after delivery (two with their babies, 11 leaving babies). The study found that pregnancies were often caused by rape and girls/women with no knowledge of abortion laws, shyness, fear, lack of desired privacy, lack of resources, misleading management at periphery all went beyond 20 weeks. Mostly, the babies were not accepted--the girls married the babies' fathers, but left their babies. Emergency contraception for unprotected sexual intercourse is essential.
Background Studies conducted around the world consistently show the existence of violence against women. Despite the increasing number of studies being conducted on violence against young married women elsewhere, this subject has received little attention from researchers and policy makers in Nepal. This paper assesses the prevalence of violence among young married women in rural Nepal. Specifically, it examines [factors related to] women's status in order to better understand the risk of violence. Methods A cross-sectional study was conducted in 2009 among 1,296 young married women aged 15-24 years in four major ethnic groups. Bivariate analysis and multivariate logistic regression were used to examine the association between selected risk factors and violence. Results More than half the women (51.9%) reported having experienced some form of violence in their lifetime. One-fourth (25.3%) reported physical violence and nearly half (46.2%) reported sexual violence. Likewise, one-third (35.8%) of women reported experiencing some form of violence in the past 12 months. No or little inter-spousal communication and low autonomy of women significantly increases the odds of experiencing violence among married women. Conclusions The violence against women is quite common among young married women in rural Nepal. Although the Domestic Violence and Punishment Act 2066 has been enacted, equal attention needs to be given to increasing women's autonomy and activities that encourage inter-spousal communication. Furthermore, more research is required in Nepal that examines dynamics of violence perpetrated by husbands. PMID:21612603
Vives-Cases, Carmen; Gil-González, Diana; Plazaola-Castaño, Juncal; Montero-Piñar, María Isabel; Ruiz-Pérez, Isabel; Escribà-Agüir, Vicenta; Ortiz-Barreda, Gaby; Torrubiano-Domínguez, Jordi
To compare the prevalence of gender-based violence among immigrant and Spanish women. To describe their responses to this problem and the possible differences. To identify specific interventions to deal with gender-based violence in immigrant women in Spain. We performed a cross-sectional survey through a self-administered questionnaire in 10,202 women attending primary care in Spain (2006-2007). A content analysis was performed of the follow-up report of law 1/2004 of integral protection measures against gender violence sent by each Spanish region (2005) and the most recent regional laws and acts. The prevalence of gender-based violence was 14.3% in Spanish women and 27.9% in immigrant women. The likelihood of gender-based violence was higher in immigrant (odds ratio adjusted: 2.06; 95% confidence interval: 1.61-2.64). Immigrant women more frequently reported that they had denounced their intimate partners and that they did not know how to manage the situation. Some Spanish regions have already started interventions to overcome access barriers to social and health services, but only three have provided data on the number of immigrant women who received economic and occupational help up to 2005. Inequalities were observed in the prevalence of gender-based violence according to country of origin, with immigrant women being more frequently affected. Immigrant women more frequently denounce their intimate partners than Spanish women but this action does not guarantee effective results. Other specific interventions have been identified in some autonomous regions of Spain but these interventions need to be evaluated to ensure that they benefit immigrant women.
Ajah, Leonard Ogbonna; Iyoke, Chukwuemeka Anthony; Nkwo, Peter Onubiwe; Nwakoby, Boniface; Ezeonu, Paul
The perception and prevalence of domestic violence (DV) in rural areas is poorly understood; the result is that most efforts at eradicating this harmful practice are concentrated in urban areas. The objective of the study was to compare the burden and perception of DV among women living in rural and urban Igbo communities of southeast Nigeria. This was a comparative, cross-sectional study of women residing in rural and urban communities in Enugu, Nigeria, who had gathered for an annual religious meeting from August 1-7, 2011. Data analysis involved descriptive and inferential statistics and was conducted with the Statistical Package for Social Sciences, software version 17.0, at a 95% level of confidence. A total of 836 women who met the eligibility criteria participated in the survey. Of these, 376 were from Okpanku, a rural community, while 460 were from Ogui Nike, an urban community. The prevalence of DV among rural women was significantly higher than that among urban women (97% versus 81%, P<0.001). In particular, the prevalence of physical violence was significantly higher among rural women than among urban women (37.2% versus 23.5%; P=0.05). In contrast, rural and urban women did not differ significantly in the proportions that had experienced psychological or sexual violence. The proportion of women who believed that DV was excusable was significantly higher among rural dwellers than among urban dwellers (58.5% versus 29.6%; P=0.03). The burden of DV against women may be higher in rural communities than in urban communities in southeast Nigeria. More rural women perceived DV as excusable; this finding suggests that factors that sustain DV could be strong in rural areas. A comprehensive program to curb DV in this area may need to significantly involve the rural areas.
Ajah, Leonard Ogbonna; Iyoke, Chukwuemeka Anthony; Nkwo, Peter Onubiwe; Nwakoby, Boniface; Ezeonu, Paul
Background The perception and prevalence of domestic violence (DV) in rural areas is poorly understood; the result is that most efforts at eradicating this harmful practice are concentrated in urban areas. The objective of the study was to compare the burden and perception of DV among women living in rural and urban Igbo communities of southeast Nigeria. Methods This was a comparative, cross-sectional study of women residing in rural and urban communities in Enugu, Nigeria, who had gathered for an annual religious meeting from August 1–7, 2011. Data analysis involved descriptive and inferential statistics and was conducted with the Statistical Package for Social Sciences, software version 17.0, at a 95% level of confidence. Results A total of 836 women who met the eligibility criteria participated in the survey. Of these, 376 were from Okpanku, a rural community, while 460 were from Ogui Nike, an urban community. The prevalence of DV among rural women was significantly higher than that among urban women (97% versus 81%, P<0.001). In particular, the prevalence of physical violence was significantly higher among rural women than among urban women (37.2% versus 23.5%; P=0.05). In contrast, rural and urban women did not differ significantly in the proportions that had experienced psychological or sexual violence. The proportion of women who believed that DV was excusable was significantly higher among rural dwellers than among urban dwellers (58.5% versus 29.6%; P=0.03). Conclusion The burden of DV against women may be higher in rural communities than in urban communities in southeast Nigeria. More rural women perceived DV as excusable; this finding suggests that factors that sustain DV could be strong in rural areas. A comprehensive program to curb DV in this area may need to significantly involve the rural areas. PMID:25336992
Torloni, M R; Campos Mansilla, B; Merialdi, M; Betrán, A P
Caesarean section (CS) rates are increasing worldwide and maternal request is cited as one of the main reasons for this trend. Women's preferences for route of delivery are influenced by popular media, including magazines. We assessed the information on CS presented in Spanish women's magazines. Systematic review. Women's magazines printed from 1989 to 2009 with the largest national distribution. Articles with any information on CS. Articles were selected, read and abstracted in duplicate. Sources of information, scientific accuracy, comprehensiveness and women's testimonials were objectively extracted using a content analysis form designed for this study. Accuracy, comprehensiveness and sources of information. Most (67%) of the 1223 selected articles presented exclusively personal opinion/birth stories, 12% reported the potential benefits of CS, 26% mentioned the short-term and 10% mentioned the long-term maternal risks, and 6% highlighted the perinatal risks of CS. The most frequent short-term risks were the increased time for maternal recovery (n = 86), frustration/feelings of failure (n = 83) and increased post-surgical pain (n = 71). The most frequently cited long-term risks were uterine rupture (n = 57) and the need for another CS in any subsequent pregnancy (n = 42). Less than 5% of the selected articles reported that CS could increase the risks of infection (n = 53), haemorrhage (n = 31) or placenta praevia/accreta in future pregnancies (n = 6). The sources of information were not reported by 68% of the articles. The portrayal of CS in Spanish women's magazines is not sufficiently comprehensive and does not provide adequate important information to help the readership to understand the real benefits and risks of this route of delivery. © 2014 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.
Torloni, MR; Campos Mansilla, B; Merialdi, M; Betrán, AP
Objectives Caesarean section (CS) rates are increasing worldwide and maternal request is cited as one of the main reasons for this trend. Women's preferences for route of delivery are influenced by popular media, including magazines. We assessed the information on CS presented in Spanish women's magazines. Design Systematic review. Setting Women's magazines printed from 1989 to 2009 with the largest national distribution. Sample Articles with any information on CS. Methods Articles were selected, read and abstracted in duplicate. Sources of information, scientific accuracy, comprehensiveness and women's testimonials were objectively extracted using a content analysis form designed for this study. Main outcome measures Accuracy, comprehensiveness and sources of information. Results Most (67%) of the 1223 selected articles presented exclusively personal opinion/birth stories, 12% reported the potential benefits of CS, 26% mentioned the short-term and 10% mentioned the long-term maternal risks, and 6% highlighted the perinatal risks of CS. The most frequent short-term risks were the increased time for maternal recovery (n = 86), frustration/feelings of failure (n = 83) and increased post-surgical pain (n = 71). The most frequently cited long-term risks were uterine rupture (n = 57) and the need for another CS in any subsequent pregnancy (n = 42). Less than 5% of the selected articles reported that CS could increase the risks of infection (n = 53), haemorrhage (n = 31) or placenta praevia/accreta in future pregnancies (n = 6). The sources of information were not reported by 68% of the articles. Conclusions The portrayal of CS in Spanish women's magazines is not sufficiently comprehensive and does not provide adequate important information to help the readership to understand the real benefits and risks of this route of delivery. PMID:24467797
Singh, Rakesh K; Patra, Shraboni
Tanzania is the country hit the hardest by the HIV epidemic in Sub-Saharan Africa. The present study was carried out to examine the factors of HIV infection among women who lived in an urban area in Tanzania. The Tanzania HIV/AIDS and Malaria Indicator Survey (2011-12) data was used. The sample size for urban and rural women who had been tested for HIV and ever had sex was 2227 and 6210 respectively. Bivariate and multivariate logistic regression analyses were used. The present study found that rural women were significantly less likely to be HIV-infected compared to urban women (OR = 0.612, p<0.00). About 10% urban women were HIV-infected whereas 5.8% women in rural areas were HIV positive. Women who had more than five sex partners were significantly four times more likely to be HIV-infected as compared to women who had one sex partner (OR = 4.49, p<0.00). The results of this study suggest that less-educated women, women belonging to poor or poorer quintile, women spending nights outside and women having more than one sex partner were significantly more likely to have HIV infection among urban women as compared to rural women. There is an urgent need for a short and effective program to control the HIV epidemic in urban areas of Tanzania especially for less-educated urban women.
Lyon, Debra; Parker, Barbara
This study used focus groups to investigate the perceptions of rural women with severe and persistent mental illness (SPMI) about their gender-related health concerns. In a series of five focus groups conducted with 16 women at rural psychosocial clubhouses, women with SPMI discussed many gender-related issues, including unresolved grief over loss of children, isolation from family members, lack of sexual partners, diminished sexuality, and bodily changes secondary to medication side-effects. Women with mental illness felt like their roles as women was superseded by their role as mentally ill individuals. Rural women with SPMI have unmet needs for women's health. Psychiatric nurses have the optimal background for addressing gender-related concerns of rural women with SPMI. Copyright 2003, Elsevier Science (USA). All rights reserved.
Pathak, Yogini; Mankodi, Hina
One of the University of Baroda's (India) Rural/Tribal Block Placement Program's major aims during the year 1988-89 was to develop energy consciousness in women, primary school children and teachers. An experimental project was designed for a rural Indian village. The objectives were to obtain information on rural energy resources; assess the role…
Simkhada, Padam P; Shyangdan, Deepson; van Teijlingen, Edwin R; Kadel, Santosh; Stephen, Jane; Gurung, Tara
What is perceived to be a disability is both culturally specific and related to levels of development and modernity. This paper explores knowledge and attitudes towards people with disabilities among rural women in Nepal, one of the poorer countries in South Asia. Four hundred and twelve married women of reproductive age (aged 15-49 years), from four villages in two different parts of Nepal, who had delivered a child within the last 24 months preceding the study, completed a standard questionnaire. The majority of the participants only considered physical conditions that limit function of an individual and are visible to naked eyes, such as missing a leg or arm, to be disability. Attitudes towards people with disability were generally positive, for example most women believed that disabled people should have equal rights and should be allowed to sit on committees or get married. Most respondents thought that disability could result from: (i) accidents; (ii) medical conditions; or (iii) genetic inheritance. Fewer women thought that disability was caused by fate or bad spirits. There is need to educate the general population on disability, especially the invisible disabilities. There is also a need for further research on disability and its social impact. • There is need to educate the general population on disability, especially the invisible disabilities and its rehabilitation. There is also a need for further research on disability and its social impact.
Peñacoba-Puente, Cecilia; Carmona-Monge, Francisco Javier; Marín-Morales, Dolores; Naber, Katharina
The aims of this study were to analyze the coping strategies used by women in the first trimester of low-risk pregnancies, their relationships to sociodemographic and pregnancy variables, and their ability to predict anxiety and depression in the third trimester. Participants in the first trimester were 285 Spanish pregnant women, of whom 122 were followed into the third trimester. The use of problem-focused coping was stable, whereas variations occurred in emotion-focused coping. Age, educational level, employment, planned pregnancy, previous childbirth, and previous miscarriage were associated with adaptive coping. Coping strategies predicting anxiety and depressive symptoms were overt emotional expression and social support seeking. Coping through religion predicted anxiety. Coping is a complex process influenced by sociodemographic and obstetric factors that can contribute to the onset of psychological symptoms. Copyright © 2012 Wiley Periodicals, Inc.
Santos-Iglesias, Pablo; Sierra, Juan Carlos
Sexual revictimization is frequent among victims of child sexual abuse. Several variables, such as sexual experience, substance abuse, and sexual assertiveness, have been proposed to explain the link between child sexual abuse and adolescent and adult sexual victimization, although they have typically been tested separately. The main objective of this study was to analyze which of these variables better explains the revictimization phenomenon using a multiple mediation analysis. The study also tested the frequency of sexual victimization experiences in a Spanish sample of college women. Four hundred and two women were interviewed. Results showed that 30.4% of them engaged in undesired sexual contact while almost 4% were victims of rape. The most frequent perpetrators were partners or ex-partners, acquaintances, or dating partners, but not strangers. Finally, the relationship between child sexual abuse and adolescent and adult sexual victimization was mediated by number of consensual sexual partners and sexual assertiveness. Results reflect some cultural differences from previous research.
Bryceson, D F
Western donor agencies in their development projects to increase the income for rural women have neglected the domestic residence as a unit of production of food, water, and fuel: 1) directly produced by sources in the field, 2) physically delivered to the residence, 3) processed, and 4) distributed to household members for consumption. An alternative approach to home economics and market-oriented production is suggested. Homestead economics is the study of women's labor as a scarce resource consisting of daily livelihood management. The detailed mechanics (time, effort, and spatial dynamics) of women's work needs to be dissected in order to determine the appropriate tools or organizational improvements that would improve the satisfaction of basic needs and the standard of living, in specific circumstances. When a participatory research approach is used, women can be involved in self-discovery, and researchers can be a useful resource. Outreach to women must entail more than training courses, publication of practical handbooks for literate women, and activation of women's groups. The influence of Western feminism on donor project design in Africa has not been realized, partly because there are real differences in the role of women and the value of children, and the physical environment. Although reproductive-age women have heavy work schedules, their children, who have completed primary school, are part of the homestead work force, and are waiting for betrothal, do have available time. Some indirect advantages of involving teenaged girls in training are a delay in age at marriage, and an affect on lifetime attitudes. The main components, which would have to be adapted to the local situation, are training in nontraditional skills related to homestead management and maintenance, and promoting formation of female youth groups for support and income-generating activities. Gender stereotyping is not an issue, because improvements in women's homestead work is part of
Pawan, Faridah; Thomalla, Therese Groff
This article describes a responsive evaluation study of ESL services and Spanish language services for immigrants in a rural county in Indiana. An ESL specialist led the evaluation of language services in the county from the perspectives of language providers and recipients. The responsive evaluation--a form of action research that uses…
Agbo, Felicia Onyemowo; Isa, Ali A. Muluku
This paper examined scientific skills and concept learning by rural women for personal and national development. The research design employed was a quasi-experimental, one-group pre-test and post-test design. A non-formal science program package to enhance and empower the rural women's knowledge and skills in their daily activities (nutrition,…
Simmons, Leigh A.; Braun, Bonnie; Charnigo, Richard; Havens, Jennifer R.; Wright, David W.
Context and Purpose: Depression among rural women is a major public health concern. The purpose of this study was to test the competing theories of social causation and social selection to assess the relationship between depression and economic status for a sample of rural, low-income women in the United States. Methods: Structural equation…
This study endeavored to investigate the impact of education on rural women's participation in political and economic activities. Six hundred rural women and 12 gender Activists were selected for this study from three Zones of Amhara Region, Ethiopia using multi-stage random sampling technique and purposeful sampling techniques respectively.…
Cates, Joan R.; Brewer, Noel T.; Fazekas, Karah I.; Mitchell, Cicely E.; Smith, Jennifer S.
Context: Because cervical cancer mortality in the United States is twice as high among black women as white women and higher in rural areas, providing human papillomavirus (HPV) vaccine to rural black adolescents is a high priority. Purpose: To identify racial differences in knowledge and attitudes about HPV, cervical cancer, and the HPV vaccine…
Bencivenga, Marcyann; DeRubis, Susan; Leach, Patricia; Lotito, Lisa; Shoemaker, Charles; Lengerich, Eugene J.
Context: Multiple national agencies and organizations recommend that women age 40 years and older have an annual screening mammogram. Women who are poor, less educated, lack a usual source of care, and reside in rural Appalachia are less likely to have had a recent mammogram. Purpose: To increase use of mammography among a rural Appalachian…
Hoang, Ha; Le, Quynh
This study investigates (i) rural women's needs in maternity care in Tasmania; (ii) the current rural maternity services in Tasmania; and (iii) the gap between women's needs and the services provided. Mixed methods study was adopted. A questionnaire explored women's views on rural maternity services from antenatal to postnatal care and also invited comments from the participants. Interviews were conducted to provide comprehensive insights into their needs in maternity care. Six rural communities in Tasmania, Australia. Women who have had childbirth experiences in rural areas in Tasmania. Two hundred ten women completed the questionnaire with a response rate of 35%. There were over 150 written comments from the survey. Twenty-two follow-up interviews were conducted. This paper reports the written comments from the survey and interviews. Five main themes emerged from the data, namely (i) access needs, (ii) safety needs, (iii) needs for rural birthing services, (iv) support needs and (v) needs for quality services. This study has revealed a comprehensive picture of rural women's needs in maternity care throughout their pregnancy to the early postnatal period. There is a major lack of maternity services in rural areas of Tasmania. The lack of rural maternity services shifts cost and risk from the health care system to rural women and their families. Women want to have greater access to maternity services in their local community and be ensured safety for themselves and their babies. Moreover, they need more support from the health care system and they desire quality services. © 2013 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.
Sevilla, Claudia; Wieslander, Cecilia K.; Alas, Alexandriah N.; Dunivan, Gena C.; Khan, Aqsa A.; Maliski RN, Sally L.; Rogers, Rebecca G.; Anger, Jennifer T.
Objectives To assess the effect of the initial visit with a specialist on disease understanding among Spanish-speaking women with pelvic floor disorders. Methods Spanish-speaking women with referrals suggestive of urinary incontinence (UI) and/or pelvic organ prolapse (POP) were recruited from public urogynecology clinics. Patients participated in a health literacy assessment and interview before and after their physician encounter. All interviews were analyzed using Grounded Theory qualitative methods. Results Twenty-seven women with POP (N=6), UI (N=11), and POP/UI (N=10) were enrolled in this study. The mean age was 55.5 years and the majority of women had marginal levels of health literacy. From our qualitative analysis, three concepts emerged. First, was that patients had poor understanding of their diagnosis before and after the encounter regardless of how extensive the physician’s explanation or level of Spanish-proficiency. Secondly, patients were overwhelmed with the amount of information given to them. Lastly, patients ultimately put their trust in the physician, relying on them for treatment recommendations. Conclusions Our findings emphasize the difficulty Spanish-speaking women with low health literacy have in understanding information regarding pelvic floor disorders. In this specific population, the physician has a major role in influencing patients’ treatment decisions and helping them overcome fears they may have about their condition. PMID:23442506
Sevilla, Claudia; Wieslander, Cecilia K; Alas, Alexandriah N; Dunivan, Gena C; Khan, Aqsa A; Maliski, Sally L; Rogers, Rebecca G; Anger, Jennifer Tash
This study aimed to assess the effect of the initial visit with a specialist on disease understanding among Spanish-speaking women with pelvic floor disorders. Spanish-speaking women with referrals suggestive of urinary incontinence (UI) and/or pelvic organ prolapse (POP) were recruited from public urogynecology clinics. Patients participated in a health literacy assessment and interview before and after their physician encounter. All interviews were analyzed using Grounded Theory qualitative methods. Twenty-seven women with POP (n = 6), UI (n = 11), and POP/UI (n = 10) were enrolled in this study. The mean age was 55.5 years, and most women had marginal levels of health literacy. From our qualitative analysis, 3 concepts emerged. First, was that patients had poor understanding of their diagnosis before and after the encounter regardless of how extensive the physician's explanation or level of Spanish-proficiency. Second, patients were overwhelmed with the amount of information given to them. Lastly, patients ultimately put their trust in the physician, relying on them for treatment recommendations. Our findings emphasize the difficulty Spanish-speaking women with low health literacy have in understanding information regarding pelvic floor disorders. In this specific population, the physician has a major role in influencing patients' treatment decisions and helping them overcome fears they may have about their condition.
Gueye, E H
Poultry production has existed for many generations in Africa, and almost every village household keeps chickens. The rural family poultry (RFP) are generally raised in free-range and/or backyard systems, which are traditional extensive husbandry systems. The development of an intensive poultry production has been the goal of the African government over the years. Despite efforts aiming for such goal, RFP is still very important in African countries that are both poor and net importers of food. It is a valuable asset because it can contribute significantly in alleviating poverty, securing food supply, and promoting gender equality. In view of this, interventions to improve RFP production systems should take into account the sociocultural issues, specifically gender-based aspects. It is noted that such interventions might, in addition to food security and poverty alleviation, also serve to promote gender equality. RFP development programs should be more women-friendly in order to facilitate women's participation, as RFP production in the region is generally a woman's business. Moreover, efforts to empower village women has to be envisaged cautiously as there is a serious risk of men taking over once the poultry sector becomes more profitable.
Boyd, Mary R; Phillips, Kenneth; Dorsey, Coretta J
Tremendous health disparities exist across various segments of the United States population with rural women particularly at risk. African Americans have higher rates of death, disease, and disability than Caucasians. Although prevalence rates for alcohol and other drug use vary across studies, African American women generally report less use than Caucasians. However, African Americans disproportionately experience negative health and social consequence of AOD use. The findings of this study provide rare information about substance abuse in rural African American women. Specifically, this manuscript reports differences between rural African American and Caucasian women (n=267) on AOD use, comorbid Axis I disorders, and violence.
Luque, John S; Tarasenko, Yelena N; Reyes-Garcia, Claudia; Alfonso, Moya L; Suazo, Norma; Rebing, Laura; Ferris, Daron G
This study examined the feasibility and efficacy of Salud es Vida-a promotora-led, Spanish language educational group session on cervical cancer screening (Pap tests)-self-efficacy (belief in ability to schedule and complete a Pap test), and knowledge among immigrant Hispanic/Latina women from farmworker backgrounds. These women are disproportionately burdened with cervical cancer, with mortality rates significantly higher than non-Hispanic whites. The two-arm, quasi-experimental study was conducted in four rural counties of Southeast Georgia in 2014-2015. Hispanic/Latina immigrant women aged 21-65 years and overdue for a Pap test were included as intervention (N = 38) and control (N = 52) group participants. The intervention was developed in partnership with a group of promotoras to create the toolkit of materials which includes a curriculum guide, a brochure, a flipchart, a short animated video, and in-class activities. Twelve (32 %) intervention group participants received the Pap test compared to 10 (19 %) control group participants (p = 0.178). The intervention group scored significantly higher on both cervical cancer knowledge recall and retention than the control group (p < 0.001). While there was no statistically significant difference in cervical cancer screening self-efficacy scores between the group participants, both groups scored higher at follow-up, adjusting for the baseline scores. The group intervention approach was associated with increased cervical cancer knowledge but not uptake of Pap test. More intensive interventions using patient navigation approaches or promotoras who actively follow participants or conducting one-on-one rather than group sessions may be needed to achieve improved screening outcomes with this population.
Sibai, Salam Adlbi
This article reports part of a wider investigation which is still being developed and analyzes in depth the lives of female university students who are both Spanish and Muslim. The first part of this research was published in the "Revista Espanola de Educacion Comparada," where the results of the study in Madrid are presented. Here, the…
A major stumbling block for the implementation of Mexico's Global Development Plan has been the country's large rural population of Indians. One government strategy to integrate this sector into the mainstream of society has been to teach Spanish, the official language, as a second language, while at the same time fostering ethnic pride. The…
McCall-Hosenfeld, Jennifer S; Weisman, Carol S
Preventive health interventions often occur less frequently among rural women compared to urban women. Preventive counseling is an important feature of comprehensive preventive healthcare provision, but geographic disparities in the receipt of preventive counseling services have not been fully described. In this study the framework of the behavioral model of healthcare utilization was employed to investigate the association between rurality and receiving preventive counseling. It was hypothesized that demographic differences in rural and urban communities, as well as differential healthcare resources, explain rural-urban healthcare disparities in preventive counseling. Data were collected by telephone survey during 2004-2005 for 2002 participants aged 18-45 years in the Central Pennsylvania Women's Health Study. Measures of preventive counseling were based on US Preventive Services Task Force recommendations as of 2004. Multivariable models assessed the independent contribution of rurality to the receipt of counseling for smoking, alcohol/drug use, birth control, nutrition, weight management, and physical activity. Rurality was assessed using Rural-Urban Community Area Codes. All models controlled for variables that predispose individuals to use health services (age, race/ethnicity, educational level), variables that enable or impede healthcare access (having a usual healthcare provider, using an obstetrician-gynecologist, poverty, and continuous health insurance coverage) and need-based variables (health behaviors and indicators). In bivariate analysis, the rural population was older, had lower educational attainment, and was more likely to be White, non-Hispanic. Urban women tended to report seeing an obstetrician-gynecologist more frequently, and engaged more frequently in binge drinking/drug use. Preventive counseling was low among both rural and urban women, and ranged from 12% of the population for alcohol/drug use counseling, to 37% for diet or nutrition
Aguado, Jaume; Campbell, Alistair; Ascaso, Carlos; Navarro, Purificacion; Garcia-Esteve, Lluisa; Luciano, Juan V.
In this study, the authors tested alternative factor models of the 12-item General Health Questionnaire (GHQ-12) in a sample of Spanish postpartum women, using confirmatory factor analysis. The authors report the results of modeling three different methods for scoring the GHQ-12 using estimation methods recommended for categorical and binary data.…
Employment Standards Administration (DOL), Washington, DC. Women's Bureau.
The report presents data on selected social, economic, and demographic characteristics of women of Spanish origin in the United States. Derived from the population reports of the U.S. Census Bureau and the March 1973 Manpower Report of the President, the statistical data pertain to age, residence, marital status, heads of families and households,…
Callén, M S; López, J M; Mastral, A M
Urban areas constitute major pollution sources due to anthropogenic activities located in these areas. Among the legislated air pollutants, the particulate matter with an aerodynamic diameter less than or equal to 10 microns (PM10) and polycyclic aromatic hydrocarbons (PAH) are controlled under Directive 2008/50/EC and Directive 2004/107/EC, respectively due to their adverse health effects. A study was carried out at four urban and rural Spanish areas during the warm and cold seasons in 2008-2009 to quantify 19 PAH associated with the atmospheric PM10 by gas chromatography-mass spectrometry-mass spectrometry detection (GC-MS-MS) with the internal standard method. The particle-bound composition of the analysed PAH was 5 and 10 times greater in industrial and urban areas, respectively when compared to those measured in rural areas. The highest PAH concentrations during the cold period were possibly due to the additional contribution of domestic heating sources and meteorological conditions such as low temperature and solar irradiation. The use of molecular diagnostic ratios indicated that the possible, major PAH pollution sources in the most polluted areas were pyrogenic sources, mainly attributed to petroleum combustion sources (motor vehicle emissions and crude oil combustion). Petrogenic sources related to evaporative emissions also seemed to contribute in the most polluted area during the warm period. Those dates with high carcinogenic character according to the benzo(a)pyrene equivalent (BaP-eq) were also possibly attributed to petroleum combustion sources.
Mendoza, Nicolás; Abad, Pedro; Baró, Francesc; Cancelo, Ma Jesús; Llaneza, Plácido; Manubens, Montserrat; Quereda, Francisco; Sánchez-Borrego, Rafael
Tibolone is a drug with complex tissue-specific action that exhibits a combination of estrogenic, progestogenic, and slight androgenic activity. Its variable profile explains its clinical effects, depending on the target tissue where it is metabolized, its metabolites' affinity for and potency in hormone receptors, and probable enzymatic activity modulation.In recent reviews and clinical trials, the effectiveness of tibolone in alleviating different hot flush menopause symptoms, mainly in mood and sexuality disorders, has been noted. In Spain, tibolone is the most prescribed hormonal treatment, and one of the most common complaints among postmenopausal women is change in sexual drive. For such reason, a panel of experts from the Spanish Menopause Society met to develop usage recommendations based on the best evidence available.
Dierssen-Sotos, Trinidad; Gómez-Acebo, Inés; Palazuelos, Camilo; Fernández-Navarro, Pablo; Altzibar, Jone M; González-Donquiles, Carmen; Ardanaz, Eva; Bustamante, Mariona; Alonso-Molero, Jessica; Vidal, Carmen; Bayo-Calero, Juan; Tardón, Adonina; Salas, Dolores; Marcos-Gragera, Rafael; Moreno, Víctor; Rodriguez-Cundin, Paz; Vinyals, Gemma Castaño; Ederra, María; Vilorio-Marqués, Laura; Amiano, Pilar; Pérez-Gómez, Beatriz; Aragonés, Nuria; Kogevinas, Manolis; Pollán, Marina; Llorca, Javier
A breast-risk score, published in 2016, was developed in white-American women using 92 genetic variants (GRS92), modifiable and non-modifiable risk factors. With the aim of validating the score in the Spanish population, 1,732 breast cancer cases and 1,910 controls were studied. The GRS92, modifiable and non-modifiable risk factor scores were estimated via logistic regression. SNPs without available genotyping were simulated as in the aforementioned 2016 study. The full model score was obtained by combining GRS92, modifiable and non-modifiable risk factor scores. Score performances were tested via the area under the ROC curve (AUROC), net reclassification index (NRI) and integrated discrimination improvement (IDI). Compared with non-modifiable and modifiable factor scores, GRS92 had higher discrimination power (AUROC: 0.6195, 0.5885 and 0.5214, respectively). Adding the non-modifiable factor score to GRS92 improved patient classification by 23.6% (NRI = 0.236), while the modifiable factor score only improved it by 7.2%. The full model AUROC reached 0.6244. A simulation study showed the ability of the full model for identifying women at high risk for breast cancer. In conclusion, a model combining genetic and risk factors can be used for stratifying women by their breast cancer risk, which can be applied to individualizing genetic counseling and screening recommendations.
Churruca, Itziar; Miranda, Jonatan; Lasa, Arrate; Bustamante, María Á; Larretxi, Idoia; Simon, Edurne
The purpose of the present work was both to analyze composition of Spanish celiac women and to study the food habits and gluten-free diet of these celiac patients, in order to determine whether they achieve a balanced and healthy diet as well as to highlight nutritional qualitative and/or quantitative differences. 54 adult celiac women (34 ± 13 years) took part in the six-month study. Height, weight and body composition were measured. An analysis of energy consumption and of the macronutrient distribution of their diet was carried out. Their fulfillment of micronutrient intake recommendations was verified. Participants showed a Body Mass Index of 21.6 ± 2.4 kg/m2. Energy Intake was slightly lower than the Dietary Reference Intakes. Excessive protein apart from over-consumption of fat was observed. More than three quarters of participants consumed meat in excess. Carbohydrate consumption along with that of fiber was below recommended levels. Vitamin D, iron, and iodine had a low percentage of recommendation compliance. In general, participants followed the recommendations of dairy products and fruit intake whereas vegetable consumption was not enough for the vast majority. We conclude that although the diet of celiac women does not differ much from the diet of general population, some considerations, such as reducing fat and protein consumption and increasing fiber intake, must be taken into account.
Martin, Julie C; Moran, Lisa J; Teede, Helena J; Ranasinha, Sanjeeva; Lombard, Catherine B; Harrison, Cheryce L
Health disparities, including weight gain and obesity exist between urban and rural dwelling women. The primary aim was to compare diet quality in urban and rural women of reproductive age, and secondary analyses of the difference in macronutrient and micronutrient intake in urban and rural women, and the predictors of diet quality. Diet quality was assessed in urban ( n = 149) and rural ( n = 394) women by a modified version of the Dietary Guideline Index (DGI) energy, macronutrient and micronutrient intake from a food frequency questionnaire (FFQ) and predictors of diet quality. Diet quality did not significantly differ between urban and rural women (mean ± standard deviation (SD), 84.8 ± 15.9 vs. 83.9 ± 16.5, p = 0.264). Rural women reported a significantly higher intake of protein, fat, saturated fat, monounsaturated fat, cholesterol and iron and a higher score in the meat and meat alternatives component of the diet quality tool in comparison to urban women. In all women, a higher diet quality was associated with higher annual household income (>$Australian dollar (AUD) 80,000 vs. <$AUD80,000 p = 0.013) and working status (working fulltime/part-time vs. unemployed p = 0.043). Total diet quality did not differ in urban and rural women; however, a higher macronutrient consumption pattern was potentially related to a higher lean meat intake in rural women. Women who are unemployed and on a lower income are an important target group for future dietary interventions aiming to improve diet quality.
Kandasamy, Niro; Soldatic, Karen; Samararatne, Dinesha
This article draws on grounded qualitative research with rural Tamil women who acquired a disability during the civil war in Sri Lanka and conceptualizes an intersectionality-peace framework. Three main themes were developed from the interviews: narratives of conflict, survival outcomes of social assistance and mobilization of cross-ethnic relationships. With the support of a local women's disability advocacy organization, Tamil women with disabilities were enabled to overcome social stigma and claim a positive identity as women with disabilities. The organization's focus on realizing disability rights created new opportunities for these highly marginalized rural women. The women were also supported to form cross-ethnic relationships with women who similarly faced multiple oppressions. These relationships transformed the women into 'agents of peace', using their newfound disability identity to foster cross-ethnic dialogue and create safe spaces in the post-conflict context.
Le, Phuoc V; Jones-Le, Erin; Bell, Carolyn; Miller, Suellen
To describe the most acceptable methods for educating women in Medrogongkar County, Tibet, about healthy pregnancy and safe motherhood. Focus group discussions with key informants were used to develop a quantitative, orally administered random sample survey. Thirty-two randomly selected villages in Medrogongkar County. One hundred and forty-eight multigravida over the age of 18 living in Medrogongkar County. Most participants reported receiving pregnancy-related information either from family members (n=85, 57.4%) or from community health workers (n=81, 54.7%), while very few reported group teaching or radio/television/videos as sources. When asked what modalities of health communication are most effective for them, participants preferred discussions with family members (n=59, 39.8%), specifically their mothers (n=34, 23.0%). Community health worker teaching (n=15, 10.1%) or group teaching (n=7, 4.7%) were reported as less effective. Despite recent efforts in Tibet to use group teaching, television/radio programs, and health professionals visiting patients' homes as health communication modalities, participants preferred to learn pregnancy-related health messages from their close family, especially their mothers. Future health communication interventions in rural Tibet and similar communities should consider targeting close family members as well as pregnant women to maximize acceptability of advice on healthy pregnancy and delivery.
Fernández-Sola, Cayetano; Martínez-Caba, María Isabel; Hernández-Padilla, José Manuel; Carmona-Samper, Esther; Granero-Molina, José
To describe and understand the experiences and perceptions of women who undergo hysterosalpingography as part of the infertility process. Nurses and midwives should conduct research into the emotional aspects of caring for patients undergoing infertility treatment. The hysterosalpingography is considered to be the most feared test in the infertility process and the one about which very little is known. A phenomenological qualitative study. Ten Spanish women who had undergone hysterosalpingography participated in this study. In-depth interviews were carried out between October 2012-May 2013. Data analysis was performed with the help of atlas.ti software to identify emerging themes. The experience of the participants who underwent hysterosalpingography during the infertility process is represented by the following three themes: (1) becoming a mother to feel complete as a person and as a woman, with the subthemes 'maternity as a life objective' and 'maternity in terms of gender identity'; (2) infertility--an intimate experience which provokes negative feelings, with the subthemes 'negative feelings regarding own infertility' and 'infertility as an experience that is little shared with others'; (3) Undergoing hysterosalpingography, with the subthemes 'feelings regarding hysterosalpingography', 'treatment by medical providers' and 'areas for improvement regarding the service given by the providers'. For women who undergo hysterosalpingography, maternity may be seen as a life objective that could identify them as women. Results suggest that although infertility is experienced with negative feelings such as anxiety, frustration and sadness, hysterosalpingography seems to be related with both hope and fear when facing the test. Knowing the experiences of these women could help nurses, midwives and physicians to provide better patient-centred care. © 2016 John Wiley & Sons Ltd.
Lichter, D T
The growing numerical significance of women in the US nonmetropolitan labor force has not been matched by parallel efforts to document the changing quality of their employment. In this paper. Lichter uses the labor utilization framework of Clogg and Sullivan to examine the prevalence and spatial convergence of various forms of female underemployment during 1970-1985. Data from the March annual demographic files of the Current Population Survey reveal that underemployment has been a significant aspect of the employment experiences of nonmetropolitan women during this period. There has been little evidence of spatial or sex convergence in labor market outcomes. Roughly 1 of every 3 rural female workers today is a discouraged worker, jobless, employed part-time involuntarily, or working for poverty-level wages. Moreover, rural women continue to suffer substantially higher levels of economic underemployment than urban women and rural men. This study reinforces the view that rural women remain a seriously underutilized labor resource in the US.
Horner-Johnson, Willi; Dobbertin, Konrad; Iezzoni, Lisa I
Previous research has found breast and cervical cancer screening disparities between women with and without disabilities, and between women living in rural versus urban areas. Living in a rural area may add to the barriers women with disabilities experience when attempting to obtain screening for breast and cervical cancer. The purpose of this study was to examine the combination of disability status and rurality in association with receipt of breast and cervical cancer screening among women age 18 to 64 in the United States. We conducted cross-sectional analyses of data from the Medical Expenditure Panel Survey, using pooled annual data files from 2002 through 2008. We compared recent receipt of breast and cervical cancer screening among four groups: 1) urban women without disabilities, 2) urban women with disabilities, 3) rural women without disabilities, and 4) rural women with disabilities. Overall, women with disabilities were less likely to be up to date with mammograms and Pap tests compared with women with no disabilities. Similarly, women in rural areas were less likely to have received breast or cervical cancer screening within recommended timeframes. Women who both had a disability and lived in a rural area were the least likely to be current with screening. Our findings suggest that living in rural regions compounds disparities in receipt of cancer screening among women with disabilities. Increased attention is needed to improve receipt of cancer screening among rural women with disabilities. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
Kwagala, Betty; Nankinga, Olivia; Wandera, Stephen Ojiambo; Ndugga, Patricia; Kabagenyi, Allen
There is limited research on how the empowerment of women and intimate partner violence (IPV) are associated with skilled birth attendance (SBA) among rural women in Uganda. Therefore, the aim of this paper was to investigate the association between women's empowerment, their experience of IPV and SBA in rural Uganda. Using data from the Uganda Demographic and Health Survey (UDHS), we selected 857 rural women who were in union, had given birth in the last 5 years preceding the survey and were selected for the domestic violence (DV) module. Frequency distributions were used to describe the background characteristics of the women and their partners. Pearson's chi-squared (χ (2)) tests were used to investigate the associations between SBA and women's empowerment; and partners' and women's socio-demographic factors including sexual violence. Multivariable logistic regression analyses were used to examine the association between SBA and explanatory variables. More than half (55 %) of the women delivered under the supervision of skilled birth attendant. Women's empowerment with respect to participation in household decision-making, property (land and house) (co)ownership, IPV, and sexual empowerment did not positively predict SBA among rural women in Uganda. Key predictors of SBA were household wealth status, partners' education, ANC attendance and parity. For enhancement of SBA in rural areas, there is a need to encourage a more comprehensive ANC attendance irrespective of number of children a woman has; and design interventions to enhance household wealth and promote men's education.
An ethnographic study examined the role of language, discrimination, and aspirations in the school success of Latino students in a small rural town. The town, located about 1,000 miles from Mexico and about 200 miles from any sizeable Latino community, contains about 200 Latinos. Almost all are Mexicans or Mexican Americans and have come to work…
Rhoades, Robert E.
During 1976, 133 former migrants representing 96 migrating units were interviewed. Through participant observation, various social contexts (villages, towns, and cities) were studied in terms of return migration. Emphasis centered on the rural context and specifically dealth with return destinations, investment behavior, problems of social…
Meyers, Susan V.
Drawing from ethnographic case studies, this article considers issues of women's access to education by exploring the literacy experiences of four women in rural Mexico. Ironically, as physical access to education in this area has increased, women's literacy experiences have become more complex, rather than more libratory. Formal literacy, as it…
Huang, Haigen; Placier, Peggy
Our study sought to understand changes in gender inequality in education across four generations of rural Chinese women's educational experiences in a small community in southern China. The 24 interviews and numerous informal conversations with 12 women showed that gender-based favouritism for men and against women undergirded family expectations,…
Naik, Chitra; And Others
The volume contains two studies from India and Thailand on the education of women, and rural women especially, who are deprived or disadvantaged. The Indian study, "Education of Girls and Women in Deprived Groups," presents a viewpoint on deprivation in society in general, and India specifically. The concomitant of deprivation is defined…
Baidya, Bhuchandra P. R.; Chaudhari, Gayatri
An evaluative study was conducted of the Training for Rural Gainful Activities (TRUGA) project and methodology in Nepal regarding women's participation and benefits. The study analyzed TRUGA as a project and as a training methodology, assessed the effects of TRUGA activities on women, and evaluated project investment in and benefits to women.…
Rosenwasser, Lara A.; McCall-Hosenfeld, Jennifer S.; Weisman, Carol S.; Hillemeier, Marianne M.; Perry, Amanda N.; Chuang, Cynthia H.
Introduction Colorectal cancer (CRC) is the third leading cause of death among U.S. women. Rural populations have lower rates of CRC screening than their urban counterparts, and rural women have lower screening rates compared with rural men. The purpose of this qualitative study was to identify (1) primary care physicians’ (PCP) beliefs regarding CRC screening in rural communities, (2) factors that may cause gender disparities in CRC screening in rural areas, and (3) solutions to overcome those barriers. Methods Semi-structured interviews were conducted with 17 PCPs practicing in rural central Pennsylvania. PCPs were asked about their CRC screening practices for women, availability of CRC screening services, reminder systems for CRC screening, and barriers to screening specific to their rural communities and to gender. Thematic analysis was used to identify major themes. Results All 17 PCPs endorsed the importance of CRC screening, but believed that there are barriers to CRC screening specific to women and to rural location. All PCPs identified colonoscopy as their screening method of choice, and generally reported that access to colonoscopy services in their rural areas was not a significant barrier. Barriers to CRC screening for women in rural communities were related to: 1) PCPs’ CRC screening practices (e.g., not using alternative screening modalities when colonoscopy is not possible), 2) gender-specific barriers to CRC screening (e.g., patients’ belief that CRC mostly affects men, embarrassment of knowing people at the endoscopy center, prioritization of family issues over personal health), 3) patient-related barriers (e.g., low educational attainment, low health literacy, poverty, under- or uninsured), 4) community-related barriers (e.g., inadequate public education about CRC, “rural culture” that does not emphasize importance of preventive health services), and 5) physician practice-related barriers (e.g., lack of effective reminder systems, lack
Peiró-Pérez, Rosana; Salas, Dolores; Vallés, Guillermo; Abad-Fernandez, Ma Soledad; Vidal, Carmen; Sanchez-Contador Escudero, Carmen; Ascunce-Elizaga, Nieves; Zubizarreta, Raquel; Pedraz, Carmen; Pérez-Gómez, Beatriz; Navarrete-Muñoz, Eva María; Vioque, Jesús; Pollán, Marina
The aim is to analyse physical activity (PA), the fulfillment recommendation of at least 150 min of moderate PA, through walking/biking (W&B), sport, both types of PA and the factors associated with inactivity by Spanish women who attended breast cancer screening programmes. The DDM-Spain is a multicentre cross-sectional study involving 3584 women, aged 45-68, attending screening in seven Spanish cities. Data were collected using a questionnaire, including age, socio-demographic and lifestyle characteristics, family burden and PA. PA was converted into metabolic equivalent of task (METs), categorized as low ≤ 600 METs min per week (m/w), moderate 600-3000 METs m/w and high ≥ 3000 METs m/w. A multivariate logistic regression was performed to identify variables associated with inactivity for each type of PA. No women achieved a high level of PA through sport. 79.2% achieved a high or moderate level of PA by W&B. Lack of sport was associated with being overweight (odds ratio OR = 1.31; 95% confidence interval CI: 1.06 to 1.62), body mass index (BMI) ≥ 30 (OR = 1.85; 95% CI: 1.44 to 2.38), smoking (OR = 1.56; 95% CI: 1.22 to 2.00) and living with a disabled person (OR = 1.64; 95% CI: 1.0 to 2.81), whereas enough sport practice was associated with higher educational or socio-economic level (SEL). Regarding W&B, inactivity was associated with BMI ≥ 30 (OR = 1.91; 95% CI: 1.49 to 2.45) and living with someone >74 (OR = 1.96; 95% CI: 1.48 to 2.58). Inactivity for both types of exercise was associated with a BMI ≥ 30 (OR = 2.13; 95% CI: 1.63 to 2.8), smoking (OR = 1.41; 95% CI: 1.09 to 1.81) and living with someone >74 (OR = 1.69; 95% CI: 1.24 to 2.28). Family burden and BMI ≥ 30 are inversely associated with both types of PA. W&B is the most common type of PA regardless of educational and SEL. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
McNeil, Daniel W; Hayes, Sarah E; Randall, Cameron L; Polk, Deborah E; Neiswanger, Kathy; Shaffer, John R; Weyant, Robert J; Foxman, Betsy; Kao, Elizabeth; Crout, Richard J; Chapman, Stella; Brown, Linda J; Maurer, Jennifer L; Marazita, Mary L
Both oral health problems and depression among pregnant women contribute to maternal-infant health outcomes. Little is known, however, about the potential effects of clinically significant depression on the oral health status of pregnant women. The purpose of the present study was to determine the influence of clinically significant depression and rural- or urban-dwelling status on oral health outcomes among pregnant women. Pregnant women (N = 685) in rural (i.e., West Virginia) and urban (i.e., Pittsburgh, PA) areas of northern Appalachia were assessed by calibrated examiners regarding gingivitis, oral hygiene, and DMFT (decayed, missing, and filled teeth), completed the Center for Epidemiologic Studies-Depression Scale (CES-D) and provided demographics. Participants were categorized based on clinically significant depressive symptoms (CES-D ≥ 16) and rural/urban domicile. Women with depression and those living in rural areas had worse oral health on all three indices than their non-depressed and urban counterparts. Depression, particularly among women in rural areas, affects certain oral health indices and represents a modifiable target for intervention. Moreover, treatments designed specifically for rural populations may be of particular utility. Women who are pregnant or planning to become pregnant may benefit from regular depression screenings from their dental and medical health care providers. © The Author(s) 2015.
Sicras-Mainar, Antoni; Navarro-Artieda, Ruth; Ibáñez-Nolla, Jordi
The objective of the study was to determine the use of resources and costs due to bone fractures in Spanish women above 50 years of age in the population scope. An observational and retrospective study was conducted in six primary care centers and two urban hospitals in Spain. Socio-demographic and co-morbidity data, use of resources (primary care consultations, complementary tests, medications, specialized care, hospitalizations, visits, urgencies), costs and productivity losses were registered. Records of 19 022 women were included, 7% showed some type of fracture between 2003 and 2007. Fractures were mostly associated with osteoporosis (OR: 3.2), fibromyalgia (OR: 2.4) and thyroid changes (OR: 2.2). In the corrected model, the total cost for patients who had a fracture was USD 3727 compared to USD 2705.5 (p<0.001) for those who did not have it. Patients with a fracture generate a greater use of resources, sanitation costs and work productivity losses.
Kwapong, Olivia Adwoa Tiwaah Frimpong
Using rural household survey data collected from 1000 female household heads selected from all the ten administrative regions in Ghana, this paper explored the policy implications for using ICTs for empowerment of rural women. A contingent valuation (CV) method was used to quantitatively estimate the influence of selected socio-economic factors on…
Juárez, Sol; Revuelta-Eugercios, Bárbara A; Ramiro-Fariñas, Diego; Viciana-Fernández, Francisco
Evidence suggests that educational differences in perinatal outcomes have increased in some countries (Eastern Europe) while remained stable in others (Scandinavian countries). However, less is known about the experience of Southern Europe. This study aims to evaluate the association between maternal education and perinatal outcomes derived from birthweight (low birthweight and macrosomia) and gestational age (pre-term and post-term births) among Spaniards living in the Autonomous Community of Andalusia during the period 2001-2011 (around 19 % of births in Spain); and to evaluate whether the educational differences narrowed or widened during that period, which includes both an economic boom (2001-2008) and the global economic crisis (2009-2011). This study uses the Andalusian Population Longitudinal Database and the Vital Statistics Data provided by the Spanish National Statistics Institute. We study live and singleton births of Spanish mothers who lived in Andalusia at the time of delivery (n = 404,951). ORs with 95 % confidence intervals (crude and adjusted) were estimated using multinomial regression models. A negative educational gradient is observed in all perinatal outcomes studied (i.e., the higher the educational status, the lower the risk of negative perinatal outcomes). However, when disaggregating the sample in two periods, the gradient is only statistically significant for pre-term birth during 2001-2008, while a full gradient is observed in all perinatal indicators in the period 2009-2011 with an increase in the educational inequalities in macrosomia and post-term. Further studies are needed in order to confirm whether there is a causal association between the widening of the educational differences in perinatal outcomes and the onset of the economic crisis in Spain, or the widening can be explained by other factors, such as changes in childbearing patterns and the composition of women accessing motherhood.
Coakes, S J; Kelly, G J
Rural women face a variety of health-related problems, some of which they share with their city sisters. However, the multiple responsibilities of women on the land, and their geographical isolation and lack of support, can lead to physical decline and increased mental strain. It is these factors which are often overlooked in the planning and allocation of funding and services to rural areas. This paper examines the application of community competence and empowerment measures in developing and implementing health services for women in rural Australian communities. A study conducted in the south-west region of Western Australia illustrates the ability of women within rural communities to identify and respond constructively to health issues of concern.
Dillon, Gina; Hussain, Rafat; Loxton, Deborah; Khan, Asad
To investigate differences in self-reported health among Australian women with a history of intimate partner violence (IPV) in relation to rurality of residence. Data were drawn from six survey waves of the Australian Longitudinal Study on Women's Health 1973-78 birth cohort. Self-reported general and mental health scores derived from the SF-36 scale were compared for women with a history of IPV living in metropolitan, regional and rural areas. Multivariable generalised estimating equations were constructed adjusting for income hardship, number of children, education, social support, age and marital status. Women with a history of IPV living in regional and rural areas had no significant differences in self-reported general health scores compared to their metropolitan counterparts. Rural women affected by IPV had slightly better self-reported mental health than equivalent women living in metropolitan or regional areas. The socio-demographic factors with the strongest association with self-reported health were income, education, social support, and number of children. Women in regional and rural areas were no more disadvantaged, in terms of self-reported general health or mental health, than IPV affected women living in major cities in Australia.
Mary Neth's 1995 book, "Preserving the Family Farm: Women, Community, and the Foundations of Agribusiness in the Midwest, 1900-1940," made a major contribution to the analysis of the connections between gender and the political economy that shaped farm women's lives and fueled farmers' resistance to the transformation of rural life wrought by agribusiness. Focusing on the processes of negotiation between women and men in farming families and rural communities, Neth illuminated the relationship between women's work and their power. Tracing the dense networks that connected farm families, she also showed how cooperation in work generated and sustained radical farm movements.
Valvi, Damaskini; Monfort, Nuria; Ventura, Rosa; Casas, Maribel; Casas, Lidia; Sunyer, Jordi; Vrijheid, Martine
Developmental exposure to phthalates may be associated with adverse health outcomes but information on the variability and predictors of urinary phthalate metabolite concentrations during pregnancy is limited. We evaluated in Spanish pregnant women (n=391) the reproducibility of urinary phthalate metabolite concentrations and predictors of exposure. We measured mono-(4-methyl-7-hydroxyoctyl) phthalate (7-OHMMeOP), mono-(2-ethylhexyl) phthalate (MEHP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP), mono-(2-carboxyhexyl) phthalate (MCMHP), mono-benzyl phthalate (MBzP), mono-ethyl phthalate (MEP), mono-iso-butyl phthalate (MiBP) and mono-n-butyl phthalate (MnBP) in two spot urine samples collected in the first and third pregnancy trimesters. Questionnaires on predictors and food-frequency questionnaires were administered in the first and/or third pregnancy trimesters. Using creatinine-adjusted phthalate metabolite concentrations (log10-trasformed) we calculated intraclass correlation coefficients (ICCs). Linear mixed and regression models assessed the associations between predictors and phthalate metabolites. The ICCs ranged from 0.24 to 0.07 and were higher for MBzP, MEP, MiBP, and lower for MEOHP and MEHHP. Overweight, lower education and social class, and less frequent consumption of organic food were associated with higher levels of some phthalate metabolites. The use of household cleaning products (bleach, ammonia, glass cleaners, oven cleaning sprays and degreasing products) at least once per week during pregnancy was associated with 10-44% higher urinary phthalate metabolites. Bottled-water consumption, consumption of food groups usually stored in plastic containers or cans, use of plastic containers for heating food and cosmetic use were not associated with increased concentrations of phthalate metabolites. This large study with repeated phthalate measurements
Alvarez-Uria, Gerardo; Midde, Manoranjan; Naik, Praveen K
To study the trends of the HIV epidemic and risk factors associated with HIV in a rural area of India. We utilized HIV prevalence among young pregnant women as an indicator of population trends in HIV infection. This was an observational study of pregnant women aged less than 25 years who were counseled and tested for HIV infection in a rural hospital between August 2007 and June 2011. Information on age, education, occupation, and community were collected prospectively from all of the women. The HIV prevalence in young pregnant women decreased from 1.22% in 2007 to 0.35% in 2011. Comparing the periods 2007-2009 and 2010-2011, a reduction in HIV prevalence was seen in all subgroups except in women from forward castes. Women whose job was not related to agriculture and women who had only completed primary education were more likely to be HIV-infected. These results indirectly indicate that the incidence of HIV infection is decreasing in this rural setting. However, an increase in the HIV prevalence in women from forward castes was observed. In rural areas, HIV testing of pregnant women who have only completed primary education or who are working in a field not related to agriculture should be encouraged, because of their higher risk of HIV infection. Copyright © 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
da Costa, Marta Cocco; Lopes, Marta Julia Marques
The present article refers to a qualitative study that was performed with the objective to identify and analyze the practice of healthcare professionals regarding rural women victims of violence, under the perspective of comprehensive care, in cities located in southern Rio Grande do Sul state. Participants were healthcare professionals and workers from health services who work in rural areas. The information was generated through interviews and analyzed using the thematic mode. In regards to care elements provided to rural women who are victims of violence, the study pointed out not only the relational strategies - welcoming, attachment and dialogue - but also the construction of collective actions through group activities, recognized as supporting health promotion, as well as individual and collective empowerment in the dimension of violent events. It was found that the professionals' care practices are aimed at focusing care on the rural women, establishing a relationship between the worker and client to produce comprehensiveness of care.
Haque, Monoarul; Hossain, Sharmin; Rumana Ahmed, Kazi; Sultana, Taslima; Chowdhury, Hasina Akhter; Akter, Jesmin
Objective: To compare the level of knowledge on reproductive health among urban and rural women of selected area of Bangladesh. Materials and methods: A descriptive cross-sectional study was undertaken among 200 women selected purposively from different rural and urban areas of Bangladesh. Data were collected using a semi-structured interviewer-administered questionnaire by face to face interview. Knowledge level was analyzed according to poor, moderate and good knowledge by pre-defined knowledge scoring. Results: Mean age of the respondents was 26 years and majority (66%) of them was housewives. Most of them (61%) had completed their primary level education. Around three-fourth of them belongs to lower-middle income group. Overall level of reproductive health knowledge was more evident among urban reproductive aged women than rural counterparts (p < 0.001). Moreover, significant knowledge gap was found regarding family planning (p = 0.005), care during pregnancy (p < 0.001), safe motherhood (p = 0.002), newborn care (p = 0.009) and birth spacing (p <0.001) between urban and rural women. Family members were the major source of information in both groups. Conclusion: A wide knowledge gap was found between Bangladeshi urban and rural respondents regarding their reproductive behaviors. Government and concerned organizations should promote and strengthen various health education programs to focus on reproductive health, especially among reproductive aged women in rural area. PMID:25904966
Schoppen, S; Pérez-Granados, A M; Navas-Carretero, S; Vaquero, M P
Postprandial hyperlipaemia is an independent risk factor for atherosclerosis. To compare postprandial lipaemia and fasting adhesion molecules levels in healthy young premenopausal(PrW) and postmenopausal (PoW) Spanish women. Twenty healthy PrW and 18 healthy PoW participated in a postprandial 7-hour intervention study. All participants were given a fat-rich standard meal (11.8% saturated, 39.7% monounsaturated, and 6.6% polyunsaturated) after a 12 h fast. Blood samples were taken at baseline and at 60, 120, 240, 360 and 420 min after eating. Triacylglycerols (TAG), total cholesterol (Chol), soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular adhesion molecule-1 (sVCAM-1) were determined in fasting serum samples and TAG and total Chol postprandial levels were measured. Anthropometric data, serum lipid and sICAM-1 presented significant higher values in PoW compared to PrW, but sVCAM-1 did not significantly differ between groups. Postprandial TAG and Chol concentrations in PoW were significantly higher than in PrW (p < 0.0001). There was a significant time influence (p < 0.0001) in TAG in PrW and PoW, while time to peak and peak concentration were significantly higher in PoW than PrW. Chol concentrations showed a significant reduction after 1 h, to reach values similar to baseline after 6 h in PrW but not in PoW. Lipid postprandial response to a fat rich meal and soluble intercellular adhesion molecules concentrations indicate a higher cardiovascular risk pattern in postmenopausal compared to premenopausal women. Soluble vascular adhesion molecule levels seem to be influenced not only by age and menopause, but also other factors like usual diet.
Lewis, Martha Wells
Although the situation is changing, rural America has been the scene of declining opportunity for 50 years. For the many rural females left behind in communities depleted by outmigration, there are limited opportunities and few role models besides that of wife, mother, and farm woman. The role of farm woman is demanding, self satisfying, and…
KOZHIMANNIL, Katy B.; CASEY, Michelle M.; HUNG, Peiyin; PRASAD, Shailendra; MOSCOVICE, Ira S.
BACKGROUND A recent American College of Obstetricians and Gynecologists and Society for Maternal Fetal Medicine consensus statement on levels of maternity care lays out designations that correspond to specific capacities available in facilities that provide obstetric care. Pregnant women in rural and remote areas receive particular attention in discussions of regionalization and levels of care, owing to the challenges in assuring local access to high-acuity services when necessary. Currently, approximately half a million rural women give birth each year in US hospitals, and whether and which of these women give birth locally is crucial for successfully operationalizing maternal levels of care. OBJECTIVES To characterize rural women who give birth in non-local hospitals and measure local hospital characteristics and maternal diagnoses present at childbirth that are associated with non-local childbirth. STUDY DESIGN This was a repeat cross-sectional analysis of administrative hospital discharge data for all births to rural women in nine states in 2010 and 2012. Multivariate logistic regression models were used to predict the odds of childbirth in a non-local hospital (at least 30 road miles from the patient's residence). We examined patient age, race/ethnicity, payer, rurality, clinical diagnoses (diabetes, hypertension, hemorrhage during pregnancy, placental abnormalities, malpresentation, multiple gestation, preterm delivery, prior cesarean delivery, and a composite of diagnoses that may require maternal-fetal medicine consultation), as well as local hospital characteristics (birth volume, neonatal care level, ownership, accreditation, and system affiliation). RESULTS The rate of non-local childbirth among 216,076 rural women was 25.4%. It varied significantly by primary payer (Adjusted Odds Ratio [95% Confidence Interval]=0.76 [0.68,0.86]) for Medicaid vs. private insurance) and by clinical conditions including multiple gestation (1.82 [1.58,2.1]), preterm
Kozhimannil, Katy B; Casey, Michelle M; Hung, Peiyin; Prasad, Shailendra; Moscovice, Ira S
A recent American Congress of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine (MFM) consensus statement on levels of maternity care lays out designations that correspond to specific capacities available in facilities that provide obstetric care. Pregnant women in rural and remote areas receive particular attention in discussions of regionalization and levels of care, owing to the challenges in assuring local access to high-acuity services when necessary. Currently, approximately half a million rural women give birth each year in US hospitals, and whether and which of these women give birth locally is crucial for successfully operationalizing maternal levels of care. We sought to characterize rural women who give birth in nonlocal hospitals and measure local hospital characteristics and maternal diagnoses present at childbirth that are associated with nonlocal childbirth. This was a repeat cross-sectional analysis of administrative hospital discharge data for all births to rural women in 9 states in 2010 and 2012. Multivariate logistic regression models were used to predict the odds of childbirth in a nonlocal hospital (at least 30 road miles from the patient's residence). We examined patient age, race/ethnicity, payer, rurality, clinical diagnoses (diabetes, hypertension, hemorrhage during pregnancy, placental abnormalities, malpresentation, multiple gestation, preterm delivery, prior cesarean delivery, and a composite of diagnoses that may require MFM consultation), as well as local hospital characteristics (birth volume, neonatal care level, ownership, accreditation, and system affiliation). The rate of nonlocal childbirth among 216,076 rural women was 25.4%. It varied significantly by primary payer (adjusted odds ratio [AOR], 0.76; 95% confidence interval [CI], 0.68-0.86 for Medicaid vs private insurance) and by clinical conditions including multiple gestation (AOR, 1.82; 95% CI, 1.58-2.1), preterm deliveries (AOR, 2.41; 95% CI, 2
Lee, Jessica; Macdonald, Doune
This paper makes use of critical discourse analysis and Bourdieu's theoretical framework to explore rural young women's meanings of health and fitness and how the healthism discourse is perpetuated through their experiences in school physical education (PE). The young women's own meanings are explored alongside interview data from their school PE…
Ghose, Malini; Mullick, Disha
This paper is based on the findings of a research study which traced 56 rural women learners 15 years after they had participated in an empowerment and education programme in North India. It attempts to understand, from the perspectives of women from marginalised communities, the ways in which participating in the programme had been empowering for…
Pearson, Veronica; Phillips, Michael R.; He, Fengsheng; Ji, Huiyu
Reports on a sample of 147 young women living in rural areas in China who had attempted suicide. The women's suicidal behavior was characterized by high levels of impulsivity and low rates of mental illness, including depression. Detailed suggestions are made about ways to implement suicide prevention strategies within the particular social and…
Nagaoka, Chizuko; Karki, Manohar
This paper examines the literacy and post-literacy needs of rural women in Nepal, describes a pilot study in using community radio to supplement a classroom-based post-literacy programme for these women, analyses the findings of this intervention and considers the implications for similar programmes in other settings.
Shan, Hongxia; Liu, Zhiwen; Li, Ling
As industrialisation and urbanisation aggressively take hold in China, all possible labour pools are being tapped to meet the market demands. Liushou women, or women who stay behind in rural areas as their spouses join the massive migrant workforce, are one such labour pool. Vocational training has been adopted by the Chinese state as a…
Balasubramanian, K.; Thamizoli, P.; Umar, Abdurrahman; Kanwar, Asha
This article is an attempt to study the role of mobile phones in the non-formal and informal context among rural women from resource poor communities. In particular, it focuses on the women's control over the mobile phone as a learning tool through the domestication of technologies. The distance learning, gender dimensions, and use of technologies…
Taub, Diane E.; McLorg, Penelope A.; Bartnick, April K.
Through exploring the lived experiences of disabled women, this study investigates how physical and social barriers affect their social relationships. In-depth tape-recorded interviews investigating a variety of social and interpersonal issues were conducted with 24 women with physical or visual impairments who lived in a rural region of the…
Bhandari, Shreya; Bullock, Linda F. C.; Sharps, Phyllis W.
This study explored strategies from the Intimate Partner Violence Strategy Index (IPVSI) that a sub-set of 20 rural, low-income, abused women of a larger, multi-site, mixed-method study employed to deal with Intimate Partner Violence (IPV) during the perinatal period. We conducted 32 in-depth interviews with women who were pregnant (N = 12) and/or…
Seguin, Rebecca A.; Eldridge, Galen; Lynch, Wesley; Paul, Lynn C.
The effect of strength training on body image is understudied. The Strong Women Program, a 10-week, twice weekly strength-training program, was provided by Extension agents to 341 older rural women (62 ± 12 years); changes in body image and other psychosocial variables were evaluated. Paired-sample t-test analyses were conducted to assess mean…
Karau, Paul Bundi; Winnie, Mueni Saumu; Geoffrey, Muriira; Mwenda, Mukuthuria
Uptake of VCT and other HIV prevention strategies among rural African women is affected by various socio-cultural and economic factors which need elucidation. Our aim was to establish the responsiveness to HIV education among rural women attending three dispensaries in Kenya. This study was designed to assess gender and psycho-social factors that influence HIV dynamics in rural Kenya. This was a cross-sectional questionnaire based study of 1347 women, conducted in October 2009. Socio-economic status as well as knowledge on methods of HIV transmission was assessed. Testing status, knowledge on existing VCT services and willingness to share HIV information with their children was assessed. Majority of the women have heard about VCT services, but significantly few of them have been tested. Those with secondary school education and above are more knowledgeable on methods of HIV transmission, while those with inadequate education are more likely to cite shaking hands, sharing utensils, mosquito bites and hugging as means of transmission (p = 0.001). 90% of educated women are willing to share HIV information with their children, compared to 40% of uneducated women. Marital status is seen to positively influence testing status, but has no significant effect on dissemination of information to children. We conclude that despite the aggressive HIV education and proliferation of VCT services in Kenya, women are not heeding the call to get tested. Education has a positive impact on dissemination of HIV information. Focus needs to shift into increasing acceptability of testing by women in rural Kenya.
Fonkem, R N
This is a discussion of the work of the Rural Women Development Council for poor rural women in Cameroon. The concept of absolute poverty involves the measurement of the quantity and quality of necessities required to maintain the average well-being of an individual or group of individuals. The standards are considered to be relative to a particular time and place. Subjective poverty is a state of acceptance by the person who is poor that he or she is poor; it is independent of the perspective of onlookers. Income levels vary resulting, and as a result, poverty exists. Under those premises, the Rural Women Development Council (RWDC) is helping to alleviate poverty in rural women through microcredit schemes. Over 200 women have engaged in farming and small trades. Increased equity, enhanced opportunity, peace and security, participation and sustainable future, in addition to increased income, help to defeat poverty. Strategies for eradicating poverty include enhancing the ability of local communities to adapt to stress, overcome emergencies and improve long-term productivity. The RWDC have observed that loanees are today economically above other rural women.
Valls, Rosa; Puigvert, Lídia; Melgar, Patricia; Garcia-Yeste, Carme
The first research conducted on violence against women in the university context in Spain reveals that 62% of the students know of or have experienced situations of this kind within the university institutions, but only 13% identify these situations in the first place. Two main interrelated aspects arise from the data analysis: not identifying and acknowledging violent situations, and the lack of reporting them. Policies and actions developed by Spanish universities need to be grounded in two goals: intransigence toward any kind of violence against women, and bystander intervention, support, and solidarity with the victims and with the people supporting the victims. © The Author(s) 2016.
Gómez-de-Tejada Romero, María-Jesús; Navarro Rodríguez, María-del-Carmen; Saavedra Santana, Pedro; Quesada Gómez, José-Manuel; Jódar Gimeno, Esteban; Sosa Henríquez, Manuel
First, to study the difference between two groups of postmenopausal women living in different population centres (rural vs urban) in the prevalence of osteoporosis, fragility fractures and factors which may influence them: hypovitaminosis D, bone mineral density, coexistence of other diseases which predispose to their appearance; secondly, to observe the influence of low socioeconomic status, categorised as poverty. 1229 postmenopausal women were studied, of whom 390 (31.7%), were living in rural areas and 839 (68.3%), in urban areas. Data regarding risk factors related to osteoporosis were obtained, and, among other biochemical measures, 25 hydroxyvitamin D and parathyroid hormone were determined. Bone densitometry was carried out in the lumbar spine and proximal femur, as well as lateral X-rays of the dorsal and lumbar spine. The women who lived in rural areas were older, shorter, heavier and had a higher body mass index than those from urban areas. Among the women from rural areas there was a higher prevalence of poverty, and higher levels of obesity, arterial hypertension and diabetes mellitus were observed, as well as a higher prevalence of densitometric osteoporosis. The rural women had lower values of bone mineral density in the lumbar spine and a higher prevalence of vertebral fractures and hypovitaminosis D. The variables which were associated independently with living in rural areas were poverty, obesity, vertebral fractures, BMD in the lumbar spine and levels of 25 hydroxyvitamin D. In our study, postmenopausal women who live in rural populations have more poverty, lower values of vitamin D, lower BMD in the lumbar spine and a higher prevalence of vertebral fractures and of osteoporosis. The higher prevalence of obesity, arterial hypertension and diabetes mellitus observed in these women may be adjuvant factors, all fostered by their socioeconomic state of poverty. Copyright © 2014. Published by Elsevier Ireland Ltd.
Bhandari, Shreya; Bullock, Linda F C; Anderson, Kim M; Danis, Fran S; Sharps, Phyllis W
We conducted 32 in-depth interviews with 20 rural, low-income, women residing in the United States who were pregnant (n = 12) or 3 months postpartum (n = 8) and had experienced intimate partner violence (IPV). Using purposive sampling and the grounded theory method, we generated a conceptual model of coping. The urge to protect the unborn baby was the primary influence for participants' decisions about separating from or permanently leaving an abusive relationship. Implications include universal screening for IPV in child-bearing women, inquiry into maternal identity development during pregnancy, and improved resource access for rural, low-income women.
Panazzola, Phaedra; Leipert, Beverly
There is inadequate knowledge regarding the prevalence, nature, and severity of mental health issues for rural senior women in Canada. Limited research has explored rural mental health, tending to focus on identifying mental illnesses that rural senior women (aged 65 years or older) experience and overlooking factors that contribute to mental health problems. Therefore, the focus of this research was to examine mental health issues of rural senior women and factors that negatively and/or positively affect their mental health. For this study, a secondary analysis technique was employed to re-analyze focus group, logbook, and pictorial data from a primary photovoice study. This secondary analysis study more specifically identified findings related to the mental health of rural senior women, such as mental health issues and factors that positively/negatively affected their mental health. The primary study explored general health promotion needs and resources of senior rural women. Two main mental health issues were identified: loneliness and negative self-concept. Two factors were found to positively affect these women's mental health: social and community resources, and personal characteristics and resources. The two factors that negatively affected these women's mental health were found to be: inadequate resources and loss in community; and devaluing of rurality, ethnicity, and gender. Study findings substantially contribute to the knowledge base regarding rural mental health by focusing on senior women and key factors in the rural context. Implications of this research are important for rural communities, practice and service delivery, and future research.
Simon, Melissa A.; Ragas, Daiva M.; Nonzee, Narissa J.; Phisuthikul, Ava M.; Luu, Thanh Ha; Dong, XinQi
To explore patient perceptions of patient-provider communication in breast and cervical cancer-related care among low-income English- and Spanish- speaking women, we examined communication barriers and facilitators reported by patients receiving care at safety net clinics. Participants were interviewed in English or Spanish after receiving an abnormal breast or cervical cancer screening test or cancer diagnosis. Following an inductive approach, interviews were coded and analyzed by the language spoken with providers and patient-provider language concordance status. Of 78 participants, 53% (n = 41) were English-speakers and 47% (n = 37) were Spanish-speakers. All English-speakers were language-concordant with providers. Of Spanish-speakers, 27% (n = 10) were Spanish-concordant; 38% (n = 14) were Spanish-discordant, requiring an interpreter; and 35% (n = 13) were Spanish mixed-concordant, experiencing both types of communication throughout the care continuum. English-speakers focused on communication barriers, and difficulty understanding jargon arose as a theme. Spanish-speakers emphasized communication facilitators related to Spanish language use. Themes among all Spanish-speaking sub-groups included appreciation for language support resources and preference for Spanish-speaking providers. Mixed-concordant participants accounted for the majority of Spanish-speakers who reported communication barriers. Our data suggest that, although perception of patient-provider communication may depend on the language spoken throughout the care continuum, jargon is lost when health information is communicated in Spanish. Further, the respective consistency of language concordance or interpretation may play a role in patient perception of patient-provider communication. PMID:23553683
Cordasco, Kristina M; Mengeling, Michelle A; Yano, Elizabeth M; Washington, Donna L
Disparities in health and health care access between rural and urban Americans are well documented. There is evidence that these disparities are mirrored within the US veteran population. However, there are few studies assessing this issue among women veterans (WVs). Using the 2008-2009 National Survey of Women Veterans, a population-based cross-sectional national telephone survey, we examined rural WVs' health and health care access compared to urban WVs. We measured health using the Medical Outcomes Study Short-Form (SF-12); access using measures of regular source of care (RSOC), health care utilization, and unmet needs; and barriers to getting needed care. Rural WVs have significantly worse physical health functioning compared to urban WVs (mean physical component score of 43.6 for rural WVs versus 47.2 for urban WVs; P = .007). Rural WVs were more likely to have a VA RSOC (16.4% versus 10.6%; P = .009) and use VA health care (21.7% versus 12.9%; P < .001), and had fewer non-VA health care visits compared with urban WVs (mean 4.2 versus 5.9; P = .021). They had similar overall numbers of health care visits (mean 5.8 versus 7.1; P = .11 ). Access barriers were affordability for rural WVs and work release time for urban WVs. Rural WVs additionally reported that transportation was a major factor affecting health care decisions. Our findings demonstrate VA's crucial role in addressing disparities in health and health care access for rural WVs. As VA continues to strive to optimally meet the needs of all WVs, innovative care models need to account for their high health care needs and persistent barriers to care. © 2016 National Rural Health Association.
Dickson, Kwamena Sekyi; Adde, Kenneth Setorwu; Amu, Hubert
Background . There is a paucity of empirical literature in Ghana on rural areas and their utilisation of health facilities. The study examined the effects of the sociodemographics of rural women on place of delivery in the country. Methods . The paper made use of data from the 2014 Ghana Demographic and Health Survey. Women from rural areas who had given birth within five years prior to the survey were included in the analysis. Descriptive analyses and binary logistic regression were used to analyse the data. Results . Wealth, maternal education, ecological zone, getting money for treatment, ethnicity, partner's education, parity, and distance to a health facility were found as the determinants of place of delivery among women in rural Ghana. Women in the richest wealth quintile were three times (OR = 3.04, 95% CI = 0.35-26.4) more likely to deliver at a health facility than the poorest women. Conclusions . It behoves the relevant stakeholders including the Ghana Health Service and the Ministry of Health to pay attention to the wealth status, maternal education, ecological zone, ethnicity, partner's education, parity, and distance in their planning regarding delivery care in rural Ghana.
Adde, Kenneth Setorwu
Background. There is a paucity of empirical literature in Ghana on rural areas and their utilisation of health facilities. The study examined the effects of the sociodemographics of rural women on place of delivery in the country. Methods. The paper made use of data from the 2014 Ghana Demographic and Health Survey. Women from rural areas who had given birth within five years prior to the survey were included in the analysis. Descriptive analyses and binary logistic regression were used to analyse the data. Results. Wealth, maternal education, ecological zone, getting money for treatment, ethnicity, partner's education, parity, and distance to a health facility were found as the determinants of place of delivery among women in rural Ghana. Women in the richest wealth quintile were three times (OR = 3.04, 95% CI = 0.35–26.4) more likely to deliver at a health facility than the poorest women. Conclusions. It behoves the relevant stakeholders including the Ghana Health Service and the Ministry of Health to pay attention to the wealth status, maternal education, ecological zone, ethnicity, partner's education, parity, and distance in their planning regarding delivery care in rural Ghana. PMID:28101522
Phillips, Julie; Hustedde, Carol; Bjorkman, Sarah; Prasad, Rupa; Sola, Orlando; Wendling, Andrea; Bjorkman, Kurt; Paladine, Heather
PURPOSE Women family physicians experience challenges in maintaining work-life balance while practicing in rural communities. We sought to better understand the personal and professional strategies that enable women in rural family medicine to balance work and personal demands and achieve long-term career satisfaction. METHODS Women family physicians practicing in rural communities in the United States were interviewed using a semistructured format. Interviews were recorded, professionally transcribed, and analyzed using an immersion and crystallization approach, followed by detailed coding of emergent themes. RESULTS The 25 participants described a set of strategies that facilitated successful work-life balance. First, they used reduced or flexible work hours to help achieve balance with personal roles. Second, many had supportive relationships with spouses and partners, parents, or other members of the community, which facilitated their ability to be readily available to their patients. Third, participants maintained clear boundaries around their work lives, which helped them to have adequate time for parenting, recreation, and rest. CONCLUSIONS Women family physicians can build successful careers in rural communities, but supportive employers, relationships, and patient approaches provide a foundation for this success. Educators, employers, communities, and policymakers can adapt their practices to help women family physicians thrive in rural communities. PMID:27184995
Phillips, Julie; Hustedde, Carol; Bjorkman, Sarah; Prasad, Rupa; Sola, Orlando; Wendling, Andrea; Bjorkman, Kurt; Paladine, Heather
Women family physicians experience challenges in maintaining work-life balance while practicing in rural communities. We sought to better understand the personal and professional strategies that enable women in rural family medicine to balance work and personal demands and achieve long-term career satisfaction. Women family physicians practicing in rural communities in the United States were interviewed using a semistructured format. Interviews were recorded, professionally transcribed, and analyzed using an immersion and crystallization approach, followed by detailed coding of emergent themes. The 25 participants described a set of strategies that facilitated successful work-life balance. First, they used reduced or flexible work hours to help achieve balance with personal roles. Second, many had supportive relationships with spouses and partners, parents, or other members of the community, which facilitated their ability to be readily available to their patients. Third, participants maintained clear boundaries around their work lives, which helped them to have adequate time for parenting, recreation, and rest. Women family physicians can build successful careers in rural communities, but supportive employers, relationships, and patient approaches provide a foundation for this success. Educators, employers, communities, and policymakers can adapt their practices to help women family physicians thrive in rural communities. © 2016 Annals of Family Medicine, Inc.
Johnson, Avita Rose; Edwin, Serin; Joachim, Nayanthara; Mathew, Geethu; Ajay, Shwetha; Joseph, Bobby
Postnatal depression, with an estimated prevalence of 13-19%, causes significant impairment of mental health among women worldwide and has long term consequences. However, more than half of all cases are not detected by healthcare providers. Screening for postnatal depression has not been given importance in maternal health programs in India. Our objective was to screen for postnatal depression among women attending a rural hospital in India, immediately postpartum and at 6-8 weeks post-delivery, and to study associated factors. A cross sectional study was done on 123 postnatal women attending a rural maternity hospital in Karnataka, South India, of whom 74 women were interviewed within one week of childbirth, and 49 women at 6-8 weeks post-delivery. The Edinburgh Postnatal Depression Scale was used to screen for postnatal depression. About 45.5% of the women screened positive for postnatal depression (44.6% of all subjects within one week of delivery and 46.9% at 6-8 weeks after delivery). Postnatal depression was significantly associated with mood swings during antenatal period, staying with the family of birth during pregnancy and away from their husbands, and was significantly higher among women who perceived their life as stressful and having a low self-esteem (P<0.05). This study found a high prevalence of postnatal depression in women in rural Karnataka. This underlines the need for incorporating screening for postnatal depression in the routine care of women during pregnancy and delivery.
Pitilin, Érica de Brito; Lentsck, Maicon Henrique
Understanding the perception of women living in a rural area about the actions and services of Primary Health Care (PHC) in a municipality of southern Brazil, which is the only one regarded as predominantly rural. A descriptive study of qualitative approach, carried out with women who lived in the countryside and required health services in the 15 days prior to collection. The results registered low fidelity to PHC attributes, focusing its functional axis on sickness, transforming the unit into small points of emergency care and a bureaucratic place where patients are referred to other types of services. The quality of service offered is compromised to offering quick, fragmented and unequal treatment in the rural context. The findings of this study highlight the need for greater efforts in order to adequate the new care model in the development of appropriate actions as designated by PHC in the rural context studied.
Through organizing informal self-help groups (SHGs), rural women in India are provided credit and extension support for various production-oriented income-generating activities. These activities usually include garment-making, embroidery, food processing, bee-keeping, basketry, gem cutting, weaving, and knitting. SHGs are self-governed, with decisions about production and marketing taken collectively, although the group leader is responsible for identifying potential marketing centers and consumers. These groups represent a new culture in rural development, breaking with traditional bureaucracy and top-down management. Informal groups empower rural women to manage rural industries and make decisions collectively for their common economic interests. Experience with SHGs in Orissa, lessons from nongovernmental organization intervention, and a model for empowering poor people in a small town in Kerala are discussed.
Urreizti, Roser; Civit, Sergi; Cols, Neus; García-Giralt, Natàlia; Yoskovitz, Guy; Aranguren, Alvaro; Malouf, Jorge; Di Gregorio, Silvana; Río, Luís Del; Güerri, Roberto; Nogués, Xavier; Díez-Pérez, Adolfo; Grinberg, Daniel; Balcells, Susana
The aims of the study were to establish the prevalence of high bone mass (HBM) in a cohort of Spanish postmenopausal women (BARCOS) and to assess the contribution of LRP5 and DKK1 mutations and of common bone mineral density (BMD) variants to a HBM phenotype. Furthermore, we describe the expression of several osteoblast-specific and Wnt-pathway genes in primary osteoblasts from two HBM cases. A 0.6% of individuals (10/1600) displayed Z-scores in the HBM range (sum Z-score >4). While no mutation in the relevant exons of LRP5 was detected, a rare missense change in DKK1 was found (p.Y74F), which cosegregated with the phenotype in a small pedigree. Fifty-five BMD SNPs from Estrada et al. [NatGenet 44:491-501,2012] were genotyped in the HBM cases to obtain risk scores for each individual. In this small group of samples, Z-scores were found inversely related to risk scores, suggestive of a polygenic etiology. There was a single exception, which may be explained by a rare penetrant genetic variant, counterbalancing the additive effect of the risk alleles. The expression analysis in primary osteoblasts from two HBM cases and five controls suggested that IL6R, DLX3, TWIST1 and PPARG are negatively related to Z-score. One HBM case presented with high levels of RUNX2, while the other displayed very low SOX6. In conclusion, we provide evidence of lack of LRP5 mutations and of a putative HBM-causing mutation in DKK1. Additionally, we present SNP genotyping and expression results that suggest additive effects of several genes for HBM. PMID:24736728
García-Arenzana, Nicolás; Navarrete-Muñoz, Eva María; Lope, Virginia; Moreo, Pilar; Vidal, Carmen; Laso-Pablos, Soledad; Ascunce, Nieves; Casanova-Gómez, Francisco; Sánchez-Contador, Carmen; Santamariña, Carmen; Aragonés, Nuria; Pérez Gómez, Beatriz; Vioque, Jesús; Pollán, Marina
High mammographic density (MD) is one of the main risk factors for development of breast cancer. To date, however, relatively few studies have evaluated the association between MD and diet. In this cross-sectional study, we assessed the association between MD (measured using Boyd's semiquantitative scale with five categories: <10%, 10-25%, 25-50%, 50-75% and >75%) and diet (measured using a food frequency questionnaire validated in a Spanish population) among 3,548 peri- and postmenopausal women drawn from seven breast cancer screening programs in Spain. Multivariate ordinal logistic regression models, adjusted for age, body mass index (BMI), energy intake and protein consumption as well as other confounders, showed an association between greater calorie intake and greater MD [odds ratio (OR) = 1.23; 95% confidence interval (CI) = 1.10-1.38, for every increase of 500 cal/day], yet high consumption of olive oil was nevertheless found to reduce the prevalence of high MD (OR = 0.86;95% CI = 0.76-0.96, for every increase of 22 g/day in olive oil consumption); and, while greater intake of whole milk was likewise associated with higher MD (OR = 1.10; 95%CI 1.00-1.20, for every increase of 200 g/day), higher consumption of protein (OR = 0.89; 95% CI 0.80-1.00, for every increase of 30 g/day) and white meat (p for trend 0.041) was found to be inversely associated with MD. Our study, the largest to date to assess the association between diet and MD, suggests that MD is associated with modifiable dietary factors, such as calorie intake and olive oil consumption. These foods could thus modulate the prevalence of high MD, and important risk marker for breast cancer. © 2013 The Authors. Published by Wiley Periodicals, Inc. on behalf of UICC.
García-Arenzana, Nicolás; Navarrete-Muñoz, Eva María; Lope, Virginia; Moreo, Pilar; Vidal, Carmen; Laso-Pablos, Soledad; Ascunce, Nieves; Casanova-Gómez, Francisco; Sánchez-Contador, Carmen; Santamariña, Carmen; Aragonés, Nuria; Gómez, Beatriz Pérez; Vioque, Jesús; Pollán, Marina
High mammographic density (MD) is one of the main risk factors for development of breast cancer. To date, however, relatively few studies have evaluated the association between MD and diet. In this cross-sectional study, we assessed the association between MD (measured using Boyd's semiquantitative scale with five categories: <10%, 10–25%, 25–50%, 50–75% and >75%) and diet (measured using a food frequency questionnaire validated in a Spanish population) among 3,548 peri- and postmenopausal women drawn from seven breast cancer screening programs in Spain. Multivariate ordinal logistic regression models, adjusted for age, body mass index (BMI), energy intake and protein consumption as well as other confounders, showed an association between greater calorie intake and greater MD [odds ratio (OR) = 1.23; 95% confidence interval (CI) = 1.10-1.38, for every increase of 500 cal/day], yet high consumption of olive oil was nevertheless found to reduce the prevalence of high MD (OR = 0.86;95% CI = 0.76-0.96, for every increase of 22 g/day in olive oil consumption); and, while greater intake of whole milk was likewise associated with higher MD (OR = 1.10; 95%CI 1.00-1.20, for every increase of 200 g/day), higher consumption of protein (OR = 0.89; 95% CI 0.80-1.00, for every increase of 30 g/day) and white meat (p for trend 0.041) was found to be inversely associated with MD. Our study, the largest to date to assess the association between diet and MD, suggests that MD is associated with modifiable dietary factors, such as calorie intake and olive oil consumption. These foods could thus modulate the prevalence of high MD, and important risk marker for breast cancer. PMID:24254818
García-Martín, Antonia; Quesada Charneco, Miguel; Alvárez Guisado, Alejandro; Jiménez Moleón, José Juan; Fonollá Joya, Juristo; Muñoz-Torres, Manuel
To analyze the effects of nutritional intervention with a milk product enriched with soy isoflavones on quality of life and bone metabolism in postmenopausal Spanish women. We performed a double-blind controlled randomized trial in ninety-nine postmenopausal women. Group S women (n=48) were randomized to consume milk product enriched with soy isoflavone (50 mg/day) while group C (n=51) consumed product control for 12 months. Parameters of quality of life (Cervantes scale), markers of bone metabolism and bone mass estimated by ultrasound of the calcaneus (QUS) were evaluated. Overall, there was an improvement in the domains menopause (P=.015) and vasomotor symptoms (P<.001). S group emphasized the assessment of vasomotor symptoms (P=.001) and differed positively from group C in health (P=.019), sex (P=.021) and partner (P=.002). Serum levels TRAP (P<.001) and OPG (P=.007) decreased and concentrations of 25-OH-vitamin D increased (P<.001) without differences between groups. In the assessment of QUS, there was an increase in estimated bone mineral density in group S (P=.040), whereas in group C there were no significant differences. Daily consumption of these milk products increases levels of 25-OH-vitamin D and decreases bone metabolism markers. Additional supplementation with soy isoflavones seems to improve quality of life and bone mass in Spanish postmenopausal women. Copyright © 2010 Elsevier España, S.L. All rights reserved.
Pilar Martínez, M; Miró, Elena; Sánchez, Ana I; Lami, María J; Prados, Germán; Ávila, Daniela
Excessive attention to pain is a common psychological characteristic among people who suffer from chronic pain. The Pain Vigilance and Awareness Questionnaire (PVAQ) is an internationally accepted tool to assess this feature, although there is no validated version of this measure for Spanish people with fibromyalgia. Since this pain syndrome mainly affects women, the aim of this study was to determine the psychometric properties of the PVAQ in Spanish women with fibromyalgia. A group of 242 women diagnosed with fibromyalgia aged between 20 and 66 years participated in the study. The goodness of fit of several structures of the PVAQ reported in previous studies was compared via confirmatory factor analysis. A two-factor solution (active vigilance and passive awareness) of the 9-item shortened version (PVAQ-9) was identified as the most appropriate (RMSEA = .08, NNFI = .96, CFI = .97, GFI = .87). It showed good reliability (internal consistency α = .82), convergent validity and divergent validity (p < .01). The optimal cutoff point for identifying fibromyalgia women with worse daily functioning was a score of 24.5, with a sensitivity of .71 and a specificity of .75. The relevance of vigilance to pain for clinical research in fibromyalgia is discussed.
Ngwa Nebasina, E
Women in Cameroon are estimated to perform about 66% of housework and agricultural work in rural areas. Women are 56.6% of the rural production force in Cameroon. This article explores the role of women in Cameroon and their impact on the environment in various ecological zones. In North Cameroon traditional practices restrict rural women to a geographic distance around their home or farm community. Women's engagement in farming is largely determined by men. Few women have environmental knowledge. In South Cameroon women are engaged in every farming activity and there is mass tilling of the soil. In North West Cameroon women use earth mounding as an agricultural technique for intensive farming and moisture retention. The practice of bush burning is widespread in all regions. In all regions women contribute substantially to the process of environmental degradation. It is suggested that group farming or block farming should be used to increase the use of beneficial technology. Women should receive counseling and technical training from nongovernmental and governmental groups. Successful programs in Cameroon were developed in the early 1960s around rural collectives in the North West. The women were known as the Corn-Mill Societies and engaged in micro-enterprises that protected communal forests and woodlots. Other micro-enterprises flourished in the Oku-Kilum Mountain forests, the Bafut Village Community Zone, and the Mount Kupe forests. Alternative energy sources or improved cooking units are still needed. Improved earth ovens were successful in Senegal in reducing fuel consumption. Village meetings and church and social gatherings might be used to further environmental education.
Dubowska, A; Skurzok, H; Krystian, T
The paper, having a diagnostic character, discusses the problems of birth control, family planning and contraception methods. The methods of the investigation were a questionnaire, interview and analysis of documentation. The investigation was carried out in two areas: urban--Katowice and rural--Istebna. The investigation was carried out among a group of 100 women between 20 and 55 years of age. All the women questioned have been married for 1-30 years. Most of them have two children--30%. Most women from both the urban and rural areas use natural methods of contraception, in. the town--Billings method and in the country--conjugal diary. Thermal method is less popular as it is time-consuming. The main reasons for choosing a natural method of contraception control are moral, religious and biological aspects, which give the women a psychic comfort and a strong feeling of attachment to the husband. Women from the urban area say that they started to use contraceptive methods after getting married whereas women from the rural area--after giving birth to a child. Contraceptive devices are used by about 30% of women. The most popular are: among women from the town--coitus interruptus, artificial abortion and less popular contraceptive devices such as oral contraceptives, intrauterine devices and chemical substances. Among women from the rural area the most common is coitus interruptus and then 2-1 cases of each of the remaining methods. Women applying contraceptive devices are aware of their harmful effects, their unreliability, immorality and violating nature. Women in the country face a lot of difficulties in buying contraceptive devices and they also (22%) use artificial abortion.(ABSTRACT TRUNCATED AT 250 WORDS)
Jackson, Afton; Shannon, Lisa
Research presenting outcomes for women who enter substance abuse treatment during pregnancy consistently shows benefits. While treatment has nearly universal benefits, there are many barriers to seeking substance abuse treatment for pregnant women. The purpose of this study is to explore barriers for rural pregnant women seeking substance abuse treatment. There were three eligibility criteria for study participation: (1) aged 18 and older, (2) pregnant, and (3) undergoing short-term inpatient detoxification at the University of Kentucky Chandler Medical Center. Eighty-five rural women (N = 85) were included in the analysis. Substance use history and previous treatment were assessed with measures adapted from the Addiction Severity Index. Treatment barriers were measured with three qualitative questions and were coded into four overarching categories: availability, accessibility, affordability, and acceptability barriers. This sample had an extensive substance use history. Almost all participants had used alcohol (98%), marijuana (98%), illicit opiates (99%), and cigarettes (97%). On average, participants reported about two barriers to receiving treatment (Mean = 1.8; SD = 1.3), with over 80% of the sample reporting having experienced any barrier to treatment. The majority experienced acceptability (51%) and accessibility (49%) barriers. Twenty-six percent (26%) of the sample reported availability barriers. A smaller percentage of participants reported affordability barriers (13%). Rural pregnant women seeking substance abuse treatment face many obstacles to receiving needed treatment. More studies on barriers to substance abuse treatment among rural pregnant women are needed. Identifying these barriers can help in improving treatment access and services.
Rennison, Callie Marie; DeKeseredy, Walter S; Dragiewicz, Molly
Woman abuse varies across intimate relationship categories (e.g., marriage, divorce, separation). However, it is unclear whether relationship status variations in violence against women differ across urban, suburban, and rural areas. We test the hypothesis that rural females, regardless of their intimate partner relationship status, are at higher risk of intimate violence than their urban and suburban counterparts. Results indicate that marital status is an important aspect of the relationship between intimate victimization and geographic area and that rural divorced and separated females are victimized at rates exceeding their urban counterparts.
Mabry, Julia; Farris, Paige E.; Forro, Vanessa A.; Findholt, Nancy E.; Purnell, Jonathan Q.; Davis, Melinda M.
Despite increasing recognition of the role nutrition plays in the health of current and future generations, many women struggle to eat healthy. We used the PhotoVoice method to engage 10 rural women in identifying perceived barriers and facilitators to healthy eating in their homes and community. They took 354 photographs, selected and wrote captions for 62 images, and explored influential factors through group conversation. Using field notes and participant-generated captions, the research team categorized images into factors at the individual, relational, community/organizational, and societal levels of a socioecological model. Barriers included limited time, exposure to marketing, and the high cost of food. Facilitators included preparing food in advance and support from non-partners; opportunities to hunt, forage, and garden were also facilitators, which may be amplified in this rural environment. Nutritional interventions for rural women of childbearing age should be multi-component and focus on removing barriers at multiple socioecological levels. PMID:28462323
Brown, Helen; Varcoe, Colleen; Calam, Betty
It has been established that the birthing experiences and outcomes of rural women are shaped by poverty, isolation, limited economic opportunities, and diminishing maternity services. We lack research into how these dynamics are compounded by intersecting forms of oppression faced by Aboriginal women, to impact on their birthing experiences and outcomes. The findings of this study of rural Aboriginal maternity care in 4 communities in British Columbia show how diminishing local birthing choices and women's struggles to exert power, choice, and control are influenced by centuries of colonization. The research questions focus on rural Aboriginal women's experiences of birthing and maternity care in this neocolonial context and their desire for supportive birthing environments. A community-based participatory and ethnographic design was employed. Individual interviews, focus groups, and participant observation were the primary data sources. Although the women's experiences in each community were shaped by distinct histories and traditions, economics, politics, and geographies, the impacts of colonization and medical paternalism and the struggle for control of women's bodies during birth intersect, placing additional stress on women. The implications for nurses of accounting for the intersecting dynamics that shape Aboriginal women's experiences and birth outcomes are discussed.
Jacobson, Lisette T; Twumasi-Ankrah, Philip; Redmond, Michelle L; Ablah, Elizabeth; Hines, Robert B; Johnston, Judy; Collins, Tracie C
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a public nutritional assistance program for low-income women and their children up to age five. This study provides insight into maternal characteristics associated with breastfeeding among urban versus rural women. A secondary analysis was conducted using the Pregnancy Nutrition Surveillance System dataset of women enrolled in the Kansas WIC program in 2011. Geographic residency status was obtained through application of the Census tract-based rural-urban commuting area codes. Descriptive variables included maternal demographics, health, and lifestyle behaviors. A multivariable binary logistic regression was used to obtain adjusted odds ratios with 95 % confidence intervals. The outcome variable was initiation of breastfeeding. A P value of ≤0.05 was considered statistically significant. The total sample size was 17,067 women. Statistically significant differences regarding socio-demographics, program participation, and health behaviors for urban and rural WIC participants were observed. About 74 % of all WIC mothers initiated breastfeeding. Urban women who were Hispanic, aged 18-19, high school graduates, household income >$10,000/year, and started early prenatal care were more likely to breastfeed. Urban and rural women who were non-Hispanic black with some high school education were less likely to breastfeed. Increased breastfeeding initiation rates are the result of a collaborative effort between WIC and community organizations. Availability of prenatal services to rural women is critical in the success of breastfeeding promotion. Findings help inform WIC program administrators and assist in enhancing breastfeeding services to the Kansas WIC population.
Wang, H H
The purpose of this study was to examine the predictors of health promotion lifestyle (HPL) and examine the similarities and differences among three ethnic groups of elderly rural women in Taiwan. Pender's Health Promotion Model was used as the conceptual framework of this study. A convenience sample of 599 elderly rural women was recruited from three rural areas: Kao-Shu, San-Di-Men, and Ma-Chia. Ho-Lo, Hakka, and aboriginal people are the three main ethnic groups in these areas. Of the 599 elderly women, 391 completed all of the interview questions. Subjects ranged from 65 to 91 years old. All instruments used in this study have been evaluated for their content validity. The interrater reliability and alpha coefficient reliability of all instruments were greater than 0.70. A survey-interview method was used to collect data. Findings showed that the predictors of HPL have differences and similarities among elderly rural women from different ethnicities. In the group of elderly Ho-Lo women, age, education, living arrangements, and perceived barriers to health promotion lifestyle (PBaHPL) were significant predictors and they explained 41.9% of total variance in HPL. In the group of elderly Hakka women, education, number of chronic health problems, PBaHPL, and perceived benefits of health promotion lifestyle (PBeHPL) were significant predictors in explaining 53.9% of total variance in HPL. Finally, in the group of elderly aboriginal women, living arrangements, PBaHPL, and PBeHPL were significant predictors in explaining 70.0% of total variance in HPL. Community nurses can use their understanding of different ethnic groups to assess, identify, and use effective health promotion interventions for elderly rural women.
Nyamathi, Adeline; Hanson, Alecia Y.; Salem, Benissa E.; Sinha, Sanjeev; Ganguly, Kalyan K.; Leake, Barbara; Yadav, Kartik; Marfisee, Mary
Background Despite the increased prevalence of HIV in the rural female population of India, adherence to antiretroviral therapy continues to be low due to several barriers which discourage rural women. Objectives To assess the effectiveness of an intervention (Asha-Life) delivered by Accredited Social Health Activists to improve antiretroviral therapy adherence of rural women living with AIDS in India compared to that of a usual care group. Method A total of 68 rural women living with AIDS, aged 18–45 years, participated in a prospective, randomized pilot clinical trial and were assessed for several factors affecting adherence, such as sociodemographic characteristics, health history, CD4 cell count, enacted stigma, depressive symptomology, help getting antiretroviral therapy, and perceived therapy benefits. Results Findings at 6 months revealed that, while both groups improved their adherence to antiretroviral therapy, there was greater improvement in the Asha-Life group (p < .001), who reported a greater reduction in barriers to antiretroviral therapy than those in the usual care group. Discussion Antiretroviral therapy adherence showed significant increase in the Asha-Life cohort, in which basic education on HIV/AIDS, counseling on antiretroviral therapy, financial assistance, and better nutrition was provided. The Asha-Life intervention may have great potential in improving antiretroviral therapy adherence and decreasing barriers among rural women living with AIDS in India. PMID:22872107
Wan, Xia; Shin, Sanghyuk S.; Wang, Qian; Raymond, H. Fisher; Liu, Huilin; Ding, Ding; Yang, Gonghuan; Novotny, Thomas E.
Background Rural-to-urban migrant women may be vulnerable to smoking initiation as they are newly exposed to risk factors in the urban environment. We sought to identify correlates of smoking among rural-to-urban migrant women in China. Methods/Principal Findings A cross-sectional survey of rural-to-urban migrant women working in restaurants and hotels (RHW) and those working as commercial sex workers (CSW) was conducted in ten provincial capital cities in China. Multiple logistic regression was conducted to identify correlates of smoking. We enrolled 2229 rural-to-urban migrant women (1697 RHWs aged 18–24 years and 532 CSWs aged 18–30 years). Of these, 18.4% RHWs and 58.3% CSWs reported ever tried smoking and 3.2% RHWs and 41.9% CSWs reported current smoking. Participants who first tried smoking after moving to the city were more likely to be current smokers compared to participants who first tried smoking before moving to the city (25.3% vs. 13.8% among RHWs, p = 0.02; 83.6% vs. 58.6% among CSWs, p = <0.01). Adjusting for other factors, “tried female cigarette brands” had the strongest association with current smoking (OR 5.69, 95%CI 3.44 to 9.41) among participants who had ever tried smoking. Conclusions/Significance Exposure to female cigarette brands may increase the susceptibility to smoking among rural-to-urban migrant women. Smoke-free policies and increased taxes may be effective in preventing rural-to-urban migrant women from smoking initiation. PMID:21829683
Peñacoba-Puente, Cecilia; Marín-Morales, Dolores; Carmona-Monge, Francisco Javier; Velasco Furlong, Lilian
In this study, our purpose was to examine whether personality and cognitive factors could be related to post-partum depression (PPD), mediated by anxiety, in Spanish women. Women were evaluated for personality and cognitive factors after the first trimester, for anxiety in the third trimester, and for PPD 4 months after childbirth. A structural equation model revealed that personality and cognitive factors were associated with anxiety and PPD as predictors. Neuroticism and extroversion proved to be the most relevant factors. Conscientiousness was associated with pregnancy anxiety. Pregnancy anxiety appeared as an independent predictor of PPD. The model presented here includes personality and cognitive and emotional factors as predictors of PPD. Comprehensive care for pregnant women should contemplate assessment and intervention on all these aspects. Special focus should be on cognitive factors and emotional regulation strategies, so as to minimize the risk of later development of emotional disorders during puerperal phases.
Lete, Iñaki; Dueñas, José Luis; Serrano, Isabel; Doval, José Luis; Martínez-Salmeán, Javier; Coll, Carme; Pérez-Campos, Ezequiel; Arbat, Agnès
To assess the attitudes of women with premenstrual symptoms in relation to their perception of complaints and request for medical advice. Cross-sectional study of a representative cohort of 2018 Spanish women aged 15-49 years. Participants were personally interviewed at home and completed the premenstrual symptoms screening tool. A total of 1554 women (73.7%) complained of some of the premenstrual symptoms during the last 12 menstrual cycles. The prevalence of moderate or severe premenstrual syndrome (PMS) was 8.9% and the prevalence of premenstrual dysphoric disorder (PMDD) 1.1%. Only 291 (18.7%) women had sought medical advice. The main reason given by 90.6% of symptomatic women for not seeking medical consultation was to consider that symptoms were normal. A total of 175 (60.1%) women received pharmacological treatment (hormonal contraceptives in 95% followed by analgesics in 50% and anti-inflammatory agents in 44%), 20% were not treated because physicians considered that symptoms were not important and would disappear spontaneously, and 12% received only advice to change life style. Women suffering from PMS or PMDD do not usually seek medical advice and among those seeking medical care, in many cases, an adequate response to their demands is not obtained. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Sayón-Orea, Carmen; Santiago, Susana; Cuervo, Marta; Martínez-González, Miguel A; Garcia, Aquilino; Martínez, Jose Alfredo
This study aims to assess the relationship of adherence to the Mediterranean dietary pattern, as well as the presence of menopausal symptoms, with overweight/obesity in Spanish perimenopausal and postmenopausal women. Participants in this cross-sectional study were 8,954 Spanish perimenopausal or postmenopausal women. Anthropometric measurements were recorded, and all women were interviewed to assess their adherence to the Mediterranean dietary pattern, using a validated questionnaire and the Menopause and Health subscale of the validated Cervantes Scale. A logistic regression model was used to investigate the association between categories of adherence to the Mediterranean diet and the odds of being overweight/obese. Multinomial logistic regression was used to study the association between menopausal symptoms and the odds of being overweight/obese (reference categories: participants in the low-adherence category and participants with no menopausal problems). After adjustment for relevant confounders, the odds ratio (95% CI) for being overweight/obese among women in the highest category of adherence to the Mediterranean dietary pattern was 0.68 (0.60-0.78; P for trend <0.001). The odds ratio (95% CI) for being overweight/obese was 3.05 (1.98-4.71) for the category "severe problems" in comparison with the category "no problems." Higher adherence to a healthy dietary pattern (Mediterranean diet) is inversely associated with overweight/obesity in perimenopausal and postmenopausal women. The occurrence of low to severe problems during perimenopause or postmenopause is positively associated with overweight/obesity. Therefore, high adherence to the Mediterranean dietary pattern and a body mass index of 25kg/m(2) or lower might improve quality of life in women at these stages.
Shariful Islam, Sheikh Mohammed; Mainuddin, Akm
The objective of the study was to find out the effects of income generating activities of rural women and their reproductive health behavior (contraceptive use) in Bangladesh. A cross-sectional study using a multi-stage sampling technique was carried out among 200 married rural women in Cox's Bazar, Bangladesh. Data were collected using a structured questionnaire on socioeconomic factors, income generating activities, women's empowerment in mobility, decision making and reproductive health behavior in terms of contraceptive use, number of children and desire for more children. Logistic regression analysis was used to determine the relationship between income generating activities and contraceptive use. Almost half (45.5%) of the participants were involved in income generating activities. A great majority (63.9%) worked year-round, two-thirds (75.0%) earned cash for their family and 21.3% were engaged in poultry farms. Women aged 26-35 years, members of any non-governmental organization and from a poor family were more likely to be engaged in income generating activities (≤0.001). Highly educated women worked more than their less educated counterparts and the opposite was true for their husbands (≤0.001). Almost half of the women (45.0%) did not use any contraceptive. Contraceptive use was significantly higher among working women (73.4%) than with non-working women (33.0%). Women engaged in income generating activities were more likely to use contraceptives compared to non-working women (odds ratio 5.6, 95% confidence interval 3.1-7.0, ≤0.001). Income generating activities seem to empower women, increase their likelihood of using contraception and are one of the key issues for changing the life of rural women in Bangladesh.
Liu, Zhaoping; Li, Wenxian; Sun, Jing; Liu, Chenghong; Zeng, Qiang; Huang, Jian; Yu, Bo; Huo, Junsheng
This study evaluated the intake of soy foods and soy isoflavones by rural adult women and potential determinant factors. Soy food consumption and information on age, education and medical history were collected on 1,188 subjects in Gansu Province and Hebei Province, China using a food frequency questionnaire to gather data on food intake over the past year. Weight and height were simultaneously measured. The results showed that 1139 (95.9%) rural women consumed soy foods in the past year. The average intake of soy foods and isoflavones was 38.7 +/- 58.2 (median = 23.5) g/d and 17.7 +/- 26.6 (median= 8.9) mg/d, respectively. Tofu accounted for the most contribution to their intake. The soy isoflavone intake ranged between 0-35 mg/day in 89.2% of subjects. Gansu women had higher intakes of soy foods and isoflavones than Henbei women (P< 0.05). Women aged 41-50 years consumed less soy foods and isoflavones than the 20-30-year olds and 31-40 year olds(P < 0.05). The intake of soy foods (P< 0.01) and isoflavones (P< 0.01) by women who experienced secondary education or above was significantly higher than illiterate women. Women without a medical history had a higher soy isoflavone intake than women with a medical history, but the difference was not statistically significant. These results suggest that the intake of soy isoflavones by Chinese rural adult women was much higher than women in Western countries. The distribution of intake was skewed to the right and varied among women in regard to region, age group and education level.
Aghi, M B; Grupta, P; Mehta, F
This report of the Smoking Intervention Project pertains to women in Kerala and Andhra, India. The typical woman in Kerala is a fulltime housewife who also works in the fields, growing, tending, and harvesting a paddy. The rural woman is somewhat literate, and she is alert, independent, and individualistic. She chews tobacco with betel leaf and areca nut, has her own private supply of chewing material, and uses it whenever she wants. Her counterpart in Andhra is less literate, probably has more children, seems poorer, and may chew tobacco but smokes a locally made cigar/cheroot called a chutta. She lights it and when well lit puts the glowing end inside her mouth. The Kerala woman typically suffers from precancerous lesions in right or left buccal mucosa, buccal groove, on or under the tongue. The Andhra woman also has lesions on the palate. Both are totally unaware of the ill effects of tobacco. Oral cancer may be called the national cancer of India. More suffer from it than from any other cancer. The Smoking Intervention Project is divided into 3 phases: phase 1 -- a cross sectional field survey, determined the prevalence rates of oral precancerous lesions and their association with tobacco habits in a population of 50,915; phase 2 -- a 10 year follow-up study of 3/5 of the original study population, which indicated that oral cancer and precancerous lesions occurred almost solely among those who smoked or chewed tobacco and oral cancer was almost always preceded by some type of precancerous lesions; and phase 3 -- the intervention part of the project is to make people give up tobacco and to investigate any effect this might have on incidence and regression rate of precancerous lesions. The intervention program outlined a timetable for employing different communication media and regulating the information flow so as not to overwhelm the target population and to make the message more easily understandable, if necessary. Intervention strategies have been continually
Rodriguez-Velasco, Francisco J.; Vera, Vicente; Lavado-Garcia, Jesus M.; Fernandez, Pilar
Osteoporosis is a polygenic disorder that is determined by the effects of several genes, each with relatively modest effects on bone mass. The aim of this study was to determine whether the vitamin D receptor single nucleotide polymorphism BsmI is associated with bone mineral density (BMD) in Spanish postmenopausal women. A total of 210 unrelated healthy postmenopausal women aged 60 ± 8 years were genotyped using TaqMan® SNP Genotyping Assays. Lumbar and femoral BMD were determined by dual-energy X-ray absorptiometry (DEXA). Daily calcium and vitamin D intake were determined by a food questionnaire. No differences were found in the femoral neck, trochanter, Ward’s Triangle, L2, L3, L4, L2-L4, or between the femoral neck and total hip BMD after further adjustment for potential confounding factors (P > 0.05) (age, BMI, years since menopause and daily calcium intake). The BsmI polymorphism in the VDR gene was not associated with BMD in Spanish postmenopausal women. PMID:26157644
Helps, Catherine; Barclay, Lesley
Aboriginal women in rural areas have lower rates of breastfeeding than Australian averages. The reasons for this are poorly understood. Aboriginal people experience higher morbidity and increased rates of chronic disease throughout the life cycle. The protective effects of sustained breastfeeding could benefit rural Aboriginal communities. To explore the factors impacting upon infant feeding choices in a rural Aboriginal Community. Semi-structured interviews were conducted with eight Aboriginal rural dwelling first time mothers. These women received a continuity of midwife and Aboriginal Health Worker model of care. Interviews were also undertaken with five Aboriginal Health Workers and two Aboriginal community breastfeeding champions. The analysis was integrated with a conventional literature review and was further developed and illustrated with historical literature. Indigenist methodology guided the study design, analysis and the dissemination of results. Three key themes were identified. These were "I'm doing the best thing for..." which encompasses the motivations underpinning infant feeding decisions; "this is what I know..." which explores individual and community knowledge regarding infant feeding; and "a safe place to feed" identifying the barriers that negative societal messages pose for women as they make infant feeding decisions. It appears loss of family and community breastfeeding knowledge resulting from colonisation still influences the Aboriginal women of today. Aboriginal women value and trust knowledge which is passed to them from extended family members and women within their Community. Cultural, historical and socioeconomic factors all strongly influence the infant feeding decisions of individuals in this study. Efforts to normalise breastfeeding in the culture of rural dwelling Aboriginal women and their supporting community appear to be necessary and may promote breastfeeding more effectively than optimal professional care of individuals can
Mehta, Naaman V; Trivedi, Mayur; Maldonado, Luis E; Saxena, Deepak; Humphries, Debbie L
Type II diabetes has risen dramatically among rural women in India, specifically in the states of Gujarat, Karnataka, Tamil Nadu and Uttar Pradesh. Recent studies suggest that rural Indian women's low level of self-efficacy, or confidence in their ability to carry out tasks, such as managing diabetes, is a key reason for this increase. Therefore, this study utilizes the Health Belief Model to analyze whether increased awareness of diabetes leads to a positive increase in levels of self-efficacy among diabetic women in two rural villages of Gujarat. A cross-sectional study of 126 known cases of women with diabetes was carried out in the villages of Rajpur and Valam in the Mehsana District in the state of Gujarat, India, to assess the relationship between diabetes knowledge and self-efficacy. The instrument was adapted from the Michigan Diabetes Research and Training Center's Diabetes Empowerment Scale-Short Form and Knowledge, Attitudes and Practices Assessment of the Indian Institute of Public Health Gandhinagar. Participants' mean knowledge score was 10.77±2.86 out of a possible 24 points, for a mean percentage of 45%. The median self-efficacy score for the women was 7 with an interquartile range of 3. The age-adjusted multiple regression analysis demonstrated a significant positive correlation between knowledge and self-efficacy (p<0.001). The observations of this study suggest a positive correlation between diabetes knowledge and self-efficacy. Future diabetes educational interventions in India should place a greater emphasis on increasing knowledge among rural women. Specifically, these interventions should emphasize the major gaps in knowledge regarding causes of diabetes, complications and treatment procedures. Educational interventions that are catered more towards rural women will be critical for improving their self-efficacy.
Huang, Kun; Tao, Fangbiao; Liu, Liu; Wu, Xiaoyan
To explore the impact of delivery mode on women's postpartum quality of life in rural China and probe factors influencing postnatal quality of life. Childbirth significantly affects puerpera's physical, psychological and social domains of quality of life. Under the circumstance of increasing high caesarean section rate in rural China, the impact of delivery mode on postnatal quality of life remains unclear. Cross-sectional study design. Women residing in rural areas and in their 0-12 months after childbirth from 30 rural townships participated in a household survey. A structured questionnaire was used to evaluate women's socio-demographic characteristics, previous pregnant experiences, foetal characteristics and use of maternal health services. The scale for rural postnatal quality of life was adopted to assess postnatal quality of life from six dimensions: physical complaints and pain, sleep and energy, sex satisfaction, interpersonal communication, self-evaluated living stress and perceived life satisfaction. The overall caeserean section rate was 70·0% (962/1375), and most of them (59·7%) were selected by maternal request. None of six dimensions and total score of quality of life displayed significant difference between women with normal delivery and cesaerean section. It was found that postnatal home visit related to good postnatal quality of life and lower husband education level, male gender of infant were associated with poor quality of life. Delivery mode did not affect postpartum quality of life in rural China. Socio-cultural determinants may contribute more in influencing postnatal quality of life. Null findings in impact of delivery mode on postpartum quality of life may cause more difficulties in maternal decision-making for vaginal delivery in rural China. The importance of postnatal home visit could justify available and quality postnatal care in improving postpartum quality of life. Further research needs to explore the effective prevention
Olsen, Jeanette M; Thorson, Diane; Baisch, Mary Jo; Monsen, Karen A
Examine factors related to physical activity among rural women using Omaha System data. Mixed methods: quantitative analysis of de-identified clinical data and thematic analysis of public health nurse (PHN) focus group data. Rural women who received PHN services (N = 852) and purposively selected PHNs (N = 12). Omaha System problems; signs/symptoms; knowledge, behavior, and status ratings; demographics. Physical activity behavior among rural women was inconsistently appropriate (M = 3.27). Age, body mass index, physiological, psychosocial, and environmental domain problems, and physical activity knowledge explained 33.2% of physical activity behavior variance. Almost all women for whom specific problems were documented had insufficient physical activity. This included physiological problems of cognition and pregnancy; psychosocial problems of abuse, caretaking/parenting, mental health, and interpersonal relationship; and environmental problems of neighborhood/workplace safety and income. Having problems in two or more domains was significantly associated with insufficient physical activity behavior (p < .001). PHNs validated findings and expressed concerns that client complexity, priorities, and time constraints may affect client assessment and documentation. PHNs should assess rural women who are not physically active for potentially serious physiological, psychosocial, and environmental problems. Departmental policies requiring assessment of Omaha System data across programs enabled population health measurement and research. © 2016 Wiley Periodicals, Inc.
Kiggundu, Edith; Castle, Jane
There is an urgent need for fresh approaches to HIV & AIDS education for adults and youth in South Africa, particularly for those marginalised by society, such as rural black women. In this article we explore the factors which affect awareness, condom use and HIV & AIDS risk among a group of women who attend classes in a rural Adult…
West, Delia Smith; Greene, Paul; Pulley, LeaVonne; Kratt, Polly; Gore, Stacy; Weiss, Heidi; Siegfried, Nicole
Few studies have investigated community clinic-based interventions to promote mammography screening among rural African American women. This study randomized older low-income rural African American women who had not participated in screening in the previous 2 years to a theory-based, personalized letter or usual care; no group differences in…
Coughlin, Steven S.; Thompson, Trevor D.
Previous studies have suggested that men and women in rural areas are less likely than those in urban areas to receive routine cancer screening. Methods: We examined the colorectal cancer screening practices of men (n = 23,565) and women (n = 37,847) aged >50 years living in rural areas and other areas of the United States using data from the…
Empowering women to control and change their lives continues to be an important goal for many nations. This article examines the empowering effects of being selected and trained to lead rural schools in Bangladesh, using survey and interview data from 152 village women working with the Bangladesh Rural Advancement Committee education programme.…
Carnahan, Leslie R.; Peacock, Nadine R.
Introduction Women living in rural areas in the United States experience disproportionately high rates of diseases such as obesity and heart disease and are less likely than women living in urban areas to meet daily physical activity (PA) recommendations. The purpose of our research was to understand age-specific perceptions of barriers and facilitators to rural women engaging in PA and to identify strategies to promote PA among these women. Methods As part of a community health assessment to learn about women’s health issues, 110 adult women participated in 14 focus groups. The women were divided into 4 age groups, and focus groups were held in various community settings. We used qualitative analysis methods to explore themes in the women’s narratives, including themes related to PA knowledge, PA behavior, and access to PA facilities. Results Participants described multiple and often conflicting individual, social, and environmental barriers and facilitators to PA. Several barriers and facilitators were shared across age groups (eg, competing priorities and inadequate knowledge about PA’s role in disease prevention and disease management). Other barriers (eg, illness and injury) and facilitators (eg, PA as a social opportunity) differed by age group. Conclusion Rural women in southernmost Illinois have often contradictory barriers and facilitators to PA, and those barriers and facilitators are different at different points in a woman’s life. Our findings suggest the need for multilevel, multisector approaches to promote PA. Additionally, this research supports the need for tailored PA promotion programs for rural women to address the barriers these women face across their lifespan. PMID:27685431
Kozica, Samantha L; Harrison, Cheryce L; Teede, Helena J; Ng, Sze; Moran, Lisa J; Lombard, Catherine B
The obesity epidemic is well established, particularly in rural settings. Programs promoting healthy lifestyles for rural women are urgently needed; however, participant engagement is challenging. In the context of a large randomized controlled trial targeting the prevention of weight gain in rural women, we explored successful recruitment strategies and aimed to understand participants' barriers, enablers and reasons for program participation. We recruited women (aged 18-55 years) from the general rural Australian population. A mixed-methods approach was applied to explore factors that influenced program participation, including quantitative questionnaires for all participants (n = 649) and qualitative semi-structured interviews conducted for a subgroup of participants (n = 45). Data were collected at three time points: baseline, 6 and 12 months post program commencement. We recruited 649 rural women through a community communication and partnering strategy, a program marketing campaign and mobilization of social networks. Program participants were diverse across education and income levels and were representative of the wider Australian regional population. Factors that influenced program engagement were divided into personal (perceived program benefits and program accessibility) and social (peer persuasion and support). Identified enablers included convenience of the program location, perceived program utility, such as weight management and optimization of lifestyle choices, as well as attending the program with peer support. Barriers to engagement, which are likely exacerbated in rural communities included lack of anonymity, self-consciousness and segregated social networks in rural settings. Participants reported that eliciting local support and maximizing publicity is fundamental to improving future program engagement. Multiple program promotion strategies including communication, marketing and partnering, as well as mobilization of social networks and peer
Alas, Alexandriah N; Dunivan, Gena C; Wieslander, Cecelia K; Sevilla, Claudia; Barrera, Biatris; Rashid, Rezoana; Maliski, Sally; Eilber, Karen; Rogers, Rebecca G; Anger, Jennifer Tash
The objective of this study was to compare perceptions and barriers between Spanish-speaking and English-speaking women in public and private hospitals being treated for pelvic organ prolapse (POP). Eight focus groups, 4 in English and 4 in Spanish, were conducted at 3 institutions with care in female pelvic medicine and reconstructive surgery. Standardized questions were asked regarding patients' emotions to when they initially noticed the POP, if they sought family support, and their response to the diagnosis and treatment. Transcripts were analyzed using grounded theory qualitative methods. Thirty-three women were Spanish-speaking and 25 were English-speaking. Spanish speakers were younger (P = 0.0469) and less likely to have a high school diploma (P < 0.0001) than English speakers. Spanish-speaking women had more concerns that the bulge or treatments could lead to cancer, were more resistant to treatment options, and were less likely to be offered surgery. Women in the private hospital desired more information, were less embarrassed, and were more likely to be offered surgery as first-line treatment. The concept emerged that patient care for POP varied based on socioeconomic status and language and suggested the presence of disparities in care for underserved women with POP. The discrepancies in care for Spanish-speaking women and women being treated at public hospitals suggest that there are disparities in care for POP treatment for underserved women. These differences may be secondary to profit-driven pressures from private hospitals or language barriers, low socioeconomic status, low health literacy, and barriers to health care.
Alas, Alexandriah N.; Dunivan, Gena C.; Wieslander, Cecelia K.; Sevilla, Claudia; Barrera, Biatris; Rashid, Rezoana; Maliski, Sally; Eilber, Karen; Rogers, Rebecca G.; Anger, Jennifer Tash
Objectives The objective of this study was to compare perceptions and barriers between Spanish-speaking and English-speaking women in public and private hospitals being treated for pelvic organ prolapse (POP). Methods Eight focus groups, 4 in English and 4 in Spanish, were conducted at 3 institutions with care in female pelvic medicine and reconstructive surgery. Standardized questions were asked regarding patients' emotions to when they initially noticed the POP, if they sought family support, and their response to the diagnosis and treatment. Transcripts were analyzed using grounded theory qualitative methods. Results Thirty-three women were Spanish-speaking and 25 were English-speaking. Spanish speakers were younger (P = 0.0469) and less likely to have a high school diploma (P < 0.0001) than English speakers. Spanish-speaking women had more concerns that the bulge or treatments could lead to cancer, were more resistant to treatment options, and were less likely to be offered surgery. Women in the private hospital desired more information, were less embarrassed, and were more likely to be offered surgery as first-line treatment. The concept emerged that patient care for POP varied based on socioeconomic status and language and suggested the presence of disparities in care for underserved women with POP. Conclusions The discrepancies in care for Spanish-speaking women and women being treated at public hospitals suggest that there are disparities in care for POP treatment for underserved women. These differences may be secondary to profit-driven pressures from private hospitals or language barriers, low socioeconomic status, low health literacy, and barriers to health care. PMID:27636216
Mutombo, Namuunda; Bakibinga, Pauline; Mukiira, Carol; Kamande, Eva
The last two decades have seen an increase in literature reporting an increase in knowledge and use of contraceptives among individuals and couples in Kenya, as in the rest of Africa, but there is a dearth of information regarding knowledge about benefits of family planning (FP) in Kenya. To assess the factors associated with knowledge about the benefits of FP for women and children, among women in rural Western Kenya. Data are drawn from the Packard Western Kenya Project Baseline Survey, which collected data from rural women (aged 15-49 years). Ordinal regression was used on 923 women to determine levels of knowledge and associated factors regarding benefits of FP. Women in rural Western Kenya have low levels of knowledge about benefits of FP and are more knowledgeable about benefits for the mother rather than for the child. Only age, spousal communication and type of contraceptive method used are significant. Women's level of knowledge about benefits of FP is quite low and may be one of the reasons why fertility is still high in Western Kenya. Therefore, FP programmes need to focus on increasing women's knowledge about the benefits of FP in this region.
Shannon, Lisa; Nash, Shondrah; Jackson, Afton
Among pregnant women, intimate partner violence (IPV) is recognized as a critical risk factor in adverse health outcomes for the mother and newborn alike. This pilot study examined IPV and health for rural Appalachian pregnant women, a particularly vulnerable high-risk and high-needs group. Participants were 77 rural, Appalachian pregnant women entering a hospital-based inpatient detoxification unit primarily for Opiate Dependence. Study participants gave informed consent to a face-to-face interview and secondary data abstraction from hospital medical records. IPV was measured via questions from the National Violence Against Women Survey, the Revised Conflict Tactics Scale (CTS2), and the Psychological Maltreatment of Women Inventory (PMWI). The majority of the sample reported lifetime psychological (89.6%) and physical (64.9%) violence. A little over three fourths (75.3%) experienced IPV in the past year. Furthermore, over one third (39.0%) experienced stalking, physical, or sexual violence in the past year. Most participants (71.4%) experienced psychological abuse in the past year. IPV experiences, in conjunction with pervasive substance use, mental and physical health problems, and poverty present in rural Appalachia, culminate in a particularly high-risk and high-needs group of pregnant women. These women present unique opportunities and challenges for prevention, intervention, and treatment. © The Author(s) 2015.
Reed, Elizabeth; Donta, Balaiah; Dasgupta, Anindita; Ghule, Mohan; Battala, Madhusudana; Nair, Saritha; Silverman, Jay; Jadhav, Arun; Palaye, Prajakta; Saggurti, Niranjan; Raj, Anita
Objectives The social positioning (i.e. social status and autonomy) of women in the household facilitates women's access to and decision-making power related to family planning (FP). Women's access to spending money, which may be an indicator of greater social positioning in the household, may also be greater among women who engage in income generating activities for their families, regardless of women's status in the household. However, in both scenarios, access to money may independently afford greater opportunity to obtain family planning services among women. This study seeks to assess whether access to money is associated with FP outcomes independently of women's social positioning in their households. Methods Using survey data from married couples in rural Maharashtra, India (n = 855), crude and adjusted regression was used to assess women's access to their own spending money in relation to past 3 month use of condoms and other forms of contraceptives (pills, injectables, intrauterine device). Results Access to money (59 %) was associated with condom and other contraceptive use (AORs ranged 1.5-1.8). These findings remained significant after adjusting for women's FP decision-making power in the household and mobility to seek FP services. Conclusion While preliminary, findings suggest that access to money may increase women's ability to obtain FP methods, even in contexts where social norms to support women's power in FP decision-making may not be readily adopted.
Giner, Elisenda; Ruiz, Laura; Serrano, Mª Ángeles; Valls, Rosa
Background/Context: Women's sexuality, and the ways they experience it, has been a major topic in feminist theories and movements throughout history. For the more than 20,000 working-class women who participated in the Free Women movement in Spain (the libertarian women's movement, which started in 1936), women's sexuality was also a key topic in…
Hysterectomy appears to be on the rise amongst low-income, rural women in India as routine treatment for gynaecological ailments. This paper explores the individual, household, socio-economic and health system factors that influenced women's decisions to undergo hysterectomy in rural Gujarat, with a focus on women's perspectives. Interviews were conducted with 35 rural, low-income women who had undergone hysterectomy, local gynaecologists and other key informants, alongside observation of daily life and health-related activities. Inductive, open coding was conducted within a framework analysis to identify thematic influences on the decision to undergo hysterectomy. Women underwent hysterectomy at an average age of 36, as treatment for typically severe gynaecological ailments. I argue that women, faced with embedded social inequality in the form of gender biases, lack of labour security and a maternal-centric health system, demonstrated pragmatic agency in their decision to remove the uterus. When they experienced gynaecological ailments, most sought two to three opinions and negotiated financial and logistical concerns. The health system offered few non-invasive services for non-maternal health issues. Moreover, women and health care providers believed there is limited utility of the uterus beyond childbearing. Women's responsibilities as caretakers, workers and producers drove them to seek permanent solutions that would secure their long-term work and health security. Thus, hysterectomy emerged as a normalised treatment for gynaecological ailments, particularly for low-income women with limited resources or awareness of potential side effects. In this setting, hysterectomy reflects the power structures and social inequalities in which women negotiated medical treatment--and the need to reverse a culture of permanent solutions for low-income women. Copyright © 2016 Elsevier Ltd. All rights reserved.
Earp, Jo Anne; Eng, Eugenia; O'Malley, Michael S.; Altpeter, Mary; Rauscher, Garth; Mayne, Linda; Mathews, Holly F.; Lynch, Kathy S.; Qaqish, Bahjat
Objectives. A community trial was undertaken to evaluate the effectiveness of the North Carolina Breast Cancer Screening Program, a lay health advisor network intervention intended to increase screening among rural African American women 50 years and older. Methods. A stratified random sample of 801 African American women completed baseline (1993–1994) and follow-up (1996–1997) surveys. The primary outcome was self-reported mammography use in the previous 2 years. Results. The intervention was associated with an overall 6 percentage point increase (95% confidence interval [CI] = –1, 14) in communitywide mammography use. Low-income women in intervention counties showed an 11 percentage point increase (95% CI = 2, 21) in use above that exhibited by lowincome women in comparison counties. Adjustment for potentially confounding characteristics did not change the results. Conclusions. A lay health advisor intervention appears to be an effective public health approach to increasing use of screening mammography among low-income, rural populations. PMID:11919066
Molina, Yamile; Zimmermann, Kristine; Carnahan, Leslie R; Paulsey, Ellen; Bigman, Cabral A; Khare, Manorama M; Zahnd, Whitney; Jenkins, Wiley D
Rural cancer disparities are increasingly documented in the USA. Research has identified and begun to address rural residents' cancer knowledge and behaviors, especially among women. Little, however, is known about rural female residents' awareness of cancer inequities and perceived contributing factors affecting them and their families. The purpose of this study was to address these gaps in the literature via a secondary analysis of qualitative needs assessment in Illinois' rural southernmost seven counties, a geographic region with relatively high rates of cancer incidence, morbidity, and mortality. A convenience sample of 202 rural adult female residents was recruited and participated in 26 focus groups, with 3-13 women per group. Inductive content analysis, guided by the principle of constant comparison, was used to analyze the qualitative data. Most respondents indicated their awareness of disproportionate cancer burden in their communities. Individual-level behaviors and environmental toxins were identified as contributing factors. Interestingly, however, environmental toxins were more often discussed as factors contributing to geographic differences, whereas individual-level behaviors were noted as important for overall cancer prevention and control. This study provides important insight into female rural residents' perspectives and offers novel venues for educational programs and research in the context of communication to eliminate disparities.
Ghosh, Bhola Nath; De, Utpal Kumar
Women living in rural areas are closely associated with the natural environment. Poor families are mostly dependent on natural resources for their survival activities viz. grazing of cattle, collection of water for drinking and cooking purposes and collection of fuel wood. In the poor families due to the compulsion of earning, adult males mostly go for outside activities and sometimes female members of the family also join them. The aforementioned natural resource collection activities are considered to be inferior, less remunerative and hence suitable for the women or young kids to perform. Thus, they are found to be more close to the nature than men and this very close relationship makes them perfect managers of the eco-system in their vicinity. The life of rural women is so much intertwined with the environment that they can't even think of her survival without it. However, there might be significant inter-household differences in the distribution of such activities between male and female members of the families, depending upon their socio-economic characteristics, cultural and religious beliefs and attitude towards women and children. The involvement of women in such activities is also found to be more in the tribal dominated societies. This paper tried to examine the extent to which women in rural Jharkhand are involved in such natural resource collection and management activities. Also, we tried to unearth various economic and cultural reasons and their impact on the involvement of women in such activities across various social and economic groups. The analysis of primary data collected from the rural areas of tribal dominated Jharkhand reveals that income, occupation and status of the families have significant inverse link with the involvement of women and also of girl children at the cost of their educational prospects. Religious and cultural beliefs also enter in the determination of extent of involvement of women and children in the rural society. It is
Panach, Layla; Mifsut, Damián; Tarín, Juan J; Cano, Antonio; García-Pérez, Miguel Ángel
Gene candidate and genome-wide association studies have revealed tens of loci of susceptibility for osteoporosis. Some limitations such as sample size, use of confounding variables, and control for multiple testing and for population stratification, however, represent common problems in these studies that make replication in independent cohorts desirable and even necessary. The main objective of the present study is to replicate previous data on three functional polymorphisms in a cohort of Spanish women. To that end, we performed an association study of three functional polymorphisms previously associated with bone phenotypes in the LRP5, TNFRSF11B, and FGFBP1 genes with low bone mineral density (BMD) in a cohort of 721 Spanish women, most of them postmenopausal. We detected a strong significant association, even when correcting for multiple comparisons, for polymorphism rs312009 in the LRP5 gene with low BMD at the lumbar-spine site. These were women with the CC genotype, which showed the worst bone parameters. Moreover, these women had a higher risk of osteoporosis (adjusted odds ratio 2.82, P = 0.001) than women with the TT/TC genotype. This association seems to be caused because the rs312009 single nucleotide polymorphism (SNP) is located at a binding site for the transcription factor RUNX2 at the 5' region of the LRP5 gene, and the T allele seems to be a better transcriber than the C allele. Regarding the other two SNPs, only the rs4876869 SNP in the TNFRSF11B gene showed a suggestive trend for both skeletal sites. These results underscore the significance of the LRP5 gene in bone metabolism and emphasize the significance of the replication of previous results in independent cohorts.
Befort, Christie A.; Donnelly, Joseph E.; Sullivan, Debra K.; Ellerbeck, Edward F.; Perri, Michael G.
Rural women have among the highest rates of obesity and sedentary lifestyle, yet few studies have examined strategies for delivering state-of-the-art obesity treatment to hard-to-reach rural areas. The purpose of this pilot trial was to examine the impact and cost-effectiveness of a 6-month behavioral weight loss program delivered to rural women by phone either one-on-one with a counselor or to a group via conference call. Thirty-four rural women (mean BMI=34.4, SD=4.6) were randomized to group phone-based treatment or individual phone-based treatment. Completers analysis showed that weight loss was greater in the group condition (mean=14.9 kg=, SD=4.4) compared to the individual condition (mean=9.5 kg, SD=5.2; p=.03). Among the total sample, 62% of participants in the group condition achieved the 10% weight loss goal compared to 50% in the individual condition, and group treatment was found to be more cost-effective. Future research is warranted to examine the benefits of group phone-based treatment for long-term management of obesity among rural populations. PMID:19962115
Zhang, Xiu-jun; Shen, Qiong; Yu, Yu-ling; Sun, Ye-huan; Yu, Guo-bin; Zhao, Dong; Ye, Dong-qing
To understand health seeking behavior and its influential factors to reproductive tract infections (RTIs) on women at reproductive age in the rural areas. 54540 fertile women aged 15 - 49 were surveyed by a stratified-cluster-random sampling method and gynecological examination were conducted in two steps: converging at the clinics, and then visiting their households, later, 31 624 women who had at least one RTI symptom were chosen. Among all the women at reproductive age, the rate of having at least one RTI symptom was 59.8% with the means of RTI symptom as 1.66 +/- 0.89. 15989 women went to see doctors out of the 31 624 women who had RTI symptoms, with a proportion of 50.6%. The results of logistic regress showed that those women whose husbands having higher education level, higher income, more RTI symptoms and better knowledge on RTI were more easily to go to the hospitals. However, those women whose husbands working out of the county, having older first bearing age and more numbers of pregnancy were less likely to go to the hospitals. Reasons that refrained them from going to see a doctor would include: 2137 (13.7%) did not know that RTI was a disease; 7443 (47.6%) of them thought that every woman were bound to have at least one symptom and it did not matter; 1629 (10.4%) of them felt shameful; 349 (2.2%) learned that the diseases were incurable; 975 (6.2%) felt the cost of treatment was too expensive; 2101 (13.4%) had no time; 1001 (6.4%) would treat themselves through buying medicines over the counter. RTI symptoms were quite prevalent among women at reproductive age but the rate of seeing a doctor was low and caused by multi-factors. Health education and gynecological census in increasing the curable rate of RTIs should to be strengthened.
O'Leary, Jeanne M.
Labor force participation of nonmetropolitan women rose in the 1970's but not in a consistent pattern. Their labor force participation rose 4.5% between 1973 and 1978, when they comprised 41% of the total nonmetropolitan labor force. Although women accounted for 89% of nonmetropolitan employment growth in the 1960's and 58% in the 1970's, their…
United Nations Educational, Scientific and Cultural Organization, Bangkok (Thailand). Principal Regional Office for Asia and the Pacific.
The inferior position assigned to Asian women jeopardizes not only their future status in society, but also the future of society itself. The major problems standing in the way of empowerment for women are individual and family related, community, sociopolitical, cultural, and economic. Centralized planning of literacy/civic education programs in…
Zhang, X-J; Wang, G-Y; Shen, Q; Yu, Y-L; Sun, Y-H; Yu, G-B; Zhao, D; Ye, D-Q
This study aims to explore the current status of married women in regard of their use of contraceptive methods (permanent methods versus non-permanent methods) and to find out factors that affect the use of contraceptive methods in rural areas of Anhui Province of China. Survey. Anhui, China. A total of 53,652 married women aged 18-49 years. A multistage probability sampling method was used to identify a representative sample of 53,652 married women aged 18-49 years. All women were asked to provide detailed information by completing detailed questionnaires. Contraceptive prevalence and influence factors. The total birth control rate of the sample was 95.2%. Samples choosing the permanent and nonpermanent contraceptive methods have taken up 46.7 and 48.5% respectively. Female sterilisation was the first choice with a usage rate of 43.6%, followed by intrauterine device (IUD), which was used by 41.1% of samples. Single-variable analysis showed that the choice of contraceptive methods was associated with age, education level, parity, frequency of sex intercourses in a month, contraceptive knowledge, RTI symptom and the gender of the last child of rural married women. A significant increase in contraceptive use of rural married women in Anhui Province of China. Female sterilisation and IUD still play the dominant role. Effective family planning methods should be advocated through adequate counselling on the correct use and proper management, with consideration of the background of custom and belief.
Craft-Rosenberg, M; Powell, S R; Culp, K
The purpose of this research is to describe the health status and health resources for homeless women and children in a Midwestern rural community. A group of 31 rural homeless women in a shelter participated in the study by answering questions on the Rural Homeless Interview developed by the investigators. The findings revealed higher than expected rates of illness, accidents, and adverse life events, with the incidence of substance abuse and mental illness being comparable to data from other homeless populations. The data on children were limited by lack of knowledge on the part of their mothers. Some mothers reported that their children were in foster care, had been adopted, or were being cared for by others. The inability to access health and dental care was reported by half of the participants.
Dubbink, Jan Henk; van der Eem, Lisette; McIntyre, James A; Mbambazela, Nontembeko; Jobson, Geoffrey A; Ouburg, Sander; Morre, Servaas A; Struthers, Helen E; Peters, Remco P H
Sexual behaviour is a core determinant of the HIV and sexually transmitted infection (STI) epidemics in women living in rural South Africa. Knowledge of sexual behaviour in these areas is limited, but constitutes essential information for a combination prevention approach of behavioural change and biomedical interventions. This descriptive study was conducted in rural Mopani District, South Africa, as part of a larger study on STI. Women of reproductive age (18-49 years) who reported sexual activity were included regardless of the reason for visiting the facility. Questionnaires were administered to 570 women. We report sexual behaviour by age group, ethnic group and self-reported HIV status. Young women (<25 years) were more likely to visit bars, practice fellatio, have concurrent sexual partners and report a circumcised partner than older women (>34 years); there was no difference for condom use during last sex act (36 % overall). Sotho women were more likely to report concurrent sexual partners whereas Shangaan women reported more frequent intravaginal cleansing and vaginal scarring practice in our analysis. HIV-infected women were older, had a higher number of lifetime sexual partners, reported more frequent condom use during the last sex act and were more likely to have a known HIV-infected partner than women without HIV infection; hormonal contraceptive use, fellatio, and a circumcised partner were less often reported. This study provides insight into women's sexual behaviour in a rural South African region. There are important differences in sexual behaviour by age group and ethnicity and HIV status; these should be taken into account when designing tailor-made prevention packages.
Bhandari, Rajika; Smith, Frank J.
Focuses on common issues of program access, quality, relevance, and sustainability in providing education to rural women, particularly in India. Addresses familial, sociocultural, individual, and institutional factors that constrain female educational attainment. A study in Madhya Pradesh, India, provides insight on form, content, and operation of…
United Nations New York, NY. Dept. of Economic and Social Information and Policy Analysis.
The link between women's education and fertility traces the pattern of modernization and demographic transition of a rural setting in the Indian state of Maharashtra. The study presents the conceptual framework underlying the analysis, background information on female status and on the demographic situation, and an outline of conditions existing…
Agho, Augustine O; Mosley, Barbara W; Rivers, Patrick A; Parker, Shandowyn
Purpose: This study was a two-year educational intervention and research project aimed at increasing the awareness of breast cancer and the utilization of Clinical Breast Examination (CBE) services and Self-Breast Examination (SBE) among elderly rural and urban African American women who are Medicare beneficiaries. Design: The study was…
Brandt, Heather M.; Sharpe, Patricia A.; McCree, Donna H.; Wright, Marcie S.; Davis, Jennifer; Hutto, Brent E.
Background: Human papillomavirus (HPV) is a very common sexually transmitted infection linked to cervical disease. Vaccines for some types of HPV were in development at the time of the study. Purpose: The study examined HPV vaccine acceptability among underserved women in a rural region of the southeastern U.S. with high rates of cervical cancer…
Explores the reasons rural women have become elementary school teachers in the state of Oaxaca (Mexico), and examines how recent economic changes may be changing the female population that wants to become teachers to an even poorer segment of society. Ethnographic research was conducted with 35 Oaxacan teachers or teacher candidates. (SLD)
Simpson, Lyn; Daws, Leonie; Wood, Leanne
To overcome barriers to participation in small business training faced by rural Australian women, training needs and delivery issues were identified and a good practice matrix was developed with the following components: marketing, content, delivery, support, impact, and innovation. Underlying principles included unique needs, diversity, use of…
Kelly, Catherine G; Cudney, Shirley; Weinert, Clarann
To investigate the spontaneous use of creative arts as a complementary therapy by rural women in the Western United States who are coping with chronic illness. Women to Women Project was an 11-week research-based computer intervention that provided health education and support to rural women with chronic illnesses in an effort to help them better adapt to living with chronic conditions. Through the use of text queries, messages posted to an unprompted, online support and health education forum were examined for references to the spontaneous use of creative arts and their influence as a complementary therapy for dealing with chronic illness. In three identified themes-coping with pain, relaxation/quality of life, and giving back to others-participants strongly suggested that creative activity was an important strategy for coping with chronic illness and that it contributed to reduced pain and increased overall well-being, regardless of whether it was the expression of a previously learned skill or a practice established after the onset of chronic illness. The use of creative arts and developing art-making interventions could significantly benefit rural individuals coping with chronic illness. Discovering methods of implementing creative arts interventions in rural populations warrants further study.
Cornell, C. E.; Littleton, M. A.; Greene, P. G.; Pulley, L.; Brownstein, J. N.; Sanderson, B. K.; Stalker, V. G.; Matson-Koffman, D.; Struempler, B.; Raczynski, J. M.
The Uniontown, Alabama Community Health Project trained and facilitated Community Health Advisors (CHAs) in conducting a theory-based intervention designed to reduce the risk for cardiovascular disease (CVD) among rural African-American women. The multiphased project included formative evaluation and community organization, CHA recruitment and…
Zhao, Xu; Haste, Helen
A Beijing-based non-governmental organization (NGO) strives to empower rural Chinese women and migrant girls by increasing their awareness of constitutional rights and promoting their capacities to exercise their civil and political rights. This article reports the NGO leaders' perceptions of the goals, strategies, and challenges in their…
Usman, Lantana M.
Recently, politics of education in Nigeria have shifted from urban to rural literacy, which led to the development of programmes such as the nomadic women's adult education programme. The primary objective of this study was to evaluate the efficacy of the programme's implementation strategies, and the extent to which the health educational…
Russell, Scott C.; McDonald, Mark B.
Examines and enumerates economic changes that have occurred in the traditional rural Navajo community of Shonto. While women's net income contributions to Shonto's economy has declined, their position has seen only a slight erosion; their activities (sheep and goat husbandry, agriculture, arts and crafts) are still considered necessary and…
As a third age PhD candidate with a passion for learning, I wanted to explore the learning of other rural third age women who live on the Lower Eyre Peninsula (LEP) of South Australia. This reflects the methodological stance of heuristic inquiry, which requires the researcher to have a passionate interest in the phenomena under investigation, and…
Han, Keonghee Tao; Leonard, Jacqueline
Using critical race theory as an analytical framework to examine White privilege and institutional racism, two teacher educators, in a rural predominantly White university tell counterstories about teaching for social justice in literacy and mathematics education courses. In sharing our counterstories in this paper, we, women faculty of color,…
Jones, Shelley K.
This paper presents findings from the third stage of a longitudinal, qualitative study involving nine female participants from a class cohort in a secondary school in rural Uganda. Since 2004-05, this study has tracked the progress of these young women's lives, and the present aspect of the study explores the ways in which they have found that…
Nielsen, Anna; Lan, Pham Thi; Marrone, Gaetano; Phuc, Ho Dang; Chuc, Nguyen Thi Kim; Stålsby Lundborg, Cecilia
We interviewed 1,805 women in a rural setting in Vietnam with the aim of investigating women's knowledge regarding reproductive tract infections (RTIs) and their health-seeking behavior. We found that women's overall knowledge was poor. Furthermore, only one-third of the symptomatic women sought health care. RTIs affect millions of women globally each year. Most vulnerable are women in low- and middle-income countries where poverty and gender inequities affect their access to health care services. Findings from our study can be used in similar rural settings worldwide to understand and manage the widespread problem of RTIs.
Mbule, Marjorie A; Byaruhanga, Yusuf B; Kabahenda, Magaret; Lubowa, Abdulrahman
In spite of intervention efforts, in Uganda, as in other developing countries, high levels of anaemia among pregnant women continue. Anaemia among women of reproductive age (15-49 years) is a matter of national concern. This study was carried out to assess determinants of anaemia in Kiboga district. This was a single cross-sectional, descriptive survey. The anaemia status of the pregnant women was determined by measuring their haemoglobin levels. Possible determinant factors including socio-economic characteristics, knowledge, attitudes, practices and food intake were assessed using a structured questionnaire. Results showed that the prevalence of anaemia among pregnant women in Kiboga district was high enough (63.1%) to be described as a severe public health problem. The uptake and utilisation of the public-health intervention package to combat anaemia in pregnancy was low, with iron/folic acid supplementation at 13.2%, use of intermittent preventive treatment of malaria 45.4%, and use of de-worming medicines 14.5%. Women from households without a functional radio were 2.07 times more likely be anaemic (95%CI, 1.08-3.00) compared with women from households where there was a functional radio. There was little awareness and functional knowledge about anaemia among pregnant women. The high prevalence of anaemia observed in Kiboga district can be attributed to poverty and limited access to nutrition and health education information which lead to low uptake and utilization of the public-health intervention package to combat anaemia in pregnancy.
Kreft Pearce, Jennifer; McCaslin, Sara; Morgan, Leann
This study investigates the attitudes women and girls from the East Texas region have towards engineering and physics. We use an online survey and interviews to determine what influences women to choose their career paths. Surprisingly, we find that women have more positive attitudes about physics and engineering than their male counterparts. For the group of students interviewed, self assessment of ability, lack of role models, and confusion about work/life balance issues were some of the determining factors in their choice not to pursue a career in a STEM field.
Jackson, M N G; McCulloch, B J
Women are just as vulnerable to 'heart attacks' (used throughout this study to mean 'myocardial infarction') as men and are often unaware of many associated symptoms. Researchers have illustrated that women have difficulty identifying the symptoms of cardiovascular disease, with patients often delaying treatment after the onset of symptoms. Some individuals wait hours or even days before seeking medical care. This is particularly concerning for older rural women because the rates of death from cardiovascular disease and cancer are higher in some rural areas. Despite idealistic views of country life as being active, less stressful, and possessing strong social and community support, rural Americans are more likely than their urban counterparts to face challenges to maintaining health.
The purpose of this paper is to utilize information gathered from a qualitative study exploring older rural women's identification of symptoms and health decision-making specific to heart attack vignettes. Snowball sampling was the main approach utilized to access participants; after an initial contact was successful, participants contacted additional older rural women to see if they might be willing to participate in an interview. This resulted in a final sample of 33 women who resided in rural Midwestern areas of the USA, were 65 years or older, lived in a county defined as rural by the US Census, and were willing to participate in a face-to-face interview. Each interview included a demographic questionnaire, a health questionnaire, and three health vignettes with follow-up questions. Vignettes provided a way of initiating discussions about health decisions without invading the privacy known to be important to rural residents. The term 'heart attack' was used in the interviews because it was thought to be better recognised than the medical term 'myocardial infarction'. All data were audio taped, transcribed, and coded using line-by-line coding. Data were analyzed using content
Background: A review of the literature produced no rigorously tested and validated Spanish-language physical activity survey or evaluation tools for use by USDA’s food assistance and education programs. The purpose of the current study was to develop and evaluate the face validity of a visually enha...
Sipsma, Eric; Isabel, Jose-Antonio Carrobles; Cerrato, Ignacio Montorio; Everaerd, Walter
Assessed Spanish college students' attitudes about forced sex and actual experiences with male-against-female sexual aggression. Students analyzed a date rape story discussed their coercive sexual activities and help-seeking behaviors. Acceptance of forced sex significantly related to sex, age, and experience with sexual aggression. Only 39…
Background According to the Pakistan Demographic and Health Survey from 2006–2007, the maternal mortality ratio in rural areas is 319 per 100,000 live births. Postpartum hemorrhage is the leading cause of maternal deaths in Pakistan. The objectives of the study were to document the feasibility of distribution of misoprostol tablets by community-based providers mainly traditional birth attendants and acceptability and use of misoprostol by women who gave birth at home. Methods A quasi-experimental design, comprising intervention and comparison areas, was used to document the acceptability of providing misoprostol tablets to pregnant women to prevent postpartum hemorrhage in the rural community setting in Pakistan. Data were collected using structured questionnaires administered to women before and after delivery at home and their birth attendants. Results Out of 770 women who delivered at home, 678 (88%) ingested misoprostol tablets and 647 (84%) ingested the tablets after the birth of the neonate but prior to the delivery of the placenta. The remaining women took misoprostol tablets after delivery of the placenta. Side effects were experienced by 40% of women and were transitory in nature. Among women who delivered at home, 80% said that they would use misoprostol tablets in the future and 74% were willing to purchase them in the future. Conclusions Self-administration of misoprostol in the home setting is feasible. Community-based providers, such as traditional birth attendants and community midwives with proper training and counseling, play an important role in reducing postpartum hemorrhage. Proper counseling and information exchange are helpful for introducing new practices in resource-constrained rural communities. Until such a time that skilled birth attendance is made more universally available in the rural setting, alternative strategies, such as training and using the services of traditional birth attendants to provide safe pregnancy care, must be
Llaneza, Placido; Iñarrea, Jose; Gonzalez, Celestino; Alonso, Ana; Arnott, Ignacio; Ferrer-Barriendos, Javier
To investigate whether body mass index, abdominal obesity or fat distribution in postmenopausal women influence their quality of Life. A cross-sectional study was carried out on 250 postmenopausal women (age: 50-64 years), with intact uterus and ovaries, sexually active, and non-hormone therapy users. Various anthropometric measurements were considered and a specific health-related quality of life (HR-QoL) instrument, the Cervantes scale, was performed. Thirty-three women were not included as they refused to participate in the study, had chronic disease such as hypertension, diabetes type 2, depression or did not answer all the scale items, so 217 patients were evaluated. According with BMI values, 34% of women were obese, 46.1% were in overweight, 19.8% were in normal weight and there were not underweight women. Any consistent relation was found between BMI and global values of HR-QoL, but obese women were diagnosed with "high level of problems" in the "psychical domain" and in the "sexuality domain". This difference in "sexuality domain" was also appreciated in women with abdominal obesity. Fat or lean mass was not correlated with HR-QoL. In our study, obesity did not affect the global HR-QoL in Spanish postmenopausal women, but could have an influence on the psychical and sexual domains. Others anthropometric measurements are not associated with changes in HR-QoL. Additional research with HR-QoL specific and validated instruments and with a longitudinal design seems necessary to confirm our results.
Cunningham, Melissa S; Skrastins, Emily; Fitzpatrick, Ryan; Jindal, Priya; Oneko, Olola; Yeates, Karen; Booth, Christopher M; Carpenter, Jennifer; Aronson, Kristan J
Objective To determine cervical cancer screening coverage and the knowledge, attitudes and barriers toward screening tests among women in rural and urban areas of Tanzania, as well as explore how they view the acceptability of the HPV vaccine and potential barriers to vaccination. Setting A cross-sectional study using interview-administered questionnaires was conducted using multistage random sampling within urban and rural areas in Kilimanjaro Region, Tanzania. Participants Women aged 18–55 were asked to participate in the survey. The overall response rate was 97.5%, with a final sample of 303 rural and 272 urban dwelling women. Primary and secondary outcome measures Descriptive and simple test statistics were used to compare across rural and urban strata. Multivariate logistic regression models were used to estimate ORs and 95% CIs. Results Most women (82%) reported they had heard of cervical cancer, while self-reported cervical cancer screening among women was very low (6%). In urban areas, factors associated with screening were: older age (OR=4.14, 95% CI 1.86 to 9.24 for ages 40–49, and OR=8.38, 95% CI 2.10 to 33.4 for >50 years), having health insurance (OR=4.15, 95% CI 1.52 to 11.4), and having knowledge about cervical cancer (OR=5.81, 95% CI 1.58 to 21.4). In contrast, among women residing in rural areas, only condom use (OR=6.44, 95% CI 1.12 to 37.1) was associated with screening. Women from both rural and urban areas had low vaccine-related knowledge; however, most indicated they would be highly accepting if it were readily available (93%). Conclusions The current proportion of women screened for cervical cancer is very low in Kilimanjaro Region, and our study has identified several modifiable factors that could be addressed to increase screening rates. Although best implemented concurrently, the availability of prophylactic vaccination for girls may provide an effective means of prevention if they are unable to access screening in the future. PMID
Yang, Li Rong; Zhao, Hong; Wang, He Ping; Li, Yai; Niu, Jing Ping; Su, Ke Jian; Mao, Hui Qing; Yang, Hua; Wei, Chang Nian; Ueda, Atsushi
The purposes of this study are to investigate and analyze the status of reproductive tract infections (RTIs) in married women in rural western China, and to develop effective strategies for improving the ability of married women to prevent RTIs in this region. We conducted in-depth interviews of 142 married women from four villages in three townships. Two questionnaires were used to gather data on married women's health care status, family income, knowledge about RTIs, relevant behaviors, and attitudes toward RTIs. Descriptive, parallel, and logistic regression analyses and the Chi-square test were applied to analyze the relationships between basic conditions and several influential factors. Over 80% of the respondents were of limited income and had with poor knowledge of and a lack of experience in preventing RTIs. Some 83.3% of the married women had experienced menstrual irregularities; 70.3% of those interviewed had experienced malodorous vaginal discharge with or without perineal itching. It was found that 80.7% of the interviewees did not have good personal hygiene habits in daily living regarding RTIs. It was found that the prevalence of RTIs was lower in women who had accurate information about RTIs. Most married women lacked basic knowledge of ways to prevent RTIs, and this, together with the limited support of the health care system and the absence of medical insurance schemes, was responsible for the observed high prevalence of RTIs. There is an urgent need to improve the capability of married women in rural China to prevent RTIs, and it is important to find effective ways to prevent these diseases. Three health promotion strategies are presently being implemented to prevent RTIs and to build capacity for disease prevention among married women in rural western China.
Hilger, T M; Smith, E M; Ault, K
To determine predictors of Chlamydia trachomatis infection among women 14-24 years of age attending family planning clinics throughout a rural Midwestern state. The study population included 16,756 women between the ages of 14 and 24 years attending family planning clinics for annual examinations throughout the state of Iowa in 1997. All women under 25 years of age having annual exams were tested for C. trachomatis during the visit. At the time of exam, both behavioral and demographic data were collected on all women participating in the study. The majority of women in the study (96%) reported no symptoms of chlamydia. Only 2.5% of all women had a positive test result. In the multivariate model, the odds ratios were significantly increased among the youngest age (14-17 years; OR = 2.2), those with mucopurulent cervicitis (OR = 3.4), cervical friability (OR = 2.2), symptomatic for infection (OR = 1.8), risk history (OR = 1.6), and black race (OR = 1.2) and predictive of a C. trachomatis infection. Risk factors predictive of C. trachomatis infection among younger aged women attending family planning clinics in a Midwest rural population are consistent with predictors of infection among women attending family planning clinics across the United States. The overall findings suggest the importance of developing screening guidelines as a means of lowering chlamydia rates. This may be a particularly difficult task in light of the low rate of symptoms that would lead a woman to seek medical care, even in younger age women who are at higher risk. In addition, screening guidelines would be more difficult to implement in a rural setting.
Yakong, Vida Nyagre; Rush, Kathy L; Bassett-Smith, Joan; Bottorff, Joan L; Robinson, Carole
This paper is a report of part of a larger study exploring rural Ghanaian women's experiences of seeking reproductive health care. The aim of this part of the study was to describe rural women's perspectives on their experiences in seeking reproductive care from professional nurses. Nurses' relationships with childbearing women have been linked to women's reproductive healthcare-seeking behaviour and service utilization. However, few researchers have studied women's perspectives on their relationships with nurses when seeking health care. In Ghana, the high rates of maternal mortality raise concerns about a number of factors, including nurses' relational practices. Data were collected in 2007 with a convenience sample of 27 Ghanaian women via in-depth interviews, focus groups and participant observation. Women's ages ranged from 15 to 49 years. The translated and transcribed data were thematically analyzed. Healthcare providers' relational practice influenced women's healthcare-seeking behaviours. Major themes from women's stories were: (a) experiences of intimidation and being scolded, (b) experiences of limited choices, (c) receiving silent treatment, and experiences of lack of privacy. Women emphasized the importance of their relationships with nurses and the impact of these relationships on their healthcare-seeking. Nursing education in Ghana must place emphasis on basic relational practices. Structural changes to health clinics and routine nursing practices are necessary to create conditions for privacy to address women's health concerns. Women's perspectives must be considered for service improvement. Further research is needed to examine nurses' perspectives on relational care. © 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell Publishing Ltd.
Hayati, Elli Nur; Eriksson, Malin; Hakimi, Mohammad; Högberg, Ulf; Emmelin, Maria
Experiencing domestic violence is considered a chronic and stressful life event. A theoretical framework of coping strategies can be used to understand how women deal with domestic violence. Traditional values strongly influenced by religious teachings that interpret men as the leaders of women play an important role in the lives of Javanese women, where women are obliged to obey their husbands. Little is known about how sociocultural and psychosocial contexts influence the ways in which women cope with domestic violence. Our study aimed to deepen our understanding of how rural Javanese women cope with domestic violence. Our objective was to explore how the sociocultural context influences coping dynamics of women survivors of domestic violence in rural Purworejo. A phenomenological approach was used to transform lived experiences into textual expressions of the coping dynamics of women survivors of domestic violence. Experiencing chronic violence ruined the women's personal lives because of the associated physical, mental, psychosocial, and financial impairments. These chronic stressors led women to access external and internal resources to form coping strategies. Both external and internal factors prompted conflicting impulses to seek support, that is, to escape versus remain in the relationship. This strong tension led to a coping strategy that implied a long-term process of moving between actively opposing the violence and surrendering or tolerating the situation, resembling an elastic band that stretches in and out. Women survivors in Purworejo face a lack of institutional support and tend to have traditional beliefs that hamper their potential to stop the abuse. Although the women in this study were educated and economically independent, they still had difficulty mobilizing internal and external support to end the abuse, partly due to internalized gender norms.
Hayati, Elli Nur; Eriksson, Malin; Hakimi, Mohammad; Högberg, Ulf; Emmelin, Maria
Background Experiencing domestic violence is considered a chronic and stressful life event. A theoretical framework of coping strategies can be used to understand how women deal with domestic violence. Traditional values strongly influenced by religious teachings that interpret men as the leaders of women play an important role in the lives of Javanese women, where women are obliged to obey their husbands. Little is known about how sociocultural and psychosocial contexts influence the ways in which women cope with domestic violence. Objective Our study aimed to deepen our understanding of how rural Javanese women cope with domestic violence. Our objective was to explore how the sociocultural context influences coping dynamics of women survivors of domestic violence in rural Purworejo. Design A phenomenological approach was used to transform lived experiences into textual expressions of the coping dynamics of women survivors of domestic violence. Results Experiencing chronic violence ruined the women's personal lives because of the associated physical, mental, psychosocial, and financial impairments. These chronic stressors led women to access external and internal resources to form coping strategies. Both external and internal factors prompted conflicting impulses to seek support, that is, to escape versus remain in the relationship. This strong tension led to a coping strategy that implied a long-term process of moving between actively opposing the violence and surrendering or tolerating the situation, resembling an elastic band that stretches in and out. Conclusions Women survivors in Purworejo face a lack of institutional support and tend to have traditional beliefs that hamper their potential to stop the abuse. Although the women in this study were educated and economically independent, they still had difficulty mobilizing internal and external support to end the abuse, partly due to internalized gender norms. PMID:23336615
Rural women in Southern Mexico link their diabetes to distressful life experiences rooted in ordinary violence. While much has been written on the use that diabetes sufferers make of their morbid condition as an idiom of distress, I investigate the personal and social effects that such an idiom has on women. As I illustrate, diabetes reflects an ambivalence that helps women to speak about the unspeakable and, at the same time, reinforces their ideas of culpability, namely that they are to blame for both the gendered violence that they endure and the diabetes from which they suffer.
Liu, Fangchao; Zhang, Shikun; Liu, Jue; Wang, Qiaomei; Shen, Haiping; Zhang, Yiping; Liu, Min
Infection with rubella virus during pregnancy can result in congenital defects and adverse pregnancy outcomes. The risk of rubella infection is greatly determined by the level of rubella antibodies in the serum. A survey of rubella antibody seronegativity rates was conducted in 780 000 women in rural China who were planning a pregnancy, in order to evaluate the herd susceptibility in different age groups and by high, middle, and low GDP per capita regions. In order to evaluate the herd susceptibility to rubella, a nationwide population-based study of rural Chinese women who were planning to have a baby and who were aged 21-49 years was instigated. As a part of the National Free Pre-conception Health Examination Project covering 29 provinces in 2012, a physical check-up program was provided to women who planned to become pregnant within the next 6 months. All medical data were from serological samples tested by ELISA, and the participants' immunity status was categorized based on levels of rubella antibodies. Economic data were also collected to explore the association between herd susceptibility and socioeconomic characteristics in the women of childbearing age. A total 264 306 of 782 293 recruited women preparing for pregnancy tested susceptible to rubella (33.79%). The seronegativity rate in women with a history of vaccination was significantly lower than that in women who had not received the vaccination or did not know their vaccination history (23.76%, 33.70%, and 35.68%, respectively). The seronegativity rates were 26.89%, 37.86%, and 32.61% in high, middle, and low GDP per capita areas, respectively. After stratified analysis and adjusting for other factors by multiple logistic regression, the lower seronegativity rates in women in high GDP per capita regions compared to women in middle and low GDP per capita regions remained in the different age groups and subgroups of immunization history. There is a clear difference in rubella-specific susceptibility
Terrill, Lauren; Gullifer, Judith
This study explored experiences of eight rural, Anglo-Australian women aged between 65 and 75 using semi-structured interviews. Thematic analysis revealed three prominent themes: (a) the free and busy me highlights the increased freedom in later life enabling choices regarding activities the women would like to engage in; (b) the secret is being positive and pragmatic emphasizes the importance of adopting a pragmatic acceptance of growing older; and (c) narratives of growth and stagnation highlights the pursuit of growth among older women in order to enhance the current self. Findings emphasize the construction of later life as one of liberation, resilience and growth.
This prospective study aims at elucidating the patterns of breastfeeding among rural Moslem women in Israel. A total of 429 parturient women living in four villages in the remote northern part and in the central, densely populated region of the country were interviewed about their breastfeeding behavior 3 and 6 months postpartum. Notwithstanding a generally strong adherence to traditional and religious norms that promote long duration of breastfeeding, only 43% persisted in suckling their infants for > or = 6 months. Bottle feeding (formula) was started by 46% of the cohort when the baby was less than 4 weeks old. The data indicate that the western lifestyle of the surrounding Jewish population has impacted on lactating rural Moslem women.
Tran, Toan K; Nguyen, Chuc T K; Nguyen, Hinh D; Eriksson, Bo; Bondjers, Goran; Gottvall, Karin; Ascher, Henry; Petzold, Max
The use of antenatal care (ANC) varies between countries and in different settings within each country. Most previous studies of ANC in Vietnam have been cross-sectional, and conducted in rural areas before the year 2000. This study aims to compare the pattern and the adequacy of ANC used in rural and urban Vietnam following two cohorts of pregnant women. A comparative study with two cohorts comprising totally 2132 pregnant women were followed in two health and demographic surveillance sites, one rural and one urban in Hanoi province, Vietnam. The women were quarterly interviewed using a structured questionnaire until delivery. The primary information obtained was the number and the content of ANC visits. Almost all women reported some use of ANC. The average number of visits was much lower in the rural setting (4.4) than in the urban (7.7). In the rural area, 77.2% of women had at least three visits and 69.1% attended ANC during the first trimester. The corresponding percentages for the urban women were 97.2% and 97.2%. Only 20.3% of the rural women compared to 81.1% of the urban women received all core ANC services. As a result, the adequate use of ANC was 5.2 times in the urban than in the rural setting (78.3% compared to 15.2%). Nearly all women received ultrasound examination during pregnancy with a mean value of 6.0 scans per woman in the urban area and 3.5 in the rural. Most rural women used ANC at commune health centres and private clinics while urban women mainly visited public hospitals. Expenditure related to ANC utilization for the urban women was 7.1 times that for the urban women. The women in the rural area attended ANC later, had fewer visits and received much fewer services than urban women. The large disparity in ANC adequacy between the two settings suggests special attention for the ANC programme in rural areas focusing on its content. Revision and enforcement of the national guidelines to improve the behaviour and practice of both users and
Perry, Cynthia K; McCalmont, Jean C; Ward, Judy P; Menelas, Hannah-Dulya K; Jackson, Christie; De Witz, Jazmyne R; Solanki, Emma; Seguin, Rebecca A
To describe our use of intervention mapping as a systematic method to adapt an evidence-based physical activity and nutrition program to reflect the needs of rural Latinas. An intervention mapping process involving six steps guided the adaptation of an evidence based physical activity and nutrition program, using a community-based participatory research approach. We partnered with a community advisory board of rural Latinas throughout the adaptation process. A needs assessment and logic models were used to ascertain which program was the best fit for adaptation. Once identified, we collaborated with one of the developers of the original program (StrongWomen - Healthy Hearts) during the adaptation process. First, essential theoretical methods and program elements were identified, and additional elements were added or adapted. Next, we reviewed and made changes to reflect the community and cultural context of the practical applications, intervention strategies, program curriculum, materials, and participant information. Finally, we planned for the implementation and evaluation of the adapted program, Mujeres Fuertes y Corazones Saludables, within the context of the rural community. A pilot study will be conducted with overweight, sedentary, middle-aged, Spanish-speaking Latinas. Outcome measures will assess change in weight, physical fitness, physical activity, and nutrition behavior. The intervention mapping process was feasible and provided a systematic approach to balance fit and fidelity in the adaptation of an evidence-based program. Collaboration with community members ensured that the components of the curriculum that were adapted were culturally appropriate and relevant within the local community context.
Verma, C; Rao, P S S
A multistage representative random sample of women and men from each of the 3 states of Bihar, Uttar Pradesh and West Bengal, from the rural blocks where the Leprosy Mission Hospitals were located were selected during 2010 to identify relevant factors that are preventing active participation of women and suggest corrective steps. Adult men and women were interviewed in depth, using a detailed checklist by the first author. A total of 1239 respondents 634 women and 605 men, were interviewed, only 44 women (7%) claimed that they had earlier participated in leprosy work, about 92% of the women felt that they had the potential to take part in leprosy work, and 70% showed willingness to participate. Factors that would encourage and facilitate more women to participate in leprosy work, included financial support (32.8%), convincing the family to grant permission (88%), and delegating them to work in proximity to their residences (15%). Some women respondents (11.0%) felt that they would provide their services voluntarily for social good. Women suggested that work should be delegated as per their capabilities and skills, and they should be given proper orientation, training and guidance. Hardly 5% of ASHA's in the clusters examined participated in leprosy related work, which needs stringent steps to re-orient and encourage them to undertake leprosy related work. It is concluded that rural Indian women are keen to play an important role in the national leprosy eradication program, with minimal support from the government and nongovernmental agencies in a truly community-based approach. This will benefit vast numbers of leprosy affected women as well as others.
Karunachandra, Nilanthi N; Perera, Irosha R; Fernando, Gihan
Sri Lanka is a middle income country and 80% of its population lives in rural areas. There is a well organized maternal and child health program and oral health care has recently been incorporated. The aim of this study was to report the oral disease burden of rural and urban antenatal women in the Western Province of Sri Lanka, thus highlighting the need to provide oral health care to this group. The sample consisted of 459 rural pregnant women in their second trimester and 348 urban pregnant women in their third trimester. Data were collected using interviewer administered questionnaires and a clinical oral examination conducted by calibrated examiners. The mean Decayed Missing and Filled Teeth (DMFT) among rural antenatal women were 5.4 ± 3, with 2.27 (± 2.31) decayed teeth, 1.25 (± 1.97) missing teeth, and 1.90 (± 1.89) filled teeth. Among urban antenatal women, the mean DMFT was 3.69 (± 3.62) with 1.04 (± 2.15) decayed teeth, 1.07 (± 1.59) missing teeth and 1.59 (± 2.06) filled teeth. Rural antenatal women had a significantly higher experience of decayed teeth (p=0.001) and filled teeth (p=0.026), and twice as many untreated dental caries, compared with urban women. Moreover, almost 60% of rural women presented with bleeding gums. Similarly, the prevalence of calculus was 30.3% for rural women and 13.5% for urban women. The most significant finding was 3.5% prevalence of shallow periodontal pockets (4-5 mm) for rural women but 73.0% for urban women (p=0.0001). In the final model of multiple logistic regression analysis, significant predictors for dental caries experience were age (adjusted OR [95% CI]: 2.51 [1.55-4.06], p=0.0001) and location (urban vs rural adjusted OR [95% CI)]: 0.25 [0.11-0.55], p=0.001). However for periodontal status the only significant association was between age and Community Periodontal Index of Treatment Needs (CPITN): CPITN=0 versus CPITN>0 in bivariate analysis for the overall sample (p=0.001). Antenatal women in Sri Lanka
Bouallalene-Jaramillo, K; Bagur-Calafat, M C; Girabent-Farrés, M
To analyze the reliability of the Spanish version of the Urogenital Distress Inventory short form (UDI-6) and Incontinence Impact Questionnaire short form (IIQ-7) questionnaires for assessing the presence of urinary incontinence, the degree of impairment and the impact on quality of life for Spanish women between the ages of 18 and 65. A total of 150 women were enrolled throughout Spain and were administered the UDI-6 and IIQ-7 questionnaires in 2 registries performed with a 15-day interval. The ICIQ-short form, in its Spanish version, was used as the gold standard. In the reliability analysis of the UDI-6, an internal consistency of 0.973 and an intraclass correlation of 0.974 were achieved, with a 95% CI between 0.964 and 0.981. For the IIQ-7, the internal consistency was 0.984 and the intraclass correlation was 0.985, with a 95% CI between 0.985 and 0.977. For both questionnaires, the kappa values for each item ranged from 0.717 to 0.876. The Spanish version of the UDI-6 and IIQ-7 questionnaires reliably and consistently assess the urogenital symptoms and their impact on the quality of life of Spanish women between 18 and 65 years of age. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.
Redondo, Iratxe; Herrero-Fernández, David
The aim of this study was to build a Spanish version of the Reading the Mind in the Eyes Test (RMET) including limited time of response and an integrated glossary, and to test its validity. A total of 433 university students (121 men and 350 women) and 38 anorexic women completed the RMET and other related measures of empathy and alexithymia. The results of the Parallel Analysis suggested a unidimensional structure for 19 items, which was verified through a Confirmatory Factor Analysis. Similarly to other research, this factor had a low reliability (α = .56, ρ = .59); however, regarding validity, the total score of the instrument showed positive correlations with empathy and negatives with alexithymia. Furthermore, healthy females were superior to males in RMET, and to anorexic women; but no significant differences appeared between healthy men and the anorexic group. This study confirms the validity of the test and permits a relatively short and inexpensive means of administration in large samples of adults. Besides, it suggests the necessity of assessing and treating the theory of mind in anorexic women.
Lisonkova, Sarka; Haslam, Matthew D; Dahlgren, Leanne; Chen, Innie; Synnes, Anne R; Lim, Kenneth I
Most studies examining geographic barriers to maternity care in industrialized countries have focused solely on fetal and neonatal outcomes. We examined the association between rural residence and severe maternal morbidity, in addition to perinatal mortality and morbidity. We conducted a retrospective population-based cohort study of all women who gave birth in British Columbia, Canada, between Jan. 1, 2005, and Dec. 31, 2010. We compared maternal mortality and severe morbidity (e.g., eclampsia) and adverse perinatal outcomes (e.g., perinatal death) between women residing in areas with moderate to no metropolitan influence (rural) and those living in metropolitan areas or areas with a strong metropolitan influence (urban). We used logistic regression analysis to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CIs). We found a significant association between death or severe maternal morbidity and rural residence (adjusted OR 1.15, 95% CI 1.03-1.28). In particular, women in rural areas had significantly higher rates of eclampsia (adjusted OR 2.70, 95% CI 1.79-4.08), obstetric embolism (adjusted OR 2.16, 95% CI 1.14-4.07) and uterine rupture or dehiscence (adjusted OR 1.96, 95% CI 1.42-2.72) than women in urban areas. Perinatal mortality did not differ significantly between the study groups. Infants in rural areas were more likely than those in urban areas to have a severe neonatal morbidity (adjusted OR 1.14, 95% CI 1.02-1.29), to be born preterm (adjusted OR 1.06, 95% CI 1.01-1.11), to have an Apgar score of less than 7 at 5 minutes (adjusted OR 1.24, 95% CI 1.13-1.31) and to be large for gestational age (adjusted OR 1.14, 95% CI 1.10-1.19). They were less likely to be small for gestational age (adjusted OR 0.90, 95% CI 0.85-0.95) and to be admitted to an neonatal intensive care unit (NICU) (adjusted OR 0.36, 95% CI 0.33-0.38) compared with infants in urban areas. Compared with women in urban areas, those in rural areas had higher rates of severe
Fulton, Philip N.
The literature suggested that marriage provides alternative occupational achievement for women who opt by choice or by circumstance to attain socioeconomic position through their husbands' occupations, and that an advantageous social contact setting is crucial for access to promising mates so that a woman's personal attributes can be beneficial…
Thomson, Tiffany L; Krebs, Valdis; Nemeth, Julianna M; Lu, Bo; Peng, Juan; Doogan, Nathan J; Ferketich, Amy K; Post, Douglas M; Browning, Christopher R; Paskett, Electra D; Wewers, Mary Ellen
We characterized the social network characteristics of women in Ohio Appalachia according to smoking status. Women ≥18 years of age were recruited from 3 Ohio Appalachian counties to complete a cross-sectional survey. Sociodemographic and smoking-related information was collected by face-to-face interview. A description of women's time (ie, spends time with) and advice (ie, gets support and advice) social network ties were obtained. An egocentric social network analysis was completed, according to the woman's smoking status. Of the 408 women enrolled, 20.1% were current smokers. Time networks were larger (p < .001), more dense (p < .001), and more redundant (p < .001) than advice networks. Current smokers had a greater proportion of smoking ties in their networks compared to non-smokers (p < .001). Daily face-to-face contact with non-smoking ties was greater in time compared to advice networks (p < .001). Current smokers in advice networks tended to have less daily contact with non-smoking ties than non-smokers (p = .06). Differences existed in characteristics of time versus advice egocentric networks. Smoking status was associated with these differences. Results will assist with future development of a network-based smoking cessation intervention.
This article focuses on the impact of a telecenter program in Bamshela, South Africa, on women in the local community. The Government's telecenter initiative was conceived with an awareness of gender issues and the need to promote women's needs and rights in mind. However, as the center moves into its second year, many opportunities for the it to have a meaningful impact on the community from the start have already been lost. It has not generated enough income to keep prices at an affordable rate. Research has shown that many Bamshela women are using the telecenter as a phoneshop. Lack of knowledge, skills, and education among women is an obstacle to their use of computers at the center; however, center managers believe that rural women will become familiar with electronic methods of communication and may come to use these services. The telecenter has a long way to go before it can replace face-to-face communication and bring prestige to the community.
Paul, Mandira; Essén, Birgitta; Sariola, Salla; Iyengar, Sharad; Soni, Sunita; Klingberg Allvin, Marie
The societal changes in India and the available variety of reproductive health services call for evidence to inform health systems how to satisfy young women's reproductive health needs. Inspired by Foucault's power idiom and Bandura's agency framework, we explore young women's opportunities to practice reproductive agency in the context of collective social expectations. We carried out in-depth interviews with 19 young women in rural Rajasthan. Our findings highlight how changes in notions of agency across generations enable young women's reproductive intentions and desires, and call for effective means of reproductive control. However, the taboo around sex without the intention to reproduce made contraceptive use unfeasible. Instead, abortions were the preferred method for reproductive control. In conclusion, safe abortion is key, along with the need to address the taboo around sex to enable use of "modern" contraception. This approach could prevent unintended pregnancies and expand young women's agency.
Castelló, Adela; Lope, Virginia; Vioque, Jesús; Santamariña, Carmen; Pedraz-Pingarrón, Carmen; Abad, Soledad; Ederra, Maria; Salas-Trejo, Dolores; Vidal, Carmen; Sánchez-Contador, Carmen; Aragonés, Nuria; Pérez-Gómez, Beatriz; Pollán, Marina
The objective of the present study was to assess the reproducibility of data-driven dietary patterns in different samples extracted from similar populations. Dietary patterns were extracted by applying principal component analyses to the dietary information collected from a sample of 3550 women recruited from seven screening centres belonging to the Spanish breast cancer (BC) screening network (Determinants of Mammographic Density in Spain (DDM-Spain) study). The resulting patterns were compared with three dietary patterns obtained from a previous Spanish case-control study on female BC (Epidemiological study of the Spanish group for breast cancer research (GEICAM: grupo Español de investigación en cáncer de mama)) using the dietary intake data of 973 healthy participants. The level of agreement between patterns was determined using both the congruence coefficient (CC) between the pattern loadings (considering patterns with a CC≥0·85 as fairly similar) and the linear correlation between patterns scores (considering as fairly similar those patterns with a statistically significant correlation). The conclusions reached with both methods were compared. This is the first study exploring the reproducibility of data-driven patterns from two studies and the first using the CC to determine pattern similarity. We were able to reproduce the EpiGEICAM Western pattern in the DDM-Spain sample (CC=0·90). However, the reproducibility of the Prudent (CC=0·76) and Mediterranean (CC=0·77) patterns was not as good. The linear correlation between pattern scores was statistically significant in all cases, highlighting its arbitrariness for determining pattern similarity. We conclude that the reproducibility of widely prevalent dietary patterns is better than the reproducibility of more population-specific patterns. More methodological studies are needed to establish an objective measurement and threshold to determine pattern similarity.
Fattah, Kazi Nazrul; Camellia, Suborna
Prevention of violence against women requires understanding men's controlling attitudes and behaviors toward women. In Bangladesh, while the incidence of men's violence against women is alarmingly increasing, existing research to understand the determinants of men's violent behavior resulted in contradictory findings. The current study explores rural Bangladeshi men's support for gender norms, beliefs, and attitudes concerning violence against women, and looks at how these are influenced by men's age, marital status, education, and affiliation with organizations that promote gender equality. The study also attempts to understand men's bystander attitudes and responses to incidents of violence against women. Using the theoretical framework of hegemonic masculinity, the study was conducted among a sample of 1,200 men and women. Results indicate that in the study areas, young, unmarried men are less supportive to gender norms, beliefs, and attitudes that promote violence against women. Positive association was observed with men's educational attainment and affiliation with nongovernmental organization (NGO) interventions. Regardless of age, marital status, or education, men's bystander response toward intervening to prevent violence against women was found to be low. Women showed similar level of support for inequitable gender norms, beliefs, and attitudes. Analysis of the findings using a hegemonic masculinity lens reveals more complicated dynamics of power and hegemonic control at work that perpetuate men's violence against women. Based on the findings, the study also identifies possible strategies for violence prevention interventions in Bangladesh.
Gurmu, Eshetu; Endale, Senait
Wife beating is the most common and widespread form of intimate partner violence in Ethiopia. It results in countless severe health, socio-economic and psychological problems and has contributed to the violation of human rights including the liberty of women to enjoy conjugal life. The main purpose of this study is to assess the levels and patterns of wife beating refusal and its associated socio-cultural and demographic factors in rural and urban Ethiopia. The 2011 Ethiopian Demographic and Health Survey (EDHS) data based on 11,097 and 5287 women in the reproductive age group (i.e. 15-49 years) living in rural and urban areas, respectively,were used in this study. Cronbach's alpha was used to assess the internal consistency of the measure of women's attitudes towards wife beating. The Statistical Package for Social Sciences was applied to analyze the data. A binary logistic regression model was fitted to identify variables that significantly predict respondents' refusal of wife beating. Separate analysis by a place of residence was undertaken as attitude towards wife beating vary between rural and urban areas. The likelihood of refusing wife beating in Ethiopia was significantly higher among urban women (54.2%) than rural women (24.5%). Although there was a significant variations in attitude towards refusing wife beating among different regions in Ethiopia, increasing educational level, high access to media, age of respondents were associated with high level of refusal of wife beating. In contrast, rural residence, being in marital union, high number of living children, being followers of some religions (Muslim followers in urban and Protestants in rural) were associated with low level of refusal of wife beating. The findings of this study reveal that wife beating in Ethiopia is a function of demographic and socio-cultural factors among which age and educational attainment of respondents, number of living children, religious affiliation, marital commitment and
Saroha, Ekta; Altarac, Maja; Sibley, Lynn M
Low contraceptive utilisation and high fertility in rural Uttar Pradesh (UP), India, is a major concern for the world's second most populous country. The association between reasons for low contraceptive utilisation and maternal factors has been inadequately researched. Data from the 'morbidity and performance assessment' study were analysed to explore reasons for low contraceptive utilisation and their association with maternal factors among 308 women in Maitha, rural UP, India. Chi-square, t-test, ANOVA, and logistic regression analyses were conducted. Majority (84.2%) of the rural women in Maitha, UP, India were not using any contraceptives. Upper caste, literate wives, and wives whose husbands were literate were more likely to use contraceptives. About one-third of the women did not want to use a contraceptive because they wanted another child. Large numbers (65.3%) of women wanted to use contraceptives but were unable to do so due to lack of knowledge (38.9%), fear of side-effects (15.5%), husband/family disapproval (15.5%), inconvenience (10.7%), and other reasons (19.1%). Maternal parity, wives' and husband's literacy were significantly associated with the reasons for low contraceptive utilisation (p < 0.05). Contraceptive utilisation can be Improved by taking into consideration such maternal characteristics. All state subsidised contraceptives should be more widely known, understood and made available.
Lin, Qian; Yang, Lina; Li, Fang; Qin, Hong; Li, Mingzhi; Chen, Jihua; Deng, Jing; Hu, Xiangying
Background: Folic acid supplementation is effective in reducing the risk of neural tube defects (NTDs). However, the use of folic acid is low among rural women in China. Nutrition education can provide information about folic acid and encourage its use. The primary objective of this study was to test the effectiveness of a village-based nutrition intervention on folic acid use among rural women. Methods: Sixty villages were randomly selected using multiple-stage sampling and were divided into control and intervention groups. The intervention included nutritional education at village clinics, written materials, and text messages (SMS). Folic acid use knowledge and behavior was assessed at baseline and after the intervention. Results: Self-reported compliance with folic acid supplement use increased from 17.0%–29.2% at baseline to 41.7%–59.2% one year post-intervention. During the same period, the folic acid knowledge score in the intervention group increased from 3.07 to 3.65, significantly higher than the control group (3.11 to 3.35). Multivariate binary logistic regression showed that the women who received folic acid education and SMS intervention were more likely to comply with folic acid supplement recommendations. Conclusions: The results indicated that an integrated village-based folic acid education intervention may be an effective way of promoting folic acid use for the prevention of NTDs in rural women. PMID:28230798
Wang, H H
The purposes of this study were to: (1) examine the relations among age, marital status, social class, perceived health, self-care agency, health-promoting lifestyle, and well-being in two groups of rural elderly Taiwanese women and (2) validate and compare two models using the two age groups of rural elderly Taiwanese women. Based on the conceptualizations of the major study variables in Orem's self-care model (1995), Pender's health promotion model (1987), and other scholars' ideas (Hartweg, 1990; Simmons, 1990), a theoretical model of health-promoting lifestyle was proposed for this study. A survey-interview method was used for data collection. Two groups of elderly women were recruited for data analysis: 168 in the younger group and 116 in the older group. The mean age was 64.66 in the younger group and 75.59 in the older group. Two models of health-promoting lifestyle were tested with a path analysis, using the Linear Structural Relations 8 (LISREL 8) program. The resultant models yielded chi2 of 13.69 with 9 degrees of freedom (p = 0.13) in the younger group and chi2 of 15.76 with 10 degrees of freedom (p = 0.11) in the older group. Other fit indices also indicate the two models fit the data well. Community nurses can assess, identify, and use effective interventions for rural elderly women on a basis of the resulting models.
Nyamathi, Adeline; Heravian, Anisa; Zolt-Gilburne, Jessica; Sinha, Sanjeev; Ganguly, Kalyan; Liu, Elaine; Ramakrishnan, Padma; Marfisee, Mary; Leake, Barbara
Although depression may be commonly experienced by persons living with AIDS, it may be challenging for health care providers to identify persons who are suffering from depression symptoms, particularly if they are living in the more isolated rural areas of India. The purpose of this study is to assess correlates of depression among women living with AIDS in rural Andhra Pradesh, India. A total of 68 rural women living with AIDS (WLA) completed baseline data and were assessed by means of structured instruments. Regression modeling revealed that disclosure avoidance and making at least six health care visits in the last six months were all associated with depression. Further, living with a spouse was associated with lower depressive symptom scores. Stigma was not found to be associated with depression. Understanding correlates of depression can lead the way toward designing culturally-tailored interventions that can mitigate disclosure avoidance and improve the health of women. A more comprehensive health focus may be needed to empower the women to seek quality care for both physical health, as well as mental health, symptomatology.
Wingler, Sylvia Adams
This dissertation focuses on the narratives of four rural art educators of the Foothills of Western North Carolina. These women are the first art educators in this area in public education. They are often viewed as the invisible women in art who support community arts, much like the "invisible women in art history." From the view of the…
In a particular way, the HIV pandemic exposes the prevailing gender relations and the definitions of male and female gender roles, both in intimate relationships and in the wider society. The HIV pandemic reveals the contradictions between women's legal rights and the persistence of women's cultural and sexual subordination. It reflects the impact of poverty, gender roles, culture and religion. Although HIV and AIDS cuts across class, South African rural black women's infection risk seems particularly high since they suffer notably from subordination and socio-economic hardships. Negotiating safer sex in marriage or intimate partnerships is very difficult for them in view of the traditional spaces in which they find themselves, where patriarchal structures are pervasive. Based on data obtained from a case study, this paper examines socio-cultural constraints to rural women's sexual agency in a patriarchal social order. These rules are based on a patriarchal code of respect, which is still pervasive in many aspects of the community under investigation. In terms of gender relations, the patriarchal code of respect is founded on an assumed 'naturalisation' of the two genders and the natural superiority of the male over the female. In terms of sexuality it is translated into male sex-right. The fear of HIV infection is omnipresent and results in unmarried women engaging in the negotiation of their wants and needs. Owing to the patriarchal code of respect, married women are perceived as having no choice in negotiating safer sex and are forced to put their lives at risk in contracting HIV. Unmarried women have greater although not endless choices in this regard. Although the study participants unexpectedly displayed a rather negative perception of other women, in order to strengthen women in their proximal environment the HIV epidemic may be seen as a vehicle for building solidarity among women in the community.
Chang, Ann Lee; Pacheco, Misty; Yoshino, Kurt; Miyamura, Jill; Maddock, Jay
Objective The purpose of this study was to examine primary cesarean delivery rates among women with low risk pregnancies in urban and rural hospitals in Hawaii. Methods This is a retrospective study of all low-risk women (term, vertex, singleton) who had a primary cesarean delivery in any Hawaii hospital from 2010 to 2011 using a statewide health information database. Hospitals were divided into two categories: rural and urban. Results Of the 27,096 women who met criteria for this study, 7105 (26.2 %) delivered in a rural hospital. Low-risk women who delivered in a rural hospital had a primary cesarean delivery rate of 18.5 % compared to 11.8 % in the urban hospitals, p < .0001. Low-risk women who delivered at rural hospitals had significantly higher unadjusted and adjusted odds ratios for cesarean delivery. The association with rural hospital was stronger after adjusting for confounders, aOR 2.47 (95 % CI 2.23-2.73) compared to unadjusted OR 1.70 (95 % CI 1.58-1.83) for primary cesarean delivery. Conclusions on practice In a geographically isolated population, rates of primary cesarean delivery among low-risk women are significantly higher in rural hospitals. This disparity should be investigated further.
Background Despite declining smoking rates among the general Australian population, rates among Indigenous Australians remain high, with 47% of the Indigenous population reporting daily smoking - twice that of other Australians. Among women, smoking rates are highest in younger age groups, with more than half of Aboriginal women smoking during pregnancy. A lack of research focused on understanding the social context of smoking by Aboriginal women in rural Australia limits our ability to reduce these rates. This study aimed to explore the factors contributing to smoking initiation among rural Aboriginal women and girls and the social context within which smoking behaviour occurs. Methods We conducted three focus groups with 14 Aboriginal women and service providers and 22 individual interviews with Aboriginal women from four rural communities to explore their perceptions of the factors contributing to smoking initiation among Aboriginal girls. Results Four inter-related factors were considered important to understanding the social context in which girls start smoking: colonisation and the introduction of tobacco; normalization of smoking within separate Aboriginal social networks; disadvantage and stressful lives; and the importance of maintaining relationships within extended family and community networks. Within this context, young girls use smoking to attain status and as a way of asserting Aboriginal identity and group membership, a way of belonging, not of rebelling. Family and social structures were seen as providing strong support, but limited the capacity of parents to influence children not to smoke. Marginalization was perceived to contribute to limited aspirations and opportunities, leading to pleasure-seeking in the present rather than having goals for the future. Conclusions The results support the importance of addressing contextual factors in any strategies aimed at preventing smoking initiation or supporting cessation among Aboriginal girls and women
Bloom, Tina L; Glass, Nancy E; Case, James; Wright, Courtney; Nolte, Kimberly; Parsons, Lindsay
Intimate partner violence (IPV) in pregnancy is common and harmful to maternal-child health. Safety planning is the gold standard for intervention, but most abused women never access safety planning. Pregnant women may face increased barriers to safety planning and risk of severe IPV, particularly if they are also rural residents. Internet-based safety planning interventions may be useful, but no such interventions specific to the needs of pregnant women have been developed. The aim was to evaluate feasibility (usability, safety, and acceptability) of Internet-based safety planning for rural and urban abused pregnant women and practicality of recruitment procedures for future trials. An existing Internet-based safety decision aid for pregnant and postpartum women was adapted; initial content validity was established with survivors of IPV, advocates, and national IPV experts; and a convenience sample of community-dwelling abused pregnant women was recruited and randomized into two groups to test the decision aid. Fifty-nine participants were enrolled; 46 completed the baseline session, 41% of whom (n = 19) resided in nonmetropolitan counties. Participants' average gestational age was 20.2 weeks, and 28.3% resided with the abusive partner. Participants reported severe IPV at baseline (mean Danger Assessment score of 16.1), but all were able to identify a safe computer, and 73.9% completed the baseline session in less than 1 week, with no adverse events reported. These findings provide preliminary evidence for the feasibility, acceptability, and safety of an Internet-based safety decision aid for urban and rural abused pregnant women.
Guy, Meghan; Norman, Wendy V.; Malhotra, Unjali
Objective To design reliable survey instruments to evaluate needs and expectations for provision of women's health services in rural communities in British Columbia (BC). These tools will aim to plan programming for, and evaluate effectiveness of, a women's health enhanced skills residency program at the University of British Columbia. Design A qualitative design that included administration of written surveys and on-site interviews in several rural communities. Setting Three communities participated in initial questionnaire and interview administration. A fourth community participated in the second interview iteration. Participating communities did not have obstetrician-gynecologists but did have hospitals capable of supporting outpatient specialized women's health procedural care. Participants Community physicians, leaders of community groups serving women, and allied health providers, in Vancouver Island, Southeast Interior BC, and Northern BC. Methods Two preliminary questionnaires were developed to assess local specialized women's health services based on the curriculum of the enhanced skills training program; one was designed for physicians and the other for women's community group leaders and aboriginal health and community group leaders. Interview questions were designed to ensure the survey could be understood and to identify important areas of women's health not included on the initial questionnaires. Results were analyzed using quantitative and qualitative methods, and a second draft of the questionnaires was developed for a second iteration of interviews. Main findings Clarity and comprehension of questionnaires were good; however, nonphysician participants answered that they were unsure on many questions pertaining to specific services. Topics identified as important and missing from questionnaires included violence and mental health. A second version of the questionnaires was shown to have addressed these concerns. Conclusion Through iterations of
Velasco, Casilda; Luna, Juan D; Martin, Aurelia; Caño, Africa; Martin-de-Las-Heras, Stella
To investigate the prevalence of intimate partner violence in Spanish women during the 12 months prior to delivery and to identify associated risk factors using two screening instruments. A population-based study. Fifteen public hospitals in southern Spain. A total of 779 women admitted to the hospital obstetrics department. Intimate partner violence was diagnosed with the Abuse Assessment Screen and Index of Spouse Abuse screening instruments. Prevalence and associated risk factors of intimate partner violence during pregnancy. According to the Abuse Assessment Screen, intimate partner violence during the pre-delivery year was experienced by 7.7% of the women, emotional abuse by 4.8%, and physical abuse by 1.7%. According to the Index of Spouse Abuse, non-physical intimate partner violence during this period was reported by 21.0% of the women and physical intimate partner violence by 3.6%. After adjusting for socio-demographic characteristics, multivariate regression models showed that an uncommitted relationship and absence of kin support were significantly associated with an increased intimate partner violence risk during the pre-delivery year. Employment was a significant protective factor against any of the three forms of intimate partner violence (Abuse Assessment Screen) and physical intimate partner violence (Index of Spouse Abuse) during this period. A high proportion of women in Spain experience intimate partner violence during or just before pregnancy. Pregnant women in an uncommitted relationship or without kin support were at greater risk of intimate partner violence. Screening instruments for intimate partner violence during pregnancy should be evaluated in different cultural contexts. © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.
Rozario, Philip A; Simpson, Gaynell M
In this study, we examined how geographic location might differently influence social support and self-rated health for rural and urban African American women caregivers. We used cross-sectional data from 253 urban and 263 rural women primary caregivers. Controlling for key demographic factors, we regressed caregivers' self-rated health on social engagement, structural, and functional aspects of social support for urban and rural caregivers separately. The perception of family functioning was positively associated with urban and rural caregivers' self-rated health. Urban caregivers reported having significantly more contact with their family and more informal helpers compared to rural caregivers. Furthermore, church attendance, a measure of social engagement, was significant for urban caregivers' self-rated health, but not rural caregivers. Our findings affirmed the importance of foregrounding context and disaggregating social support, and point to the need for interventions targeting family functioning and paying attention to geographic location.
Anson, O; Haanappel, F W
Almost five decades ago, the Chinese Communist Party wished to abolish all "remnants of feudalism," including the patriarchal social order. Just one year after the revolution, the Marriage Law endorsed women's rights within the family, but no operative measures were taken to enforce it. Some of the economic reforms since independence even strengthened patrilocality and, possibly, patriarchal values. The purpose of this study was to explore the degree to which patrilocality served to maintain the traditional patriarchal stratification among women in the household by exploring women's health patterns and utilization of health services. Data were collected from 3859 women residing in rural Hebei, and variation in health and help seeking of six categories of relation to household head--mothers, wives, daughters, daughters-in-law, family heads, and other relatives--were explored. Utilization of health services is not dependent on women's position in the household, but primarily on per-capita income. Health patterns seem to indicate that mothers of the head of the household still have a considerable power to define their roles and share of household work. Women head of family, most of whom are married, appear to be under strain, which could be a result of their culturally "deviant" position. We conclude that old patriarchal values are intertwined with values of equality in current rural China.
Weinert, Clarann; Cudney, Shirley; Comstock, Bryan; Bansal, Aasthaa
The Women To Women project, a computer-based support and educational research intervention, was designed to help rural women better understand and manage their chronic illnesses. Its impact on psychosocial adaptation has been reported elsewhere. This article reports on the effect of a computer intervention on chronic illness self-management skills and quality of life. Using a parallel 2-group study design, the researchers randomized 309 middle-aged rural women with chronic conditions to either a computer-based intervention or a control group. They collected data on self-management of chronic illness and quality of life indicators at baseline and at the end of the intervention. Women in the intervention group reported significantly more self-efficacy in managing their chronic disease than those in the control group and the observed effect was of moderate size. Women in the intervention group also reported statistically significant gains in quality of life; effect sizes were small but consistent. Select chronic illness self-management skills and quality of life can be positively influenced by a well-designed computer intervention. Copyright© by Ingram School of Nursing, McGill University.
Nyamathi, Adeline; Ekstrand, Maria; Zolt-Gilburne, Jessica; Ganguly, Kalyan; Sinha, Sanjeev; Ramakrishnan, Padma; Suresh, P.; Marfisee, Mary; Leake, Barbara
AIDS-related stigma has received increasing attention in the literature; however, little is known about the devastating impact it has on rural women living with AIDS (WLA) in India. This cross-sectional study (N = 68), analyzed from complete baseline data, identified a number of correlates of stigma among rural WLA in South India. Structured instruments were used to capture sociodemographic history, stigma, knowledge of HIV, depressive symptoms along with the recording of CD4 data. A higher level of felt stigma and more AIDS symptoms were related to avoidant coping, while fewer adherence strategies and lower support for ART adherence were also associated with avoidant coping. These findings promote the need for support and resources for rural India WLA. PMID:21915715
Nyamathi, Adeline; Salem, Benissa; Ernst, E J; Keenan, Colleen; Suresh, P; Sinha, Sanjeev; Ganguly, Kalyan; Ramakrishnan, Padma; Liu, Yihang
In this prospective, randomized clinical trial, correlates of adherence to antiretroviral therapy (ART) were assessed using a baseline questionnaire among 68 rural women living with AIDS (WLA) in India. Unadjusted analyses revealed positive relationships of ART adherence with Hindu religion, and support from spouses and parents, whereas negative associations were found with depression, poor quality of life, and having ten or more HIV symptoms. Multiple linear regression analysis also revealed that WLA who were Hindu, not depressed, had ART support from spouses and parents, and perceived some benefit from ART were more adherent to ART than their respective counterparts. This study reveals the unique challenges which rural WLA experience and the need to mitigate these challenges early in ART treatment. Further, the findings enable the refinement of an intervention program which will focus on strengthening ART adherence among rural WLA.
Gao, Ying; Huang, Yubei; Song, Fengju; Dai, Hongji; Wang, Peishan; Li, Haixin; Zheng, Hong; Dong, Henglei; Han, Jiali; Wang, Yaogang; Chen, Kexin
To evaluate the urban-rural disparity of overweight/obesity and explore its potential trend with breast cancer among Chinese women. The prevalence of overweight/obesity for Chinese rural women (35.2%, 29.2% for overweight and 6.0% for obesity) was significantly higher than that for Chinese urban women (33.4%, 27.7% for overweight and 5.7% for obesity) (P < 0.001). For either rural or urban women, the prevalence of overweight/obesity was highest in north region, followed by east region for rural women and north-east region for urban women. For rural women, higher prevalence of overweight/obesity was significantly positively associated with elder age, Han nationality, low level of education, no occupation, high family income, less number of family residents, insurance, and elder age at marriage. Similar positive associations were also found for urban women, except negative associations for high family income, less number of family residents, and elder age at marriage. A non-significant positive trend between overweight/obesity and breast cancer was found for rural women [odds ratio (OR): 1.06; 95% confidence interval (CI): 0.87-1.29], but a significant positive trend for urban women (OR: 1.55; 95% CI: 1.19-2.02). A total of 1 210 762 participants were recruited from the Chinese National Breast Cancer Screening Program. Overweight and obesity were defined as body mass index (BMI) ranged 24.0-27.9 kg/m2 and BMI ≥ 28.0kg/m2, respectively. There was an obvious urban-rural disparity of overweight/obesity distribution among Chinese women, which could also lead to an obvious disparity of breast cancer distribution.
Jejeebhoy, Shireen J
This study explores similarities and differences in the perceptions of rural Indian women and their husbands with regard to various dimensions of women's autonomy and investigates the extent to which various reproductive outcomes--contraception, unmet need, recent fertility, and spousal communication--are influenced by individual partners' views of women's autonomy. Data are drawn from a 1993-94 community-based study of women's autonomy in Uttar Pradesh and Tamil Nadu, states that are, respectively, more and less patriarchal. Matched data were obtained from 1,660 women and their husbands. Results indicate no more than a loose agreement between women and their husbands concerning the dimensions of women's autonomy within the home. Where disagreement is expressed, husbands are more likely to project a comparatively liberal picture of their wives' autonomy than do their wives, and the inference can be made that in surveys men tended to provide more "acceptable" responses than when they were questioned in greater depth. Findings also suggest that cultural context affects the influences that wives' and their husbands' perceptions of women's autonomy have on reproductive outcomes. A clear regional divide is seen, net of individual and household characteristics, in the influence of almost every aspect of women's autonomy.
Kaur, Ravneet; Garg, Suneela
Domestic violence is a major contributor to physical and mental ill health of women and is evident, to some degree, in every society in the world. The World Health Organization reports that globally 29% to 62% of women have experienced physical or sexual violence by an intimate partner. Ending gender discrimination and all forms of violence against women requires an understanding of the prevailing culture of bias and violence. The present study was conducted in a rural area in India. Focus group discussions (FGDs) were conducted among married women in the age group of 18 to 35 years. Physical violence was a major cause of concern among these women. Some women had to suffer even during pregnancy. An alcoholic husband emerged as the main cause for domestic violence. Husbands' relatives instigating wife beating was also common. Majority of the women preferred to remain silent despite being victimized. The women feared to resort to law because of implications such as social isolation. To address this, all sectors including education, health, legal, and judicial must work in liaison. Gender inequality must be eliminated and equal participation of women in the decision-making and development processes must be ensured.
Ghose, Malini; Mullick, Disha
This paper is based on the findings of a research study which traced 56 rural women learners 15 years after they had participated in an empowerment and education programme in North India. It attempts to understand, from the perspectives of women from marginalised communities, the ways in which participating in the programme had been empowering for them, or not. While most of the women were indeed able to transform several areas in their lives, this study illustrates that empowering outcomes cannot be assumed or articulated in categorical terms and that bringing about change requires the negotiation of power at various levels. The women's narratives stand in contrast to the prevalent discourses around women's literacy and empowerment, which highlight the importance of literacy only in terms of its positive impact on attaining development goals. Despite the vigorously discussed de-politicisation of the concept of empowerment, the authors show in this paper that empowerment, when informed by a critical feminist understanding, continues to provide a useful framework to analyse women's experiences related to education, as a process enabling women to understand and negotiate structures of power - which are neither static nor wholly dominating - and to find spaces to exercise agency. There are few longitudinal studies which trace the long-term impact of educational programmes on adult women, and most studies are in the nature of impact assessments of programmes. Through this paper the authors argue for the need to analyse the complexities around the relationship between women's education and empowerment.
Troyer, Mark B; Ferketich, Amy K; Murray, David M; Paskett, Electra D; Wewers, Mary Ellen
Clinical trials are needed to inform evidence-based smoking cessation approaches in rural and Appalachian women, but trial enrollment in these groups is sparse. Little is known about factors associated with enrollment of Appalachian women in tobacco dependence treatment randomized clinical trials (RCT). We report a comparison of Appalachian women enrolling in a tobacco dependence treatment RCT to those declining and identify correlates to enrollment. Smokers identified during a cervical health-related survey among Ohio Appalachian women were invited to enroll in a tobacco dependence treatment RCT incorporating behavioral counseling and nicotine replacement. Women who agreed to enroll were compared to women who declined in terms of sociodemographic, health- and smoking-related measures. The mean age of women sampled was 35.1 years. Women reported daily consumption of 1-10 (39%), 11-20 (46%), or >20 (16%) cigarettes. In a multivariable logistic regression model adjusting for age and nicotine dependence, pros of smoking most outweighing cons (odds ratio [OR] = 0.11, 95% confidence intervals [CI] = 0.03, 0.39), ≥3 prior quit attempts versus 1 attempt (OR = 0.18, 95% CI = 0.06, 0.59), and not having health insurance (OR = 0.29, 95% CI = 0.12, 0.77) were associated with decreased odds of RCT enrollment. Rural Appalachian women who enrolled in a tobacco dependence treatment RCT differed significantly in motivational and cognitive attitudes toward smoking, insurance status, and number of prior quit attempts, as compared to those who did not enroll. Techniques that foster motivation to quit smoking as a means of boosting RCT enrollment are discussed.
Sánchez-Borrego, Rafael; von Schacky, Clemens; Osorio, María José Alonso; Llaneza, Plácido; Pinto, Xavier; Losa, Fernando; Navarro, Mª Concepción; Lubián, Daniel; Mendoza, Nicolás
The consumption of long-chain omega-3 polyunsaturated fatty acids (LCO3-PUFAs) has shown a great variety of beneficial effects, including cardiovascular, metabolic and inflammatory effects, which make them interesting for the postmenopausal woman. Because LCO3-PUFAs could be effective and safe during this period, a panel of experts from the Spanish Menopause Society met to establish a set of recommendations for their use in postmenopausal women based on the best available evidence. The decrease in triglycerides is the most consistent effect observed with LCO3-PUFAs (at doses greater than 3g/day). In addition, LCO3-PUFAs have antiarrhythmic effects, reduce blood pressure, improve depressive and psychotic symptoms, and do not increase the risk of cancer. However, further studies are needed to confirm the benefit of LCO3-PUFAs in the relief of menopause symptoms and osteoporosis. Copyright © 2017 Elsevier B.V. All rights reserved.
Keshet-Sitton, Atalya; Or-Chen, Keren; Yitzhak, Sara; Tzabary, Ilana; Haim, Abraham
Women are exposed to indoor and outdoor artificial light at night (ALAN) in urban and rural environments. Excessive exposure to hazardous ALAN containing short wavelength light may suppress pineal melatonin production and lead to an increased breast cancer (BC) risk. Our objective was to address the differences in BC risks related to light exposure in urban and rural communities. We examined indoor and outdoor light habits of BC patients and controls that had lived in urban and rural areas in a 5-year period, 10 to 15 years before the time of the study. Individual data, night time sleeping habits and individual exposure to ALAN habits were collected using a questionnaire. A total of 252 women (110 BC patients and 142 controls) participated in this study. The sample was divided to subgroups according to dwelling area and disease status. Age matching was completed between all subgroups. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated for urban and rural women separately, using binary logistic regression. OR results of urban population (92 BC patients and 72 control) revealed that BC risk increases with daily use of cellphone (OR = 2.13, 95% CI = 1.01-4.49, P < .05) and residence near strong ALAN sources (OR = 1.51, 95% CI = 0.99-2.30, P < .06). Nevertheless, BC risk decreases if a woman was born in Israel (OR = 0.44, 95% CI = 0.21-0.93, P < .03), longer sleep duration (OR = 0.75, 95% CI = 0.53-1.05, P < .1), and reading with bed light illumination before retiring to sleep (OR = 0.77, 95% CI = 0.61-0.96, P < .02). Furthermore, in the rural population (18 BC patients and 66 control) BC risk increases with the number of years past since the last menstruation (OR = 1.12, 95% CI = 1.03-1.22, P < .01). However, BC risk decreases with longer sleep duration (OR = 0.53, 95% CI = 0.24-1.14, P < .1), reading with room light illumination before retiring to sleep (OR = 0.55, 95% CI = 0.29-1.06, P < .07), and sleeping with closed shutters during the night (OR
Keshet-Sitton, Atalya; Or-Chen, Keren; Yitzhak, Sara; Tzabary, Ilana; Haim, Abraham
Women are exposed to indoor and outdoor artificial light at night (ALAN) in urban and rural environments. Excessive exposure to hazardous ALAN containing short wavelength light may suppress pineal melatonin production and lead to an increased breast cancer (BC) risk. Our objective was to address the differences in BC risks related to light exposure in urban and rural communities. We examined indoor and outdoor light habits of BC patients and controls that had lived in urban and rural areas in a 5-year period, 10 to 15 years before the time of the study. Individual data, night time sleeping habits and individual exposure to ALAN habits were collected using a questionnaire. A total of 252 women (110 BC patients and 142 controls) participated in this study. The sample was divided to subgroups according to dwelling area and disease status. Age matching was completed between all subgroups. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated for urban and rural women separately, using binary logistic regression. OR results of urban population (92 BC patients and 72 control) revealed that BC risk increases with daily use of cellphone (OR = 2.13, 95% CI = 1.01-4.49, P < .05) and residence near strong ALAN sources (OR = 1.51, 95% CI = 0.99-2.30, P < .06). Nevertheless, BC risk decreases if a woman was born in Israel (OR = 0.44, 95% CI = 0.21-0.93, P < .03), longer sleep duration (OR = 0.75, 95% CI = 0.53-1.05, P < .1), and reading with bed light illumination before retiring to sleep (OR = 0.77, 95% CI = 0.61-0.96, P < .02). Furthermore, in the rural population (18 BC patients and 66 control) BC risk increases with the number of years past since the last menstruation (OR = 1.12, 95% CI = 1.03-1.22, P < .01). However, BC risk decreases with longer sleep duration (OR = 0.53, 95% CI = 0.24-1.14, P < .1), reading with room light illumination before retiring to sleep (OR = 0.55, 95% CI = 0.29-1.06, P < .07), and sleeping with closed shutters during the night (OR
Abidoye, R. O.; Olukoya, A. A.
Compared blood screening data for 200 urban and rural pregnant women in Nigeria. Found that rural subjects had a greater incidence of moderate anemia than did urban subjects, and corpuscular hemoglobin concentrations fell with increased gestational age. No relationship was found between hemoglobin counts and nutrition habits. (HTH)
Purpose. To test the impact of two home visiting curricula on postnatal physical activity in rural, Southern, African American mothers. Design. Randomized controlled trial. Setting. Three rural counties in Mississippi. Subjects. Between September 2013 and May 2016, 54 postpartum women randomized...
Antić, Ljiljana; Djikanović, Bosiljka; Vuković, Dejana
Family planning is an important aspect of population policy at the state level, because the demographic trends in Serbia are very unfavorable. The objective of this study was to examine the differences in family planning between the women in rural and urban areas of Serbia. This study represents the secondary analysis of the National Health Survey of the population in Serbia from 2006, which was conducted as a cross sectional study, on a representative sample of the population. The respondents who used condoms as a method of contraception, were often younger, better educated, had better financial status, lived in Vojvodina, and had no children. Our study showed that there were differences in terms of family planning between the women of urban and rural areas, however, these differences could be explained by differences in age and education.
Schoenfeld, Naomi; Juarbe, Teresa C
In this ethnographic study, we describe the perceived health needs and resources of women in two rural Ecuadorian communities. Nineteen women participated in semistructured interviews. Women worked 3 to 30 hours outside the home each week but described their financial resources as insufficient. Most participants perceived their health as fair to poor. Four themes emerged related to the participants' health needs: (1) lack of money, (2) "it's better to be alone," (3) the physical burden of women's roles, and (4) suffering/self-sacrifice. Traditional medicine, local experts in traditional remedies, and nutrition emerged as resources to prevent illness. We believe our results offer valuable information in facilitating participatory health projects for social change.
Stal, Karen Berit; Pallangyo, Pedro; van Elteren, Marianne; van den Akker, Thomas; van Roosmalen, Jos; Nyamtema, Angelo
To assess perceptions of the quality of obstetric care of women who delivered in a rural Tanzanian referral hospital. A descriptive-exploratory qualitative study, using semistructured in-depth interviews and participatory observation. Nineteen recently delivered women and 3 health workers were interviewed. Although most women held positive views about the care they received in hospital, several participants expressed major concerns about negative attitudes of healthcare workers. Lack of medical communication given by care providers constituted a major complaint. A more positive attitude by health workers and the provision of adequate medical information may promote a more positive hospital experience of women in need of obstetric care and enhance attendance. © 2015 John Wiley & Sons Ltd.
Baturka, N; Hornsby, P P; Schorling, J B
To increase understanding of body image among rural, African-American women through open-ended interviews. Individuals' perceptions of body image were investigated using open-ended, in-depth interviews that were tape-recorded, transcribed, and analyzed to identify common themes and to compare thematic data across three body mass index categories (obese, overweight, and normal). University-affiliated rural community health center. Twenty-four African-American women, aged 21 to 47 years. Respondents reported the following common themes: dissatisfaction with current weight; fluctuating levels of dissatisfaction (including periods of satisfaction); family and social pressure to be self-accepting; and social and physical barriers to weight loss. The interviews revealed ambivalence and conflicts with regard to body image and weight. Among these women, there was strong cultural pressure to be self-accepting of their physical shape, to "be happy with what God gave you," and to make the most of their appearance. The pressure to be self-accepting often conflicted with these obese women's dissatisfaction with their own appearance and weight. Although the respondents believed they could lose weight "if [they] put [their] mind to it," those women wanting to lose weight found that they lacked the necessary social support and resources to do so. The conflicts stemming from social pressures and their own ambivalence may result in additional barriers to the prevention of obesity, and an understanding of these issues can help health care providers better address the needs of their patients.
Amin, R; Becker, S; Bayes, A
Nongovernmental organizations (NGOs) in rural Bangladesh are reaching out to poor women with collateral-free credit programs aimed at both alleviating poverty and increasing women's status. The present study investigated the hypothesis that participation in credit-related activities by NGO credit members leads to greater empowerment of credit members compared to nonmembers. The sample was comprised of 1164 loanees and 1200 nonloanees from the five NGO areas in Bangladesh and of 1200 nonloanees from non-program areas of rural Bangladesh with no significant NGO presence. NGO credit members had significantly higher scores on all three indices of female empowerment: inter-spouse consultation, autonomy, and authority. Moreover, nonmembers within NGO program areas had higher autonomy and authority scores than nonmembers within the comparison areas. Even after background variables were controlled in the multivariate analysis, NGO credit membership and residence in an NGO program area remained significantly and positively associated with both the autonomy and authority indices. Other variables that exerted a significant positive effect on women's empowerment were concrete or corrugated buildings, area of residence outside the southern or eastern regions, nonagricultural occupation, respondent's education, and age. In focus group discussions, NGO credit loanees reported that the program made them more confident, assertive, intelligent, self-reliant, and aware of their rights. NGO credit programs that target poor women are likely to produce substantial improvements in women's social and economic status, without the long delays associated with education or employment opportunities in the formal sector.
Muula, Adamson S; Thomas, James C; Pettifor, Audrey E; Strauss, Ronald P; Suchindran, Chirayath M; Meshnick, Steve R
Correct and consistent condom use within an HIV-discordant partnership could prevent sexual transmission of human immunodeficiency virus (HIV). Data on ever-married women from rural Malawi were obtained from the Malawi Diffusion and Ideational Change Project (MDICP) of 2006. We assessed the strength of association between religion and acceptability of condom use within marriage in general and also when one of the partners is suspected or known to be HIV infected. A total of 1,664 ever-married women participated in the MDICP 2006. Of these, 66.7% believed condom use was acceptable within marriage when one partner suspects or knows that the other was HIV infected; 38.2% believed condoms were acceptable within marriage generally. Only 13.8% reported ever having used condoms within the current or most recent marriage. Multivariate analysis found no difference in acceptability of condoms within marriage between Christians and Muslims, or between Catholics and all but one of the individual denominations assessed. Christian women in rural Malawi were no more or no less likely to accept condom use than Muslim women; there was also no difference in attitude toward condom use within marriage among Malawian women.
Bhandari, Shreya; Bullock, Linda F. C.; Richardson, Jeanita W.; Kimeto, Pamela; Campbell, Jacquelyn C.; Sharps, Phyllis W.
A subsample of 12 African American women (6 urban and 6 rural) were selected from a larger longitudinal, randomized control trial, Domestic Violence Enhanced Home Visitation (DOVE-R01 900903 National Institute of Nursing Research [NINR]/National Institutes of Health [NIH]). All African American women were chosen to control for any racial- and/or race-related cultural differences that may exist among women across geographical areas. The experiences of abuse during the perinatal period are drawn from in-depth interviews conducted at five points in time during pregnancy and the post-partum period. The analysis describes three major themes that highlight the similarities and differences among rural and urban women. The main themes found were (1) types of abuse, (2) location of abuse, and (3) response to abuse. In addition, two sub-themes (a) defiance and compliance and (b) role of children were also identified. Implications for universal screening for women of reproductive age, safer gun laws, and the need for further research are discussed. PMID:25315478
Neufeld, Lynnette M; Haas, Jere D; Grajéda, Ruben; Martorell, Reynaldo
The accurate estimation of gestational age in field studies in rural areas of developing countries continues to present difficulties for researchers. Our objective was to determine the best method for gestational age estimation in rural Guatemala. Women of childbearing age from four communities in rural Guatemala were invited to participate in a longitudinal study. Gestational age at birth was determined by an early second trimester measure of biparietal diameter, last menstrual period (LMP), the Capurro neonatal examination and symphysis-fundus height (SFH) for 171 women-infant pairs. Regression modelling was used to determine which method provided the best estimate of gestational age using ultrasound as the reference. Gestational age estimated by LMP was within +/-14 days of the ultrasound estimate for 94% of the sample. LMP-estimated gestational age explained 46% of the variance in gestational age estimated by ultrasound whereas the neonatal examination explained only 20%. The results of this study suggest that, when trained field personnel assist women to recall their date of LMP, this date provides the best estimate of gestational age. SFH measured during the second trimester may provide a reasonable alternative when LMP is unavailable.
Pérez-Fernández, M Reyes; Almazán Ortega, Raquel; Martínez Portela, José M; Alves Pérez, M Teresa; Segura-Iglesias, M Carmen; Pérez-Fernández, Román
The probability of developing osteoporosis decreases with an adequate supply of vitamin D, a balanced diet, and increased physical activity. In this study, we evaluated whether an educational intervention improves osteoporosis-related behavior in perimenopausal women from rural areas. A randomized experimental evaluation was performed of an educational intervention. The variables were physical activity, calcium intake and sun exposure in women from rural areas aged 45-54 years (n=216) at time 0 and 12 months after the educational intervention. In the control group (n=106), the information was sent by surface mail (month 0). In the intervention group (n=110), two interactive workshops were given (month 0). The topic of the workshops and the information sent by surface mail was healthy habits for osteoporosis prevention. After 12 months, the intervention group, but not the control group, had increased their physical activity (p=0.006), sun exposure (p=0.029), and calcium intake (53% to 64%). A simple educational intervention in perimenopausal women from rural areas improved healthy habits for osteoporosis prevention. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.
Thwala, Siphiwe B P; Holroyd, Eleanor; Jones, Linda K
This study explores and describes the values, beliefs, and practices of rural Swazi women regarding childbearing in the postpartum period. A retrospective ethnographic research design was used. A snowballing sampling method was used to recruit fifteen participants. Face-to-face unstructured audio-taped interviews and field notes were utilised to gather data. Results showed that rural Swazi women held a dual health belief system of modern and traditional medicinal use; practiced lengthy periods of postpartum confinement; customarily gave regular enemas and traditional medicines to their babies; undertook the specific cultural practice of taking the baby to enyonini [a tree struck by lightening] to perform specific rituals; used self-prescribed pharmacy medicines; used both traditional and modern contraception; as well as practiced breastfeeding. Rural Swazi women observe modern health practices alongside traditional customary practices that are inherent to their health belief and value systems in the postnatal period. These customary beliefs and values underpin their birth practices postpartum. Recommendations include the need to consider including formal knowledge on cultural aspects of childbirth and postpartum care into midwifery education; a review of maternal care practices and policies to incorporate widely practised traditional elements including redressing the use of self-prescribed pharmacy medicines to ensure a higher level of safety. Copyright © 2011 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Kincaid, Shannon D.
Women have historically been underrepresented in the fields of science, technology, engineering, and math (STEM fields). The underrepresentation of women in STEM may be attributable to a variety of factors. These may include different choices men and women typically make in response to incentives in STEM education. For example, STEM career paths may be less accommodating to people who are less resilient. Another factor may be that there are relatively few female STEM role models. Perhaps strong gender stereotypes discourage women from pursuing STEM education and STEM jobs. The factors that contribute to success and the barriers that impeded success must be identified before any steps can be taken to improve the educational outcomes for women in STEM disciplines. Consequently, relatively little is known about the role of resilience in academically successful adult women in rural community colleges enrolled in STEM disciplines and the mechanisms that underlie the performance deficits that occur as a result of stereotype threat effect. This mixed method study addressed those knowledge gaps by determining: (1) if high resilience is positively correlated to high grade point average for women enrolled in STEM disciplines in rural community colleges in North Carolina, and (2) if stereotype threat effect is a risk factor for these women. Quantitative data were collected by using "The Resilience Scale" (Wagnild & Young, 1987) and through examination of grade point average of students from Datatel data management software. Qualitative data were collected through semi-structured focus group interviews. Findings from this study indicate high resilience is positively correlated to high grade point average for women enrolled in STEM disciplines in rural community colleges in North Carolina, and stereotype threat effect was a risk factor for low-scoring women (i.e. those women who reported resilience scores less than 121 and grade point averages lower than 2.70) and was not a
Searle, Jennifer; Goldberg, Lisa; Aston, Megan; Burrow, Sylvia
Participant narratives from a feminist and queer phenomenological study aim to broaden current understandings of trauma. Examining structural marginalisation within perinatal care relationships provides insights into the impact of dominant models of care on queer birthing women. More specifically, validation of queer experience as a key finding from the study offers trauma-informed strategies that reconstruct formerly disempowering perinatal relationships. Heteronormativity governs birthing spaces and presents considerable challenges for queer birthing women who may also have an increased risk of trauma due to structurally marginalising processes that create and maintain socially constructed differences. Analysis of the qualitative data was guided by feminist and queer phenomenology. This was well suited to understanding queer women's storied narratives of trauma, including disempowering processes of structural marginalisation. Semistructured and conversational interviews were conducted with a purposeful sample of thirteen queer-identified women who had experiences of birthing in rural Nova Scotia, Canada. Validation was identified as meaningful for queer women in the context of perinatal care in rural Nova Scotia. Offering new perspectives on traditional models of assessment provide strategies to create a context of care that reconstructs the birthing space insofar as women at risk do not have to come out as queer in opposition to the expectation of heterosexuality. Normative practices were found to further the effects of structural marginalisation suggesting that perinatal care providers, including nurses, can challenge dominant models of care and reconstruct the relationality between queer women and formerly disempowering expectations of heteronormativity that govern birthing spaces. New trauma-informed assessment strategies reconstruct the relationality within historically disempowering perinatal relationships through potentiating difference which avoids
Routray, Parimita; Torondel, Belen; Clasen, Thomas; Schmidt, Wolf-Peter
While women and girls face special risks from lack of access to sanitation facilities, their ability to participate and influence household-level sanitation is not well understood. This paper examines the association between women's decision-making autonomy and latrine construction in rural areas of Odisha, India. We conducted a mixed-method study among rural households in Puri district. This included a cross sectional survey among 475 randomly selected households. These were classified as either having a functional latrine, a non-functional latrine or no latrine at all. We also conducted 17 in-depth interviews and 9 focus group discussions among household members of these three categories of households. Decisions on the construction of household level sanitation facilities were made exclusively by the male head in 80% of households; in 11% the decision was made by men who consulted or otherwise involved women. In only 9% of households the decision was made by women. Households where women were more involved in general decision making processes were no more likely to build a latrine, compared to households where they were excluded from decisions. Qualitative research revealed that women's non-involvement in sanitation decision making is attributed to their low socio-economic status and inability to influence the household's financial decisions. Female heads lacked confidence to take decisions independently, and were dependent on their spouse or other male family members for most decisions. The study revealed the existence of power hierarchies and dynamics within households, which constrained female's participation in decision-making processes regarding sanitation. Though governments and implementers emphasize women's involvement in sanitation programmes, socio-cultural factors and community and household level dynamics often prevent women from participating in sanitation-related decisions. Measures are needed for strengthening sanitation policies and effective
Sánchez-Moreno, Marita; López-Yáñez, Julián; Altopiedi, Mariana
This article discusses the results obtained by two consecutive enquiries into the leadership styles and training needs of women and men leading higher education organisations. It compares the findings of the first stage of two studies, based on ad hoc questionnaires responded to by 136 women and 129 men. Results showed only subtle differences…
van Teijlingen, Edwin; Raja, Edwin Amalraj; Dhakal, Keshar Bahadur
In Nepal, most births take place at home, and many, particularly in rural areas, are not attended by a skilled birth attendant. The main objectives of the study were to assess the use of skilled delivery care and barriers to access such care in a rural community and to assess health problems during delivery and seeking care. This cross-sectional study was carried out in two Village Development Committees in Nepal in 2006. In total, 150 women who had a live birth in the 24 months preceding the survey were interviewed using a structured questionnaire. The sample population included married women aged 15-49 years. Forty-six (31%) women delivered their babies at hospital, and 104 (69%) delivered at home. The cost of delivery at hospital was significantly (p<0.001) higher than that of a delivery at home. Results of univariate analysis showed that women from Brahmin-Chhetri ethnicity, women with higher education or who were more skilled, whose husbands had higher education and more skilled jobs, had first or second childbirth, and having adverse previous obstetric history were associated with institutional delivery while women with higher education and having an adverse history of pregnancy outcome predicted the uptake of skilled delivery care in Nepal. The main perceived problems to access skilled delivery care were: distance to hospital, lack of transportation, lack of awareness on delivery care, and cost. The main reasons for seeking intrapartum care were long labour, retained placenta, and excessive bleeding. Only a quarter of women sought care immediately after problems occurred. The main reasons seeking care late were: the woman or her family not perceiving that there was a serious problem, distance to health facility, and lack of transport. The use of skilled birth attendants at delivery among rural women in Nepal is very poor. Home delivery by unskilled birth attendants is still a common practice among them. Many associated factors relating to the use of skilled
Dhakal, Sulochana; van Teijlingen, Edwin; Raja, Edwin Amalraj; Dhakal, Keshar Bahadur
In Nepal, most births take place at home, and many, particularly in rural areas, are not attended by a skilled birth attendant. The main objectives of the study were to assess the use of skilled delivery care and barriers to access such care in a rural community and to assess health problems during delivery and seeking care. This cross-sectional study was carried out in two Village Development Committees in Nepal in 2006. In total, 150 women who had a live birth in the 24 months preceding the survey were interviewed using a structured questionnaire. The sample population included married women aged 15-49 years. Forty-six (31%) women delivered their babies at hospital, and 104 (69%) delivered at home. The cost of delivery at hospital was significantly (p < 0.001) higher than that of a delivery at home. Results of univariate analysis showed that women from Brahmin-Chhetri ethnicity, women with higher education or who were more skilled, whose husbands had higher education and more skilled jobs, had first or second childbirth, and having adverse previous obstetric history were associated with institutional delivery while women with higher education and having an adverse history of pregnancy outcome predicted the uptake of skilled delivery care in Nepal. The main perceived problems to access skilled delivery care were: distance to hospital, lack of transportation, lack of awareness on delivery care, and cost. The main reasons for seeking intrapartum care were long labour, retained placenta, and excessive bleeding. Only a quarter of women sought care immediately after problems occurred. The main reasons seeking care late were: the woman or her family not perceiving that there was a serious problem, distance to health facility, and lack of transport. The use of skilled birth attendants at delivery among rural women in Nepal is very poor. Home delivery by unskilled birth attendants is still a common practice among them. Many associated factors relating to the use of
Whitfield, Kyly C; Karakochuk, Crystal D; Liu, Yazheng; McCann, Adrian; Talukder, Aminuzzaman; Kroeun, Hou; Ward, Mary; McNulty, Helene; Lynd, Larry D; Kitts, David D; Li-Chan, Eunice C Y; McLean, Judy; Green, Timothy J
Thiamin deficiency in infancy is the underlying cause of beriberi, which can be fatal without rapid treatment. Reports of thiamin deficiency are common in Cambodia; however, population representative data are unavailable. Because B-complex vitamin deficiencies commonly occur in combination, riboflavin was also investigated. We determined the biomarker status of thiamin and riboflavin in women of childbearing age in rural and urban Cambodia. We measured thiamin (erythrocyte thiamin diphosphate; TDP) and riboflavin (erythrocyte glutathione reductase activity coefficient; EGRac) status in a representative sample of Cambodian women (aged 20-45 y) in urban Phnom Penh (n = 146) and rural Prey Veng (n = 156), Cambodia, and, for comparison purposes, in a convenience sample of women in urban Vancouver, British Columbia, Canada (n = 49). Thiamin insufficiency (TDP ≤ 90 nmol/L) was common among both urban (39%) and rural (59%) Cambodian women (P < 0.001), whereas <20% of Vancouver women were thiamin insufficient (P < 0.001). The prevalence of suboptimal and deficient riboflavin status (EGRac ≥ 1.3) was 89%, 92%, and 70% among women in Phnom Penh, Prey Veng, and Vancouver, respectively (P < 0.001). Suboptimal status of both thiamin and riboflavin were common in Cambodian women, with substantially higher rates among women living in rural Prey Veng than in urban Phnom Penh. Strategies may be needed to improve the thiamin and riboflavin status of women in Cambodia. The unexpected finding of high riboflavin inadequacy status in Vancouver women warrants further investigation. © 2015 American Society for Nutrition.
Fisher, Jane; Tran, Thach Duc; Biggs, Beverley; Dang, Tho Hai; Nguyen, Trang Thu; Tran, Tuan
Intimate partner violence against women (IPV) is regarded increasingly as a public health problem worldwide. The overall aim of this study was to examine the associations between different exposures to IPV and women's mental health during pregnancy and after childbirth in rural Vietnam. This was a secondary analysis of data generated in a community-based longitudinal investigation in which a cohort of pregnant women were recruited and followed until 6 months after childbirth. Different forms of IPV were measured by the Intimate Partner Violence section of the WHO Multi-Country Study on Women's Health and Domestic Violence Against Women questionnaire. The Edinburgh Postnatal Depression Scale-Vietnam Validation was used to assess symptoms of the common perinatal mental disorders of depression and anxiety (CPMD). Overall, 497 women were recruited and complete data were available from 417 (83.9%). Exposure to either lifetime or perinatal IPV including emotional abuse, physical violence and sexual violence was associated with increased CPMD symptoms (adjusted odds ratio, OR, ranges 1.3-14.3) and suicidal thoughts (OR ranges 4.7-6.1) in women during pregnancy and after childbirth. Experiencing more than one form of IPV increased the magnitude of the association between IPV and CPMD symptoms and thoughts of suicide. It is clearly essential in this and other resource-constrained settings to address emotional, physical and sexual violence perpetrated by an intimate partner in any strategies to reduce the risk of perinatal mental health problems in women.
Chanda, Sanjoy Kumar; Howlader, Hasan; Nahar, Nasrin
The key focus of this study is to explain the level of education of married women and their participation in decision making process at different arena of rural household. To find out the nature of the reality, survey research design was used for this study. The study was conducted at Maharajpur, one of the unions of Jhenidah district in Bangladesh in 2011. The respondents of the study consisted of 120 married women who were purposively selected from the study area. Data were collected through direct interview method using an interview schedule. Data were shown on univariate, as well as bivariate statistical tables and then analyzed. The study reveals that a significant percent (93.3) of higher level of education completed women had their consent of getting married whereas no consent was made by illiterate women. In the same way 46.7 percent higher level of education completed women had high level of purchasing power in compare to illiterate (.0%) and primary (14.6%) level completed women for the same level of purchasing. In the political decision making 86.7 percent higher level of education completed women had own consent to vote for election in contrast to 77.8 percent illiterate and 70.7 percent primary level completed women were influenced by their husband to decide voting.
Mackert, Michael; Kahlor, Leeann; Silva, Kristi; Padilla, Yolanda
Hispanic women are 1.5-3 times as likely as non-Hispanic white women to have a child affected by neural tube defects. This disparity exists in spite of varied interventions designed to address the problem. The purpose of this research was to investigate Hispanic women's knowledge of folic acid, perceptions of existing education campaigns, and provide guidance for future promotion efforts. Three focus groups with Hispanic mothers (N = 18) were conducted to garner insights on these issues. Results suggested that these women understood the benefits of folic acid, did not see major cultural barriers to consuming folic acid-rich foods, and did not perceive insurmountable challenges to consuming a multivitamin with folic acid. For many women, an initial pregnancy served as their initial cue to action, suggesting a need for the continued development of education strategies that communicate the benefits of folic acid supplementation prior to pregnancy. Such strategies may necessitate targeting younger audiences, including teenagers.
Grigore, Mihaela; Popovici, Razvan; Pristavu, Anda; Grigore, Ana Maria; Matei, Mioara; Gafitanu, Dumitru
In 2012 the National Screening Program for all women between 25 and 64 years of age was launched in Romania. Public awareness is an important factor in the success of a screening program. For this reason, we intended to assess the perception and the level of awareness of Romanian women regarding the Pap test in the prevention of cervical cancer. A cross-sectional study was conducted among 454 women from rural and urban areas. For our study, we used a questionnaire covering general characteristics, awareness, knowledge and practices regarding cervical cancer and Pap smear. 431 participants (95%) had heard of cervical cancer and Pap smear but only 71.8% knew the exact role of it. Bivariate analysis showed that knowledge about the importance of the Pap smear, early detection and treatment of early-stage cervical cancer was reduced among women with low socio-economic status, mainly living in rural area. The most frequent reasons for avoiding Pap smear screening were: lack of money, embarrassment or fear of gynaecological consultation and pain, the feeling that they don't need it, misconceptions about cervical cancer, fatalistic attitude, perceived low susceptibility to cervical cancer. Because the uptake and the success of cervical cancer screening are determined by women's knowledge and awareness of Pap smear, it is critical to improve these perceptions in the near future especially in rural area characterized by a low socio-economic status. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Borrull-Guardeño, Jessica; Domínguez, Alberto; Merizalde-Torres, Milton H; Sánchez-Martínez, Vanessa
The incidence of invasive cervical cancer and its mortality have been reduced through primary and secondary prevention. Screening rates tend to be lower in vulnerable groups, such as people with severe mental disorders, who have a later detection of cancer and a higher mortality. The access of these women to cervical cancer screening is uncertain in our context. The aim of this study was to determine the cervical cancer screening rates in women with severe mental disorders. This was a descriptive cross-sectional study. Women 25 to 65 years old who were admitted during 2016 to the psychiatric unit of a public hospital in Spain were included in the study, and it was determined if they had had cervical cancer screening. A total of 103 eligible women, with a mean age of 45.6 years, were enrolled. Only 28 of the participants (27.2%) had had a cervical cancer screening done in the last 5 years. By age groups, statistically significant differences were found, with women between 35 and 44 years of age having higher rates of cervical cancer screening (41.9%) and the oldest, between 55 and 65 years of age, having the lowest (5%). Women with severe mental health disorders who were admitted to acute psychiatric care units had much lower cervical cancer screening rates compared with the general population. Mental health nurses could be the optimum professionals to promote cancer primary and secondary prevention in women with mental disorders.
Manyema, M; Norris, S A; Said-Mohamed, R; Tollman, S T; Twine, R; Kahn, K; Richter, L M
Approximately 25% of the world's population consists of young people. The experience of violence peaks during adolescence and the early adult years. A link between personal experience of violence and mental health among young people has been demonstrated but rural-urban differences in these associations are less well known in low to middle income countries. The aim of this study was to investigate the associations between interpersonal violence and psychological distress among rural and urban young women. Data on experiences of violence and psychological distress were collected from a total of 926 non-pregnant young women aged between 18 and 22 years of age in rural and urban sites in South Africa. The General Health Questionnaire-28 was used to assess psychological distress as an indicator of mental health. Generalised structural equation models were employed to assess potential pathways of association between interpersonal violence and psychological distress. Thirty-four percent of the urban young women (n = 161) reported psychological distress compared to 18% of rural young women (n = 81). In unadjusted analysis, exposure to interpersonal violence doubled the odds of psychological distress in the urban adolescents and increased the odds 1.6 times in the rural adolescents. In adjusted models, the relationship remained significant in the urban area only (OR 1.84, 95% CI 1.13-3.00). Rural residence seemed protective against psychological distress (OR 0.41, 95% CI 0.24-0.69). Structural equation modelling did not reveal any direct association between exposure to interpersonal violence and psychological distress among rural young women. Stressful household events were indirectly associated with psychological distress, mediated by violence among young women in the urban area. The relationship between violence and psychological distress differs between urban and rural-residing young women in South Africa, and is influenced by individual, household and community
Crosby, Richard A; Yarber, William L; DiClemente, Ralph J; Wingood, Gina M; Meyerson, Beth
This study compared HIV-associated sexual health history, risk perceptions, and sexual risk behaviors of low-income rural and nonrural African American women. A cross-sectional statewide survey of African American women (n = 571) attending federally funded Special Supplemental Nutrition Program for Women, Infants, and Children clinics was conducted. Adjusted analyses indicated that rural women were more likely to report not being counseled about HIV during pregnancy (P =.001), that a sex partner had not been tested for HIV (P =.005), no preferred method of prevention because they did not worry about sexually transmitted diseases (P =.02), not using condoms (P =.009), and a belief that their partner was HIV negative, despite lack of testing (P =.04). This study provided initial evidence that low-income rural African American women are an important population for HIV prevention programs.
Background Information concerning lipid disturbances in HIV-infected women on antiretroviral therapy (ART) is scarce. The objective of the study is to describe the lipid profile in a large cohort of HIV-infected women on contemporary ART and analyse differences between regimes and patient's characteristics. Methods Observational, multicentre, cross-sectional study from the Spanish VACH Cohort. 922 women on stable ART without lipid-lowering treatment were included. Results Median age was 42 years, median CD4 lymphocyte count was 544 cells/mm3, and 85.6% presented undetectable HIV-1 viral load. Median total cholesterol (TC) was 189 mg/dL (interquartile range, IQR, 165-221), HDL cholesterol 53 mg/dL (IQR, 44-64), LDL cholesterol 108 mg/dL (IQR, 86-134), and triglycerides 116 mg/dL (IQR, 85-163). Mean accumulated time on ART was 116 months; 47.4% were on NNRTI-based regimes, 44.7% on PI, and 6.7% on only-NRTI therapy. 43.8% were also hepatitis C (HCV) coinfected. Patients on PI treatment presented higher TC/HDL ratio than those on NNRTI (p < 0.001). Significantly higher HDL values were observed in NNRTI-treated patients. HCV-coinfected patients presented lower TC/HDL ratio than the non HCV-coinfected. In multivariate analysis, factors independently associated with TC/HDL ratio were age, triglyceride levels and HCV co-infection. PI treatment presented a non-significant association with higher TC/HDL ratio. Conclusions In HIV-infected women, the NNRTI-based ART is associated with a better lipid profile than the PI-based. Factors unrelated to ART selection may also exert an independent, significant influence on lipids; in particular, age, and triglyceride levels are associated with an increased TC/HDL ratio while HCV co-infection is associated with a reduced TC/HDL ratio. PMID:21816091
Kelly-Hanku, A; Aeno, H; Wilson, L; Eves, R; Mek, A; Nake Trumb, R; Whittaker, M; Fitzgerald, L; Kaldor, J M; Vallely, A
Sexual violence against women and girls is commonplace in Papua New Guinea (PNG). While the experiences of women are rightly given central place in institutional responses to sexual violence, the men who perpetrate violence are often overlooked, an oversight that undermines the effectiveness of prevention efforts. This paper draws on interviews conducted with young men as part of a qualitative longitudinal study of masculinity and male sexuality in a rural highland area of PNG. It explores one aspect of male sexuality: men's narratives of sexual violence. Most striking from the data is that the collective enactment of sexual violence against women and girls is reported as an everyday and accepted practice amongst young men. However, not all women and girls were described as equally at risk, with those who transgress gender roles and roles inscribed and reinforced by patriarchal structures, at greater risk. To address this situation, efforts to reduce sexual violence against women and girls require an increased focus on male-centred intervention to critically engage with the forms of patriarchal authority that give license to sexual violence. Understanding the perceptions and experiences of men as perpetrators of sexual violence is a critical first step in the process of changing normative perceptions of gender, a task crucial to reducing sexual violence in countries such as PNG.
Barrera, Alinne Z.; Wickham, Robert E.; Muñoz, Ricardo F.
Background Postpartum depression (PPD) is a maternal mental health problem that affects women from all regions of the world. Unfortunately, even in developed countries, half of the cases go undetected and, consequently, untreated. Individuals from low and middle income countries trend toward underutilization of mental health services, partly due to the limited number of available psychological resources. The primary aims of this pilot randomized controlled trial were to adapt to the Internet the Mothers and Babies Course/Curso Mamás y Bebés, a prevention of PPD intervention, to describe the characteristics of the pregnant women who engaged in the intervention site, and to obtain preliminary data on the efficacy of the Internet intervention to reduce the risk of PPD. Methods Pregnant women, 18 years or older who were interested in using the site for themselves were recruited and randomly assigned to a fully-automated self-help Internet intervention or to an information-only control condition. Randomized participants were invited to complete monthly depression assessments up to six months postpartum. To examine the prevention effects of the Internet intervention, pregnant women who did not meet current criteria for a major depressive episode, who engaged with the study website, and who provided depression data during the postpartum follow-up period were included in the study analyses. Results Participants were 111 predominantly Spanish-speaking (82.9%) and Latino/Hispanic (71.3%) pregnant women residing in 23 countries worldwide. The effect of the prevention intervention condition failed to reach significance at the a priori alpha-level. However, the observed coefficient trended in the hypothesized direction (b = −0.514, χ2 (1) = 3.43, p = .061; HR = 0.598). The benefits of receiving the e-MB Internet intervention was greater for pregnant women reporting high (vs. low) levels of prenatal depression symptoms (b = −0.605, χ2 (1) = 5.20, p =.023). Conclusions
Staton-Tindall, Michele; Harp, Kathi L H; Minieri, Alexandra; Oser, Carrie; Webster, J Matthew; Havens, Jennifer; Leukefeld, Carl
Rural women, particularly those in the criminal justice system, are at risk for HIV related to the increasing prevalence of injection drug use as well as limited services. Research on HIV risk correlates, including drug use and mental health, has primarily focused on urban women incarcerated in prisons. The purpose of this exploratory study is to examine dual HIV risk by 3 different mental health problems (depression, anxiety, and posttraumatic stress disorder [PTSD]) among drug-using women in rural jails. This study involved random selection, screening, and face-to-face interviews with 136 women in 1 Appalachian state. Analyses focused on the relationship between mental health and HIV risk. Nearly 80% of women self-reported symptoms of depression, and more than 60% endorsed symptoms consistent with anxiety and PTSD symptoms. Mental health significantly correlated with severity of certain types of drug use, as well as risky sexual activity. In addition, for women experiencing anxiety and PTSD, injection drug use moderated the relationship between mental health and risky sexual activity. Based on these rates of drug use, mental health problems, and the emergence of injection drug use in rural Appalachia, the need to explore the relationships between these issues among vulnerable and understudied populations, such as rural women, is critical. Because of service limitations in rural communities, criminal justice venues such as jails provide opportune settings for screening, assessment, and intervention for drug use, mental health, and HIV education and prevention. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
Lai, Li-Jung; Chou, Chia-Lin; Su, H Irene; Chen, Tzeng-Ji; Chou, Li-Fang; Chou, Yueh-Ching; Hwang, Shinn-Jang; Yu, Hann-Chin
Background A shortage of gynecologists exists in many countries. Even within an affluent country, gynecological clinics might not be evenly distributed. The purpose of the study was to investigate the disparity in gynecological care between adult women living in towns with and without gynecologists in Taiwan. Methods Data sources were the cohort datasets of the National Health Insurance Research Database, with claims data of 1 million beneficiaries in 2010. A woman’s residency was operationally inferred from the locations where she had most frequently visited physicians’ clinics or local community hospitals within the year. Results In Taiwan, 145 (39.4%) of 368 towns had no practicing gynecologist. Of 382,167 women with health care use in the datasets, 21,794 (5.7%) lived in towns without a gynecologist. The overwhelming majority of these towns lay in sparsely populated, rural areas. During the year, 132,702 women (34.7%) had sought medical help for gynecological diseases and 113,698 (29.8%) had visited gynecologists for gynecological diseases. Women in towns without a gynecologist were less likely to consult for gynecological diseases (23.8% versus 35.4%; P<0.001) and visit gynecologists (18.7% versus 30.4%; P<0.001) than women in towns with a gynecologist. The disparity existed in each age group. Among 5,189 adult women living in towns without a gynecologist and having gynecological diseases, 78.5% (number [n]=4,074) visited gynecologists out of town, especially for infertility, benign disorders of the uterus and ovaries, gynecological examinations, and contraceptive problems, and by contrast 23.3% (n=1,209) visited nongynecologists in town, most commonly for menopausal disorders, endometriosis and pelvic pain, menstrual disorders and hormonal dysfunction, and genital dysplasia. Conclusion Gynecological care of rural women was adversely affected by the shortage of gynecologists. The consequences of accessibility in underserved areas deserve further
Lai, Li-Jung; Chou, Chia-Lin; Su, H Irene; Chen, Tzeng-Ji; Chou, Li-Fang; Chou, Yueh-Ching; Hwang, Shinn-Jang; Yu, Hann-Chin
A shortage of gynecologists exists in many countries. Even within an affluent country, gynecological clinics might not be evenly distributed. The purpose of the study was to investigate the disparity in gynecological care between adult women living in towns with and without gynecologists in Taiwan. Data sources were the cohort datasets of the National Health Insurance Research Database, with claims data of 1 million beneficiaries in 2010. A woman's residency was operationally inferred from the locations where she had most frequently visited physicians' clinics or local community hospitals within the year. In Taiwan, 145 (39.4%) of 368 towns had no practicing gynecologist. Of 382,167 women with health care use in the datasets, 21,794 (5.7%) lived in towns without a gynecologist. The overwhelming majority of these towns lay in sparsely populated, rural areas. During the year, 132,702 women (34.7%) had sought medical help for gynecological diseases and 113,698 (29.8%) had visited gynecologists for gynecological diseases. Women in towns without a gynecologist were less likely to consult for gynecological diseases (23.8% versus 35.4%; P<0.001) and visit gynecologists (18.7% versus 30.4%; P<0.001) than women in towns with a gynecologist. The disparity existed in each age group. Among 5,189 adult women living in towns without a gynecologist and having gynecological diseases, 78.5% (number [n]=4,074) visited gynecologists out of town, especially for infertility, benign disorders of the uterus and ovaries, gynecological examinations, and contraceptive problems, and by contrast 23.3% (n=1,209) visited nongynecologists in town, most commonly for menopausal disorders, endometriosis and pelvic pain, menstrual disorders and hormonal dysfunction, and genital dysplasia. Gynecological care of rural women was adversely affected by the shortage of gynecologists. The consequences of accessibility in underserved areas deserve further investigation.
Barefoot, K Nikki; Warren, Jacob C; Smalley, K Bryant
Previous research has consistently demonstrated that, in comparison to their cisgender heterosexual counterparts, lesbians face a multitude of women's healthcare-related disparities. However, very little research has been conducted that takes an intersectionality approach to examining the potential influences of rural-urban location on the health-related needs and experiences of lesbians. The purpose of this study was to quantitatively compare rural and urban lesbians' access to women's health care, experiences with women's healthcare providers (WHCPs), and preventive behavior using a large, diverse sample of lesbians from across the USA. A total of 895 (31.1% rural and 68.9% urban) lesbian-identified cisgender women (ie not transgender) from the USA participated in the current online study. As part of a larger parent study, participants were recruited from across the USA through email communication to lesbian, gay, bisexual, and transgender (LGBT)-focused organizations and online advertisements. Participants were asked to complete a series of questions related to their women's healthcare-related experiences and behaviors (ie access to care, experiences with WHCPs, and preventive behavior). A series of χ2 analyses were utilized in order to examine rural-urban differences across dependent variables. An examination of sexual risks revealed that relatively more rural lesbians reported at least one previous male sexual partner in comparison to the urban sample of lesbians (78.1% vs 69.1%, χ2(1, N=890)=7.56, p=0.006). A similarly low percentage of rural (42.4%) and urban (42.9%) lesbians reported that they have a WHCP that they see on a regular basis for preventive care. In terms of experiences with WHCP providers, relatively fewer rural lesbians indicated that their current WHCP had discussed/recommended the human papillomavirus (HPV) vaccination in comparison to urban lesbians (27.5% vs. 37.2%; χ2 (1, N=796)=7.24, p=0.007). No other
Background High-risk strains of human papillomavirus (HPV) cause cervical cancer. American Indian (AI) women in the Northern Plains of the U.S. have significantly higher incidence and mortality rates for cervical cancer than White women in the same geographical area. We compared HPV prevalence, patterns of HPV types, and infection with multiple HPV types in AI and White women living in South Dakota, U.S. Methods We analyzed the HPV status of cervical samples collected in 2006-2008 from women aged 18-65 years who attended two rural AI reservation clinics (n = 235) or an urban clinic in the same area serving mostly White women (n = 246). Data collection occurred before HPV vaccination was available to study participants. HPV DNA was amplified by using the L1 consensus primer system and an HPV Linear Array detection assay to identify HPV types. We used chi-square tests to compare HPV variables, with percentages standardized by age and lifetime number of sexual partners. Results Compared to White women, AI women were younger (p = 0.01) and reported more sexual partners (p < 0.001). A lower percentage of AI women tested negative for HPV infection compared to Whites (58% [95% CI = 51-65] vs. 77% [95% CI = 71-82]; p < 0.001), and a higher percentage of AI women were infected by oncogenic types (30% [95% CI = 25-36] vs. 16% [95% CI = 11-21]; p = 0.001). Infections among AI women showed a wider variety and very different pattern of HPV types, including a higher prevalence of mixed HPV infections (19% [95% CI = 26-38] vs. 7% [95% CI = 4-11]; p = 0.001). AI women had a higher percentage of HPV infections that were not preventable by HPV vaccination (32% [95% CI = 26-38] vs. 15% [95% CI = 11-21]; p < 0.001). Conclusions A higher HPV burden and a different HPV genotyping profile may contribute to the high rate of cervical cancer among AI women. PMID:21943050
Schmidt-Grimminger, Delf C; Bell, Maria C; Muller, Clemma J; Maher, Diane M; Chauhan, Subhash C; Buchwald, Dedra S
High-risk strains of human papillomavirus (HPV) cause cervical cancer. American Indian (AI) women in the Northern Plains of the U.S. have significantly higher incidence and mortality rates for cervical cancer than White women in the same geographical area. We compared HPV prevalence, patterns of HPV types, and infection with multiple HPV types in AI and White women living in South Dakota, U.S. We analyzed the HPV status of cervical samples collected in 2006-2008 from women aged 18-65 years who attended two rural AI reservation clinics (n = 235) or an urban clinic in the same area serving mostly White women (n = 246). Data collection occurred before HPV vaccination was available to study participants. HPV DNA was amplified by using the L1 consensus primer system and an HPV Linear Array detection assay to identify HPV types. We used chi-square tests to compare HPV variables, with percentages standardized by age and lifetime number of sexual partners. Compared to White women, AI women were younger (p = 0.01) and reported more sexual partners (p < 0.001). A lower percentage of AI women tested negative for HPV infection compared to Whites (58% [95% CI = 51-65] vs. 77% [95% CI = 71-82]; p < 0.001), and a higher percentage of AI women were infected by oncogenic types (30% [95% CI = 25-36] vs. 16% [95% CI = 11-21]; p = 0.001). Infections among AI women showed a wider variety and very different pattern of HPV types, including a higher prevalence of mixed HPV infections (19% [95% CI = 26-38] vs. 7% [95% CI = 4-11]; p = 0.001). AI women had a higher percentage of HPV infections that were not preventable by HPV vaccination (32% [95% CI = 26-38] vs. 15% [95% CI = 11-21]; p < 0.001). A higher HPV burden and a different HPV genotyping profile may contribute to the high rate of cervical cancer among AI women.
Hannah, Chona T; Lê, Quynh
Access to health care services is vital for every migrant's health and wellbeing. However, migrants' cultural health beliefs and views can hinder their ability to access available services. This study examined factors affecting access to healthcare services for intermarried Filipino women in rural Tasmania, Australia. A qualitative approach using semi-structured interviews was employed to investigate the factors affecting access to healthcare services for 30 intermarried Filipino women in rural Tasmania. The study used grounded theory and thematic analysis for its data analysis. Nvivo v8 (www.qsrinternational.com) was also used to assist the data coding process and analysis. Five influencing factors were identified: (1) language or communication barriers; (2) area of origin in the Philippines; (3) cultural barriers; (4) length of stay in Tasmania; and (5) expectations of healthcare services before and after migration. Factors affecting intermarried Filipino women in accessing healthcare services are shaped by their socio-demographic and cultural background. The insights gained from this study are useful to health policy-makers, healthcare professionals and to intermarried female migrants. The factors identified can serve as a guide to improve healthcare access for Filipino women and other migrants.
Maternal mortality in Zimbabwe has unprecedentedly risen over the last two and half decades although a decline has been noted recently. Many reasons have been advanced for the rising trend, including deliveries without skilled care, in places without appropriate or adequate facilities to handle complications. The recent decline has been attributed to health systems strengthening through a multi-donor pooled funding mechanism. On the other hand, the proportion of community deliveries has also been growing steadily over the years and in this study we investigate why. We used twelve (12) focus group discussions with child-bearing women and eight (8) key informant interviews (KIIs). Four (4) were traditional birth attendants and four (4) were spiritual birth attendants. A thematic approach was used to analyse the data in Ethnography software. The study shows that women prefer community deliveries due to perceived low economic, social and opportunity costs involved; pliant and flexible services offered; and diminishing quality and appeal of institutional maternity services. We conclude that rural women are very economic, logical and rational in making choices on place of delivery. Delivering in the community offers financial, social and opportunity advantages to disenfranchised women, particularly in remote rural areas. We recommend for increased awareness of the dangers of community deliveries; establishment of basic obstetric care facilities in the community and more efficient emergency referral systems. In the long-term, there should be a sustainable improvement of the public health delivery system to make it accessible, affordable and usable by the public. PMID:28793315
Melton, Bridget; Marshall, Elaine; Bland, Helen; Schmidt, Michael; Guion, W Kent
Though the positive link between physical activity and maternal health is well documented, physical activity declines during pregnancy and, internationally, rural mothers are less likely than urban mothers to engage in physical activity. Some evidence suggests that self-efficacy is related to sustained engagement in physical activity. The purpose of this study was to examine self-efficacy, perceived benefits, and knowledge of safe exercise among 88 rural pregnant women in a southeastern region of the United States. Exercise self-efficacy was significantly related to maternal age and gestation. Women over age 26 years, and those in the second and third trimesters, scored significantly higher than younger women or those in the first trimester. Fifty-two percent (n = 46) of participants perceived that activity would decrease energy levels, 37.5% (n = 33) did not know that exercise can decrease the risk of gestational diabetes, and 47.6% (n = 41) were unaware that a mother who is overweight is more likely to have an overweight child. Results confirm a need for education to improve women's knowledge about health benefits and safety information related to physical activity during pregnancy. © 2013 Wiley Publishing Asia Pty Ltd.
Dodzo, Munyaradzi Kenneth; Mhloyi, Marvellous
Maternal mortality in Zimbabwe has unprecedentedly risen over the last two and half decades although a decline has been noted recently. Many reasons have been advanced for the rising trend, including deliveries without skilled care, in places without appropriate or adequate facilities to handle complications. The recent decline has been attributed to health systems strengthening through a multi-donor pooled funding mechanism. On the other hand, the proportion of community deliveries has also been growing steadily over the years and in this study we investigate why. We used twelve (12) focus group discussions with child-bearing women and eight (8) key informant interviews (KIIs). Four (4) were traditional birth attendants and four (4) were spiritual birth attendants. A thematic approach was used to analyse the data in Ethnography software. The study shows that women prefer community deliveries due to perceived low economic, social and opportunity costs involved; pliant and flexible services offered; and diminishing quality and appeal of institutional maternity services. We conclude that rural women are very economic, logical and rational in making choices on place of delivery. Delivering in the community offers financial, social and opportunity advantages to disenfranchised women, particularly in remote rural areas. We recommend for increased awareness of the dangers of community deliveries; establishment of basic obstetric care facilities in the community and more efficient emergency referral systems. In the long-term, there should be a sustainable improvement of the public health delivery system to make it accessible, affordable and usable by the public.
Nie, Peng; Sousa-Poza, Alfonso; Xue, Jianhong
There is evidence that household air pollution is associated with poor health in China, and that this form of air pollution may even be more of a health concern in China than the much-publicized outdoor air pollution. However, there is little empirical evidence on the relationship between household air pollution and health in China based on nationally representative and longitudinal data. This study examines the association between the type of domestic cooking fuel and the health of women aged ≥16 in rural China. Using longitudinal and biomarker data from the China Family Panel Studies (n = 12,901) and the China Health and Nutrition Survey (n = 15,539), we investigate the impact of three major domestic cooking fuels (wood/straw, coal, liquefied petroleum gas (LPG)) on health status using both cross-sectional and panel approaches. Compared to women whose households cook with dirty fuels like wood/straw, women whose households cook with cleaner fuels like LPG have a significantly lower probability of chronic or acute diseases and are more likely to report better health. Cooking with domestic coal instead of wood or straw is also associated with elevated levels of having certain risks (such as systolic blood pressure) related to cardiovascular diseases. Our study provides evidence that using cleaner fuels like LPG is associated with better health among women in rural China, suggesting that the shift from dirty fuels to cleaner choices may be associated with improved health outcomes.
Weinert, Clarann; Cudney, Shirley; Comstock, Bryan; Bansal, Aasthaa
Adapting to living with chronic conditions is a life-long psychosocial challenge. The purpose of this study was to report the effect of a computer intervention on the psychosocial adaptation of rural women with chronic conditions. A two-group study design was used with 309 middle-aged, rural women who had chronic conditions, randomized into either a computer-based intervention or a control group. Data were collected at baseline, at the end of the intervention, and 6 months later on the psychosocial indicators of social support, self-esteem, acceptance of illness, stress, depression, and loneliness. The impact of the computer-based intervention was statistically significant for five of six of the psychosocial outcomes measured, with a modest impact on social support. The largest benefits were seen in depression, stress, and acceptance. The women-to-women intervention resulted in positive psychosocial responses that have the potential to contribute to successful management of illness and adaptation. Other components of adaptation to be examined are the impact of the intervention on illness management and quality of life and the interrelationships among environmental stimuli, psychosocial response, and illness management.
Gunaratna, Nilupa S; Bosha, Tafese; Belayneh, Demissie; Fekadu, Tigist; De Groote, Hugo
For impact of nutritionally improved biofortified crops, consumer acceptance specifically by women and children is necessary when the target beneficiaries are young children. The objective was to assess women's and children's acceptance of a biofortified crop, quality protein maize (QPM), for complementary feeding in rural Ethiopia. Randomly sampled mothers (n = 61) of young children (6-24 months) evaluated flours from a QPM and a conventional maize variety for five sensory characteristics and overall acceptance by mother and child in a home use test with a double-blind, randomized controlled cross-over design. Women distinguished the varieties when used to prepare porridge, and QPM scored more favorably for texture in hand and mouth (both P < 0.05). The varieties did not differ in overall acceptance, which was, however, affected by order of presentation, mothers' number of children, and enumerators who collected data (all P < 0.05). Aroma and taste were key in mothers' acceptance, and appearance was further important for children. Women were more than twice as likely to prefer QPM over conventional maize. Consumer acceptance is unlikely to impede uptake and impact of QPM on young children's nutritional status. Home use testing proved feasible for assessing acceptance in rural areas with food insecurity and limited education. © 2015 Society of Chemical Industry. © 2015 Society of Chemical Industry.
Karim, K M Rabiul; Emmelin, Maria; Lindberg, Lene; Wamala, Sarah
Women-focused development initiatives have become a controversial issue connected with women's health and welfare. Previous studies indicated that development initiatives might increase women's workload, family conflict, and marital violence. This study explored the gendered characteristics of a development initiative Rural Mother Center in Bangladesh. Data incorporated policy document and interviews of social workers working with the mother centers in two northwest subdistricts. The qualitative content analysis of data emerged a general theme of expanding women's responsibility while maintaining male privilege explaining gendered design and practice of the development initiative. The theme was supported by two gendered categories related to the design: (a) essentializing women's participation; (b) maintaining traditional gender, and four categories related to the practice; (c) inadequate gender knowledge and skills; (d) reinforcing traditional gender; (e) using women for improving office performance; and (f) upholding male privilege. The study suggests that though women-focused development initiatives need to be embraced with gender-redistributive policies, the social workers should be trained for attaining gender-transformative motivation and competencies.
Cuca, Yvette P; Onono, Maricianah; Bukusi, Elizabeth; Turan, Janet M
Pregnant women who fear or experience HIV-related stigma may not get care for their own health or medications to reduce perinatal transmission of HIV. This study examined factors associated with anticipating and experiencing HIV-related stigma among 1777 pregnant women attending antenatal care clinics in rural Kenya. Women were interviewed at baseline, offered HIV testing and care, and a sub-set was re-interviewed at 4-8 weeks postpartum. Women who were older, had less education, whose husbands had other wives, and who perceived community discrimination against people with HIV had significantly greater adjusted odds of anticipating HIV stigma. Over half of the HIV-positive women interviewed postpartum reported having experienced stigma, much of which was self-stigma. Women experiencing minor depression, and those whose family knew of their HIV status had significantly greater adjusted odds of experiencing stigma. Lack of women's empowerment, as well as depression, may be important risk factors for HIV-related stigma and discrimination.
Bhuiya, Abbas; Sharmin, Tamanna; Hanifi, S M A
This paper reports finding from a study carried out in a remote rural area of Bangladesh during December 2000. Nineteen key informants were interviewed for collecting data on domestic violence against women. Each key informant provided information about 10 closest neighbouring ever-married women covering a total of 190 women. The questionnaire included information about frequency of physical violence, verbal abuse, and other relevant information, including background characteristics of the women and their husbands. 50.5% of the women were reported to be battered by their husbands and 2.1% by other family members. Beating by the husband was negatively related with age of husband: the odds of beating among women with husbands aged less than 30 years were six times of those with husbands aged 50 years or more. Members of micro-credit societies also had higher odds of being beaten than non-members. The paper discusses the possibility of community-centred interventions by raising awareness about the violation of human rights issues and other legal and psychological consequences to prevent domestic violence against women.
Aguado, Jaume; Campbell, Alistair; Ascaso, Carlos; Navarro, Purificación; Garcia-Esteve, Lluïsa; Luciano, Juan V
In this study, the authors tested alternative factor models of the 12-item General Health Questionnaire (GHQ-12) in a sample of Spanish postpartum women, using confirmatory factor analysis. The authors report the results of modeling three different methods for scoring the GHQ-12 using estimation methods recommended for categorical and binary data. A discriminant function analysis was also performed to test the utility of a multiple factor model. A two-phase cross-sectional study was designed: (a) 1,453 women visiting at 6 weeks postpartum completed the GHQ-12 and the Edinburgh Postnatal Depression Scale questionnaire and (b) based on the Edinburgh Postnatal Depression Scale outcomes, participants were stratified and randomly selected within each stratum for clinical evaluation. Using the Likert-type scoring approach, Hankins's one-factor model with "method effects" obtained the best fit. In addition, Graetz's three-factor model provided little discrimination between diagnostic groups, the factors being highly correlated. These results support the presence of only one latent factor in the GHQ-12.
Rodríguez-Muñoz, María de la Fe; Vallejo Slocker, Laura; Olivares Crespo, María Eugenia; Izquierdo Méndez, Nuria; Soto, Cristina; Le, Huynh-Nhu
Prenatal depression is a major public health problem, therefore predicting and preventing it is a relevant objective for public health agendas. Consequently, it is important to have adequate screening tools to detect risk factors associated with prenatal depression. The aim of this study was to evaluate the psychometric properties reliability and factor structure of the Spanish version of the Postpartum Depression Predictors Inventory- Revised- Prenatal Version (PDI-R) in pregnant women who attend prenatal care in an urban hospital in Spain. The sample was formed of 445 women receiving prenatal care in an obstetrics clinic in an urban public hospital in Madrid, Spain. The internal consistency of PDPI-R was assessed by measuring Cronbach's Alfa index, calculating the COR curve and percentiles for this sample. The PDPI-R showed good internal consistency in this sample (Cronbach's Alfa = 0,855). The area under the COR curve is 0,84 p≤0,001. Sensibility and specificity values were 62,3% and 69,5% respectively, and the cut-off point with greatest sensibility and specificity was 4. The PDPI-R is reliable and can be used to screen for risk factor for depression during pregnancy.
Ozumba, B C; Obi, S N; Ijioma, N N
The contraceptive information and services offered to single women in most developing countries is compromised by stigma attached to premarital sex. This study was to ascertain the knowledge, attitude and practice of contraception among single women in a rural and urban community in southeast Nigeria, using a cross-sectional survey of 279 and 295 single women in Ngwo (rural) and Enugu (urban) community. The mean age of the population was 21.3 years. Contraceptive awareness was more among the urban than rural respondents (90.2% vs 34.1%). The major sources of contraceptive knowledge were mass media (68%) and peer groups (86.3%) for the urban and rural respondents, respectively. Most respondents in both groups had positive attitude towards contraception. More urban than rural respondents (68.3% vs 12.5%) began sexual activity during adolescence and the level of contraceptive use during first coitus were 48.4% and 13.7%, respectively. Of the currently sexually active respondents, 32.5% (rural) and 59.7% (urban) were using a form of modern contraception. Condoms, followed by oral pills were the most popular contraceptive method because they can easily procure them over the counter. Poor contraceptive information, highly critical behavior of family planning providers towards unmarried women seeking contraception and attitude of male partners militate against contraceptive practice. There is need to promote information and education on contraception among single women, their male partners and family planning providers.
Kershaw, Trace S; Small, Maria; Joseph, Gabriel; Theodore, Melanie; Bateau, Reginald; Frederic, Rikerdy
Given that condom use is not directly under a woman's control, the sexual division of power may play an important role in sexual behavior among pregnant women. We assessed the influence of factors related to the theory of gender and power (e.g., relationship power, abuse history, and sexual communication) on sexual behavior (e.g., two or more partners in the year prior to pregnancy, condom use, condom-use intentions, and STI diagnosis) among 196 pregnant women recruited from five community dispensaries in rural Haiti. Results showed that gender and power factors significantly related to sexual behavior. Gender and power factors were most significant for condom use and intention to use condoms, accounting for 18 and 25% of the variance above and beyond HIV knowledge and demographic covariates, respectively. These results suggest the need to create prevention interventions that restore power imbalances, provide support for women suffering abuse, and strengthen communication skills.
Ghosh, Arnab; Bhagat, Minakshi
The present community based cross-sectional study aimed to investigate anthropometric and body composition measures, and blood pressure characteristics by TV viewing times in rural women of Asian Indian Origin. A total of 343 apparently healthy rural Asian Indian women living in and around Santiniketan, West Bengal, India and aged between 25 and 65 years took part in the study. Anthropometric measures namely body mass index (BMI), percentages of body fat (PBF), basal metabolic rate (BMR), and intra-abdominal visceral fat (IVF) were measured using an Omron body fat analyzer. Fat mass (FM), fat free mass (FFM), arm muscle area (AMA), arm fat area (AFA), and arm muscle circumference (AMC) were calculated using standard techniques. Each individual was also asked how many minutes/day they spend watching TV. Comparison of central obesity status (CNO = waist circumference < 80 cm and CO = waist circumference ≥ 80 cm) by TV viewing times (categories) revealed a significant difference [χ(3)2 14.29] for central obesity status across the groups. Increased leisure-time activity was associated with central obesity status and warrant early intervention to prevent increasing incidences of cardiovascular disease in this population. Copyright © 2014 Wiley Periodicals, Inc.
Wallace, Lauren J; Summerlee, Alastair J S; Dewey, Cate E; Hak, Chantharith; Hall, Ann; Charles, Christopher V
In Cambodia, both anaemia and vitamin A deficiency are serious health problems. Despite this, few comprehensive nutritional surveys have been completed to date. This study evaluates the adequacy of iron and vitamin A intakes, as well as women's nutritional knowledge in rural Kandal province. Twenty-four hour recalls, pile sort activities, socioeconomic surveys, focus groups, and market surveys were carried out with 67 women from 5 villages in rural Kandal Province. Ninety seven percent of women did not meet their daily-recommended intake of iron, while 70% did not meet their daily-recommended intake of vitamin A. Although many women consume vitamin A-rich and iron rich-foods daily, they do not consume large enough quantities of these foods. Results suggest that both the cost of foods as well as the extent of health knowledge is linked to nutritional practice. Most animal-source iron and vitamin A-rich foods are considered expensive; however, small fish, and several plant-source vitamin A-rich foods are inexpensive and easy to access. Despite health education, food restrictions lead some healthy foods to be considered to be harmful to women. Ultimately, this study demonstrates the importance of developing comprehensive nutritional interventions in Cambodia. Health programming must provide women with not only suggestions to include low-cost nutrient-rich foods, but also advise them about the quantities that are likely to have an impact on nutritional status. Programs should take a community-based, inter-sectoral approach that simultaneously combines culturally informed health education with initiatives that combat poverty and increase access to nutrient rich foods.
Cunningham, Kenda; Ploubidis, George B; Menon, Purnima; Ruel, Marie; Kadiyala, Suneetha; Uauy, Ricardo; Ferguson, Elaine
To examine the association between women's empowerment in agriculture and nutritional status among children under 2 years of age in rural Nepal. Cross-sectional survey of 4080 households conducted in 2012. Data collected included: child and maternal anthropometric measurements; child age and sex; maternal age, education, occupation and empowerment in agriculture; and household size, number of children, religion, caste and agro-ecological zone. Associations between the Women's Empowerment in Agriculture Index (WEAI)'s Five Domains of Empowerment (5DE) sub-index and its ten component indicators and child length-for-age Z-scores (LAZ) and weight-for-length Z-scores (WLZ) were estimated, using ordinary least-squares regression models, with and without adjustments for key child, maternal and household level covariates. Two hundred and forty rural communities across sixteen districts of Nepal. Children under 24 months of age and their mothers (n 1787). The overall WEAI 5DE was positively associated with LAZ (β=0·20, P=0·04). Three component indicators were also positively associated with LAZ: satisfaction with leisure time (β=0·27, P<0·01), access to and decisions regarding credit (β=0·20, P=0·02) and autonomy in production (β=0·10, P=0·04). No indicator of women's empowerment in agriculture was associated with WLZ. Women's empowerment in agriculture, as measured by the WEAI 5DE and three of its ten component indicators, was significantly associated with LAZ, highlighting the potential role of women's empowerment in improving child nutrition in Nepal. Additional studies are needed to determine whether interventions to improve women's empowerment will improve child nutrition.
Torondel, Belen; Clasen, Thomas; Schmidt, Wolf-Peter
Background While women and girls face special risks from lack of access to sanitation facilities, their ability to participate and influence household-level sanitation is not well understood. This paper examines the association between women's decision-making autonomy and latrine construction in rural areas of Odisha, India. Methods We conducted a mixed-method study among rural households in Puri district. This included a cross sectional survey among 475 randomly selected households. These were classified as either having a functional latrine, a non-functional latrine or no latrine at all. We also conducted 17 in-depth interviews and 9 focus group discussions among household members of these three categories of households. Results Decisions on the construction of household level sanitation facilities were made exclusively by the male head in 80% of households; in 11% the decision was made by men who consulted or otherwise involved women. In only 9% of households the decision was made by women. Households where women were more involved in general decision making processes were no more likely to build a latrine, compared to households where they were excluded from decisions. Qualitative research revealed that women’s non-involvement in sanitation decision making is attributed to their low socio-economic status and inability to influence the household’s financial decisions. Female heads lacked confidence to take decisions independently, and were dependent on their spouse or other male family members for most decisions. The study revealed the existence of power hierarchies and dynamics within households, which constrained female’s participation in decision-making processes regarding sanitation. Conclusions Though governments and implementers emphasize women’s involvement in sanitation programmes, socio-cultural factors and community and household level dynamics often prevent women from participating in sanitation-related decisions. Measures are needed for
Fan, Xiaojing; Wang, Weihua; Liu, Ruru; Dang, Shaonong; Kang, Yijun
To study the current status and risk factors of spontaneous abortion of women with Tibetan ethnicity at reproductive age in rural areas. Pregnant women who lived in Tibet were interviewed on their former reproductive history and being followed on the outcomes of pregnant from 2006 to 2012. Generalized Poisson regression model was used to explore the influencing factors of spontaneous abortion. OR value of the research factors was estimated and its 95% confidence interval counted. There were 1 557 pregnant women under this study, with a total number of 2 687 pregnancies and 2 382 productions. 171 women underwent spontaneous abortion, with a total number of 204 times, 93 women had histories of abortion, with a total number of 101 times. Among all the Tibetan pregnant women, the ratio between spontaneous abortion and pregnant women was 7.6% while the rate of spontaneous abortion was 7.9% . Ratio between the number of women who had experienced spontaneous abortion and the total number of women under survey was 11.0% . Pregnancy appeared the important reason on spontaneous abortion. The risk of having spontaneous abortion would increase among women who had more than 3 pregnancies. Results from Poisson regression analysis revealed that the odds ratio (OR) value before the adjustment was 3.921 (95% CI:2.553-6.021) but after the adjustment, it increased to 4.722 (95% CI:2.834-7.866). The increase of production time could reduce the risk of spontaneous abortion in women of childbearing age. Risks related to spontaneous abortion were associated with the number of pregnancies. Women seemed to have lower risk for spontaneous abortion after 2009, with OR value as 0.419 (95%CI:0.285-0.616) before, compared to aOR value as 0.580 (95%CI:0.380-0.885) after the adjustment Social-demographic characteristics was not found to be particularly associated with the occurrence of spontaneous abortion. Rate of spontaneous abortion among Tibetan women at childbearing age was not particularly
Ahmed, Zebun N.
A study explored how rural women in the village of Srefultoli, Bangladesh describe, from their own point of view, their experiences with nonformal education (NFE). Feminist research has shown that existing NFE programs in developing countries give women traditional knowledge of family planning, nutrition, and health care, but they do not deal with…
Abuya, Benta A.; Onsomu, Elijah O.; Moore, DaKysha; Piper, Crystal N.
The objective of this study was to examine the association between education and domestic violence among women being offered an HIV test in urban and rural areas in Kenya. A sample selection of women who experienced physical (n = 4,308), sexual (n = 4,309), and emotional violence (n = 4,312) aged 15 to 49 allowed for the estimation of the…
Urquieta-Salomon, Jose E.; Tepichin-Valle, Ana Maria; Tellez-Rojo, Martha Maria
The objective of this study is to evaluate the impact of a pilot study that promoted productive and capacity-building activities among deprived rural women of Mexico. The evaluation design is observational; 1,278 women are interviewed, and the comparison group is estimated by propensity score matching. The results show a positive impact on the…
Hetzel, Lisa C.
The purpose of this qualitative study was to explore how adult college women attending rural community colleges experience being an online student. A study of this nature was warranted as enrollment in online courses continues to increase (Allen & Seaman, 2010) and as women are more likely to enroll in online courses (Kramarae, 2001; van…
Murry, Velma M.; Harrell, Amanda W.; Brody, Gene H.; Chen, Yi-Fu; Simons, Ronald L.; Black, Angela R.; Cutrona, Carolyn E.; Gibbons, Frederick X.
This investigation of the effects of stressful life events on rural African American women's relationship well-being, psychological functioning, and parenting included 361 married or long-term cohabiting women. Associations among stressful events, socioeconomic status, perceived racial discrimination, coping strategies, psychological functioning,…
Using a critical theory framework, the article explores emancipatory narratives obtained through a case study of women in rural India. In-depth interviews, focus group conversations, observations, and document analysis highlight the complexity of the subsequent set of challenges facing women as it relates to both the education and empowerment for…
Mphande-Finn, Joyce T.; Sommers-Flanagan, John
The unique experience of HIV/AIDS among rural women in the United States was explored using qualitative interviews with 7 women who are HIV positive. Based on these interviews, eight themes emerged. These included (a) daily powerful emotions, (b) emotional and physical abandonment, (c) romantic betrayal, (d) medical treatment issues, (e) loss and…
1- Knowledge and attitudes about Human Papilloma Virus (HPV) vaccination and cervical cancer screening among women in rural Uganda Authors...1. Mbarara University of Science and Technology, Department of Obstetrics and Gynecology 2. Makerere University Kampala. 3. United States Army...Abstract Cervical cancer is one of the major causes of death among women worldwide. There is an established linkage between cervical cancer and
Rivas, A; Romero, A; Mariscal-Arcas, M; Monteagudo, C; López, G; Lorenzo, Ma L; Ocaña-Peinado, F M; Olea-Serrano, F
Several lines of evidence suggest a tight association between oxidative stress and the pathogenesis of osteoporosis in humans. The intake of antioxidants may influence Bone Mineral Density by acting as free radical scavengers, preventing oxidation-induced damage to bone cells. The aim of this study was to assess the association between the Dietary Antioxidant Quality Score and bone mineral density in a sample of healthy women. A total of 280 women were grouped into three major groups: women aged ≤ 35 years; women aged 36-45, and finally women aged >45 years. Calcaneous Bone Mineral Density (g/cm²) was measured by dual energy X-ray absorptiometry. Data on the eating habits of each participant were collected with a structured 24-hour diet recall questionnaire. A Dietary Antioxidant Quality Score was used to calculate antioxidant-nutrient intake. A significant and positive association was observed among Bone Mineral Density and dietary intake of vitamin C and selenium. Zinc intake was significantly related to Bone Mineral Density in the youngest group. Low antioxidant consumers were considered individuals whose Dietary Antioxidant Quality Score was lower or equal than the median (3.5), and high antioxidant consumers were those whose Dietary Antioxidant Quality Score were higher than 3.5. Bone Mineral Density was higher in the participants defined as high antioxidant consumers in all aged groups. The study showed that there is an association between Bone Mineral Density and the Dietary Antioxidant Quality Score in all the women studied. Therefore, new therapies for osteoporosis based on higher dietary antioxidant intakes might be developed basing on the results obtained in this study.
Tarraga, P; Orgaz, M; Bermejo, P; Abellan, J; Tricio, M; Tarraga, M
This study aimed to estimate prevalence of metabolic syndrome and all its components to know the cardiovascular risk and metabolic control of the main risk factors in postmenopausal women aged over 45 years in the province of Cuenca (Castilla la Mancha, Spain). In this cross-sectional study, we randomly selected 716 postmenopausal women from 3,108 women aged over 45. Metabolic syndrome was identified according to the National Cholesterol Education Program Adult Treatment Panel III definition. Cardiovascular risk was calculated by the Systematic Coronary Risk Evaluation (< 65 years). The American Diabetes Association[Combining Acute Accent]s standards of medical care in diabetes were used to estimate metabolic control. The statistical analysis was done with SPPS.19 RESULTS:: Prevalence of metabolic syndrome was 61.7% (95%CI: 56.9-66.4). Prevalence of each component was: high blood pressure: 95.8% (95%CI: 95.7-95.8), abdominal obesity: 91% (95%CI: 90.9-91.0), low high-density lipoproteins cholesterol (HDLc) levels: 70% (95%CI: 69.8-69.9), high triglyceride levels: 56.9% (95%CI: 56.4-56.9), high glucose levels: 54.3% (95%CI: 54.2-54.3). Cardiovascular risk was moderate until 65 years, but was high after this age. Metabolic control in postmenopausal women was very good for glucose, bad for systolic blood pressure and worse for lipid levels. Bad blood pressure control was associated with being over 65 years, being hypertensive and taking treatment for diabetes, but it reduced when being physically limited to do moderate exercise and anxiety increased. Prevalence of metabolic syndrome in postmenopausal women in the province of Cuenca is the highest in Spain. High blood pressure and abdominal obesity are the commonest components. Cardiovascular risk was moderate-high in postmenopausal women, but systolic blood pressure and lipid profile were unsatisfactorily controlled. Early intervention is necessary to achieve a better risk profile.
Weaver, Addie; Himle, Joseph A.; Taylor, Robert Joseph; Matusko, Niki N.; Abelson, Jamie M.
IMPORTANCE There is a paucity of research among African Americans and rural residents. Little is known about the association between urbanicity and depression or about the interaction of urbanicity, race/ethnicity, and sex on depression and mood disorder prevalence. OBJECTIVE To examine the interaction of urbanicity and race/ethnicity on lifetime and 12-month major depressive disorder (MDD) and mood disorder prevalence for African American women and non-Hispanic white women. DESIGN, SETTING, AND PARTICIPANTS The US National Survey of American Life data were used to examine the interaction of urbanicity and race/ethnicity on lifetime and 12-month diagnoses of DSM-IV MDD and mood disorder among female respondents, who included noninstitutionalized African American, Caribbean black, and non-Hispanic white women in the United States between February 2001 and June 2003. Participants included 1462 African American women and 341 non-Hispanic white women recruited from the South because all suburban and rural National Survey of American Life respondents resided in this region. Bivariate multiple logistic regression and adjusted prevalence analyses were performed. Urban, suburban, or rural location (assessed via Rural-Urban Continuum Codes), self-reported race/ethnicity, and sociodemographic factors (age, education, household income, and marital status) were included in the analysis. MAIN OUTCOMES AND MEASURES Lifetime and 12-month MDD and mood disorder assessed via the World Mental Health Composite International Diagnostic Interview. RESULTS Compared with urban African American women, rural African American women had a significantly lower odds of meeting criteria for lifetime (odds ratio [OR], 0.39; 95% CI, 0.23–0.65) and 12-month (OR, 0.29; 95% CI, 0.18–0.46) MDD and for lifetime (F = 0.46; 95% CI, 0.29–0.73) and 12-month (F = 0.42; 95% CI, 0.26–0.66) mood disorder. However, the interaction of urbanicity and race/ethnicity suggested that rural non-Hispanic white
Ranganathan, Meghna; Heise, Lori; Pettifor, Audrey; Silverwood, Richard J; Selin, Amanda; MacPhail, Catherine; Delany-Moretlwe, Sinead; Kahn, Kathleen; Gómez-Olivé, F Xavier; Hughes, James P; Piwowar-Manning, Estelle; Laeyendecker, Oliver; Watts, Charlotte
Young adolescent women in sub-Saharan Africa are three to four times more likely to be HIV-positive than boys or men. One of the relationship dynamics that is likely to be associated with young women's increased vulnerability to HIV is transactional sex. There are a range of HIV-related risk behaviours that may drive this vulnerability. However, to date, limited epidemiological data exist on the role of transactional sex in increasing HIV acquisition, especially among young women in sub-Saharan Africa. Our paper presents data on the prevalence of self-reported engagement in transactional sex and explores whether transactional sex is associated with increased risk of HIV infection among a cohort of young, rural, sexually active South African women. We also explore whether this relationship is mediated through certain HIV-related risk behaviours. We analyzed baseline data from a phase III trial of conditional cash transfers for HIV prevention of 693 sexually active, school-going young women aged 13-20 years in rural South Africa. We examined the association between young women's engagement in transactional sex and HIV infection. Transactional sex is defined as a non-commercial, non-marital sexual relationship whereby sex is exchanged for money and/or gifts. We explored whether this relationship is mediated by certain HIV-related risk behaviours. We used logistic and multinomial regression and report unadjusted and adjusted odds ratios with 95% CI. Overall, 14% (n=97) of sexually active young women reported engaging in transactional sex. Engagement in transactional sex was associated with an increased risk of being HIV-positive (aOR: 2.5, CI: 95% 1.19-5.25, p=0.01). The effect size of this association remained nearly unchanged when adjusted for certain other dimensions of HIV risk that might help explain the underlying pathways for this relationship. This study provides quantitative support demonstrating that transactional sex is associated with HIV infection in young
Ranganathan, Meghna; Heise, Lori; Pettifor, Audrey; Silverwood, Richard J; Selin, Amanda; MacPhail, Catherine; Delany-Moretlwe, Sinead; Kahn, Kathleen; Gómez-Olivé, F Xavier; Hughes, James P; Piwowar-Manning, Estelle; Laeyendecker, Oliver; Watts, Charlotte
Introduction Young adolescent women in sub-Saharan Africa are three to four times more likely to be HIV-positive than boys or men. One of the relationship dynamics that is likely to be associated with young women's increased vulnerability to HIV is transactional sex. There are a range of HIV-related risk behaviours that may drive this vulnerability. However, to date, limited epidemiological data exist on the role of transactional sex in increasing HIV acquisition, especially among young women in sub-Saharan Africa. Our paper presents data on the prevalence of self-reported engagement in transactional sex and explores whether transactional sex is associated with increased risk of HIV infection among a cohort of young, rural, sexually active South African women. We also explore whether this relationship is mediated through certain HIV-related risk behaviours. Methods We analyzed baseline data from a phase III trial of conditional cash transfers for HIV prevention of 693 sexually active, school-going young women aged 13–20 years in rural South Africa. We examined the association between young women's engagement in transactional sex and HIV infection. Transactional sex is defined as a non-commercial, non-marital sexual relationship whereby sex is exchanged for money and/or gifts. We explored whether this relationship is mediated by certain HIV-related risk behaviours. We used logistic and multinomial regression and report unadjusted and adjusted odds ratios with 95% CI. Results Overall, 14% (n=97) of sexually active young women reported engaging in transactional sex. Engagement in transactional sex was associated with an increased risk of being HIV-positive (aOR: 2.5, CI: 95% 1.19–5.25, p=0.01). The effect size of this association remained nearly unchanged when adjusted for certain other dimensions of HIV risk that might help explain the underlying pathways for this relationship. Conclusions This study provides quantitative support demonstrating that transactional
Joshi, Ashish; Wilhelm, Susan; Aguirre, Trina; Trout, Kate; Amadi, Chioma
Computer technology can be effectively used to educate patients and improve knowledge and attitudes, leading to healthier behavior. Among rural women, breastfeeding outcomes seem to be worst compared to women living in urban areas. The implementation of a bilingual computer mediated health education program to disseminate information and improve outcomes among users with low literacy levels has proven to be successful. The objective of this pilot study was to examine the usability of an interactive, bilingual touch screen computer-based educational program to promote breastfeeding practices among Hispanic women living in rural settings. A convenience sample of 10 Hispanic rural women at the Regional West Medical Center (RWMC), Scottsbluff was enrolled during May 2013. Information about this cross-sectional study was made available through the flyers at the RWMC. A brief introduction of the prototype was given and study subjects were then asked to complete a predefined set of tasks by interacting with the prototype. Users were assigned 6 tasks and information was gathered about the time taken to complete the tasks, number of attempts, and if assistance was needed. Notes and test sessions were audiotaped. Usability assessment was performed using the System Usability Scale (SUS). The mean age of the study participants was 28 years (SD 3.6), the majority of them had 12 or more years of education (90%, 9/10), and 60% (6/10) had breastfed less than 6 months. There were 90% (9/10) of the study participants that had no prior history of taking prenatal classes and 80% (8/10) that did not intend to take any prenatal classes in the future. The average SUS scores were 90 and SD was 10.5. There were three participants that had average SUS scores of 100, followed by scores of 97.5 (1/10), 95 (1/10), 87.5 (1/10), 85 (2/10), 82.5 (1/10), and one participant had a score of 67.5 (1/10). No assistance was needed to complete any of the tasks. The study participants were able to
Karim, Rabiul; Lindberg, Lene; Wamala, Sarah; Emmelin, Maria
Without taking masculine issues into account, women's participation in development initiatives does not always guarantee their empowerment, health, and welfare in a male-dominated society. This study aimed to explore men's perceptions of women's participation in development (WPD) in rural Bangladesh. In adopting a qualitative approach, the study examined 48 purposively selected married and unmarried men aged 20-76 years in three northwest villages. Data collection was accomplished through four focus group discussions (FGDs) with 43 men clustered into four groups and through individual interviews with five other men. A qualitative content analysis of the data revealed an overall theme of "feeling challenged by fears and hopes," indicating variations in men's views on women's participation in development initiatives as represented by three main categories: (a) fearing the loss of male authority, (b) recognizing women's roles in enhancing family welfare, and (c) valuing women's independence. In the context of dominant patriarchal traditions in Bangladesh, these findings provide new insight into dynamics and variations of men's views, suggesting a need to better engage men during different stages of women-focused development initiatives.
Inasmuch as women's subordinate status is a product of the patriarchal structures of constraint that prevail in specific contexts, pathways of women's empowerment are likely to be "path dependent." They will be shaped by women's struggles to act on the constraints that prevail in their societies, as much by what they seek to defend as by what they seek to change. The universal value that many feminists claim for individual autonomy may not therefore have the same purchase in all contexts. This article examines processes of empowerment as they play out in the lives of women associated with social mobilization organizations in the specific context of rural Bangladesh. It draws on their narratives to explore the collective strategies through which these organizations sought to empower the women and how they in turn drew on their newly established "communities of practice" to navigate their own pathways to wider social change. It concludes that while the value attached to social affiliations by the women in the study is clearly a product of the societies in which they have grown up, it may be no more context-specific than the apparently universal value attached to individual autonomy by many feminists.
Vung, Nguyen Dang; Ostergren, Per-Olof; Krantz, Gunilla
Health effects and health care seeking were investigated among women in rural Vietnam exposed to physical and/or sexual violence from their partner in the past year. The study was conducted within the framework of the demographic surveillance site in Bavi District, Ha Tay Province in northern Vietnam. Face-to-face interviews based on a questionnaire developed by the WHO for use in violence research were conducted with 883 randomly selected women. Past-year violence and health effects were investigated in bi and multivariate analyses. The prevalence of past-year physical and/or sexual violence was 9.2% (n = 81). Women exposed to violence ran a considerably elevated risk of memory loss (OR 3.7; 1.8-7.5), pain or discomfort (OR 3.8; 2.3-6.3), sadness or depression (OR 4.5; 2.7-7.5) and having suicidal thoughts (OR 2.8; 1.04-7.3) compared with those with no violence experience in the past year, when adjusted for socio-demographic factors. Almost 50% (n = 40) of the women exposed to violence reported injuries and, of those, 58% had to seek health care. Physical and/or sexual violence are common occurrences in Vietnam, associated with pain, injuries and mental health problems in exposed women. These results point to the need for a reliable health surveillance system, along with health care and support activities for victimised women, and policy initiatives to prevent this violence.
Puri, Mahesh; Frost, Melanie; Tamang, Jyotsna; Lamichhane, Prabhat; Shah, Iqbal
Sexual violence within marriage is a public health and human rights issue; yet it remains a much neglected research area, especially in Nepal. This paper represents one of the first attempts to quantify the extent of sexual violence and its determinants among young married women in Nepal. A cross-sectional survey was conducted among 1,296 married women aged 15-24 years in four major ethnic groups in rural Nepal. The survey data were used to estimate the prevalence and identify determinants of sexual violence. The relative importance of different correlates of sexual violence in the past 12 months at the individual, household and community levels were examined by using a multi-level multivariate statistical approach. Of the young women surveyed 46% had experienced sexual violence at some point and 31% had experienced sexual violence in the past 12 months. Women's autonomy was found to be particularly protective against sexual violence both at the individual and community level. Women's educational level was not found to be protective, while the educational level of the husband was found to be highly protective. The high prevalence of sexual violence against young women by husbands found in this study is a matter for serious concern and underscores the need for a comprehensive response by policymakers.
Saroha, Ekta; Altarac, Maja; Sibley, Lynn M
The objective of this study was to examine the association between caste and maternal health care service use among rural Hindu women in India. We analyzed data from the Morbidity and Performance Assessment, a population-based cross-sectional study, for 482 Hindu women who were pregnant during January 1998 to January 1999 in Maitha, Uttar Pradesh, India. Maternal health care service use among both upper and lower caste women was very low. Upper caste women were almost three times more likely to use antenatal care (odds ratio [OR] = 2.72; 95% confidence interval [CI], 1.40-5.30), tetanus toxoid (OR = 2.50; 95% CI, 1.48-4.21), and contraceptives (OR = 2.66; 95% CI, 1.28-5.54) and almost five times (OR = 4.77; 95% CI, 1.81-12.54) more likely to have a trained birth attendant compared to the lower caste women. Caste was a significant determinant of tetanus toxoid use and trained birth attendant even after adjusting for sociodemographic factors. Besides caste, maternal literacy was the one sociodemographic factor that was significantly associated with the use of all maternal health care services. Information dissemination and awareness generation can improve the use of subsidized maternal health care services among women of all caste groups.
Prieto, Jaime; Gómez, Miguel-Ángel; Pollard, Richard
The purpose of this study was to quantify the home advantage in both men's and women's First and Second Division water polo leagues, to compare the results obtained according to sex of participants and the level of competition, and to test for possible differences in home advantage when considering the interaction between these two factors. The sample comprised four seasons from 2007-2008 to 2010-2011 for a total of 1942 games analyzed. The results showed the existence of home advantage in both men's and women's First and Second Divisions. After controlling for the competitive balance of each league in each season, there was a significant difference between men's and women's leagues, with higher home advantage for men's leagues (58.60% compared with 53.70% for women's leagues). There was also a significant difference between the levels of competition, with greater home advantage for the Second Division (57.95% compared with 54.35% for First Division). No significant differences in home advantage were found when considering the interaction between sex of participants and the level of competition. The results in relation to sex of participants and the level of competition are consistent with previous studies in other sports such as football or handball.
Martínez-Maestre, Maria Angeles; Machuca, Guillermo; González-Cejudo, Carmen; Flores, José Ramón Corcuera; Cardoso, Rafael Torrejón; Castelo-Branco, Camil
Osteoporosis and periodontitis are common disorders that affect aging populations. It has been hypothesized that both conditions may be related. The aim of this study was to evaluate the relationship between osteoporosis and periodontitis using vertebral fragility fracture as a real marker of osteoporosis and periodontal clinical examination to define periodontitis. Six hundred thirty-four women aged 55 to 70 years, with fragility spine fractures, and living in the same healthcare region of Seville, Spain, were invited to take part in this cross-sectional study conducted from 2008 to 2010. All the women included in the study were referred to undergo spine radiological examination, spinal densitometry, and full-mouth periodontal assessment. With the exception of number of teeth (19 in the fractured postmenopausal group and 23 in the control group; P < 0.007) and sites with a clinical attachment level lower than 7 mm (P < 0.048), there were no significant differences in clinical and periodontal parameters among women in the fractured postmenopausal group and the control group. In short, fractured postmenopausal women have lost more teeth with more advanced attachment loss (clinical attachment level >7 mm). None of the definitions of periodontitis used resulted in significant differences between groups. The relationship between periodontitis and osteoporosis remains unclear, and further studies considering fragility fracture as a real marker of osteoporosis are warranted to clarify the exact role and effect of one condition on the other and the corresponding clinical implications.
Gao, Guo-Peng; Zhang, Ren-Jie; Zhang, Xiu-Jun; Jia, Xiao-Min; Li, Xiu-De; Li, Xiang; Wang, Cheng-Cheng; Tong, Fei; Sun, Ye-Huan
This study aims to assess the prevalence of and factors associated with induced abortion among married women in rural areas of Anhui Province, China. A multistage probability sampling method was used to identify a representative sample of 53,652 married women aged 18-49 years in rural areas of Anhui Province, China. All women were interviewed in the form of a standardized questionnaire. We found that 32.0% (16,800) of these women had had at least one induced abortion: 21.1% (11,090) of women had had one; 7.6% (3976) of women had had two; and 4.1% (1734) of women had had at least three. The number of induced abortions per 100 pregnancies was found to be 22.0. Multivariate analysis showed that education, the age of a woman at her first marriage, number of total births, number of total pregnancies, and contraceptive methods were significant predictors for induced abortion after controlling for women's current age, employment and family yearly income. The study shows that the prevalence of induced abortion is still very high among married women in rural China, and highly effective methods of contraception (sterilization, intrauterine device) decrease women's recourse to induced abortion. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.
Kornelsen, Jude; McCartney, Kevin; Williams, Kim
This article was developed as part of a larger realist review investigating the viability and efficacy of decentralized models of perinatal surgical services for rural women in the context of recent and ongoing service centralization witnessed in many developed nations. The larger realist review was commissioned by the British Columbia Ministry of Health and Perinatal Services of British Columbia, Canada. Findings from that review are addressed in this article specific to the sustainability of rural perinatal surgical sites and the satisfaction of providers that underpins their recruitment to and retention at such sites. A realist method was used in the selection and analysis of literature with the intention to iteratively develop a sophisticated understanding of how perinatal surgical services can best meet the needs of women who live in rural and remote environments. The goal of a realist review is to examine what works for whom under what circumstances and why. The high sensitivity search used language (English) and year (since 1990) limiters in keeping with both a realist and rapid review tradition of using reasoned contextual boundaries. No exclusions were made based on methodology or methodological approach in keeping with a realist review. Databases searched included MEDLINE, PubMed, EBSCO, CINAHL, EBM Reviews, NHS Economic Evaluation Database and PAIS International for literature in December 2013. Database searching produced 103 included academic articles. A further 59 resources were added through pearling and 13 grey literature reports were added on recommendation from the commissioner. A total of 42 of these 175 articles were included in this article as specific to provider satisfaction and service sustainability. Operative perinatal practice was found to be a lynchpin of sustainable primary and surgical services in rural communities. Rural shortages of providers, including challenges with recruitment and retention, were found to be a complex issue, with
Soriano-Vidal, F J; Vila-Candel, R; Soriano-Martín, P J; Tejedor-Tornero, A; Castro-Sánchez, E
Maternity care has focused on lowering maternal and neonatal morbidity, though women's beliefs and expectations of care have been set aside. Women face childbirth with preconceived expectations, some of which could be expressed on their birth plan. The latter could beinfluenced by health professionals through prenatal education classes, though this has not been measured before. Antenatal classes have been argued against,since no resulting improvement in childbirth experience has been demonstrated, though some advantages may be seen: they favour communication and give time for expressing maternal expectations and beliefs. The present study evaluates the influence of prenatal educational classes led by midwives upon women birth preferences. A multicentre, observational, prospective study was carried out, measuring variables in pregnant women attending prenatal educational classes in different health centres within the health districts in Valencia (Spain) over the period January-October 2012. Birth plan preferences were compared prior to and upon completion of the classes. A total of 212 eligible pregnant women (78.3% nulliparous) with an average age of 31.39±4.0 years consented to participate in the study. There were significant differences in birth plan preferences prior to and upon completion of the prenatal classes. Three items showed an increase between the initial session and the end of the intervention: the ability to push spontaneously, episiotomy avoidance, and early breastfeeding. An adjusted general linear model was used to compare pre-post results in relation to sociodemographic and obstetric variables. The changes in birth plans could suggest that prenatal educational classes exert an influence upon maternal birth preferences. Copyright © 2018 Elsevier Ltd. All rights reserved.
Wylie, Blair J; Ae-Ngibise, Kenneth A; Boamah, Ellen A; Mujtaba, Mohammed; Messerlian, Carmen; Hauser, Russ; Coull, Brent; Calafat, Antonia M; Jack, Darby; Kinney, Patrick L; Whyatt, Robin; Owusu-Agyei, Seth; Asante, Kwaku P
Use of pesticides by households in rural Ghana is common for residential pest control, agricultural use, and for the reduction of vectors carrying disease. However, few data are available about exposure to pesticides among this population. Our objective was to quantify urinary concentrations of metabolites of organophosphate (OP), pyrethroid, and select herbicides during pregnancy, and to explore exposure determinants. In 2014, 17 pregnant women from rural Ghana were surveyed about household pesticide use and provided weekly first morning urine voids during three visits ( n = 51 samples). A total of 90.1% (46/51) of samples had detectable OP metabolites [geometric mean, GM (95% CI): 3,5,6-trichloro-2-pyridinol 0.54 µg/L (0.36-0.81), para-nitrophenol 0.71 µg/L (0.51-1.00)], 75.5% (37/49) had detectable pyrethroid metabolites [GM: 3-phenoxybenzoic acid 0.23 µg/L (0.17, 0.32)], and 70.5% (36/51) had detectable 2,4-dichlorophenoxyacetic acid levels, a herbicide [GM: 0.46 µg/L (0.29-0.73)]. Concentrations of para-nitrophenol and 2,4-dichlorophenoxyacetic acid in Ghanaian pregnant women appear higher when compared to nonpregnant reproductive-aged women in a reference U.S. Larger studies are necessary to more fully explore predictors of exposure in this population.
Sileo, Katelyn M; Wanyenze, Rhoda K; Lule, Haruna; Kiene, Susan M
Uganda has one of the highest unmet needs for family planning globally, which is associated with negative health outcomes for women and population-level public health implications. The present cross-sectional study identified factors influencing family planning service uptake and contraceptive use among postpartum women in rural Uganda. Participants were 258 women who attended antenatal care at a rural Ugandan hospital. We used logistic regression models in SPSS to identify determinants of family planning service uptake and contraceptive use postpartum. Statistically significant predictors of uptake of family planning services included: education (AOR = 3.03, 95 % CI 1.57-5.83), prior use of contraceptives (AOR = 7.15, 95 % CI 1.58-32.37), partner communication about contraceptives (AOR = 1.80, 95 % CI 1.36-2.37), and perceived need of contraceptives (AOR = 2.57, 95 % CI 1.09-6.08). Statistically significant predictors of contraceptive use since delivery included: education (AOR = 2.04, 95 % CI 1.05-3.95), prior use of contraceptives (AOR = 10.79, 95 % CI 1.40-83.06), and partner communication about contraceptives (AOR = 1.81, 95 % CI 1.34-2.44). Education, partner communication, and perceived need of family planning are key determinants of postpartum family planning service uptake and contraceptive use, and should be considered in antenatal and postnatal family planning counseling.
Kimoto, Riko; Ronquillo, Dolores; Caamaño, Maria C; Martinez, Guadalupe; Schubert, Lisa; Rosado, Jorge L; Garcia, Olga; Long, Kurt Z
Qualitative research using semi-structured interviews and key informant interviews were used to explore how women from low socioeconomic rural households in Queretaro State, Mexico perceived and reacted to their obesogenic environment. Reduced availability of healthy food options and household financial constraints along with reduced agency of women in this setting were factors that limited women's ability to access and consume diets consistent with the promotion of good health. The cultural values that emphasised obesity as a desirable state for women and the women's social networks that promoted these values were also identified as playing a role in reinforcing certain behaviours. Public health advocates wanting to design interventions in such settings need to be sensitive to the cultural as well as the environmental context described for rural Mexican women. © 2013 The Authors. Published by Elsevier Ltd All rights reserved.
Okonofua, Friday; Ntoimo, Lorretta; Ogungbangbe, Julius; Anjorin, Seun; Imongan, Wilson; Yaya, Sanni
Although Primary Health Care (PHC) was designed to provide universal access to skilled pregnancy care for the prevention of maternal deaths, very little is known of the factors that predict the use of PHC for skilled maternity care in rural parts of Nigeria - where its use is likely to have a greater positive impact on maternal health care. The objective of this study was to identify the factors that lead pregnant women to use or not use existing primary health care facilities for antenatal and delivery care. The study was a cross-sectional community-based study conducted in Esan South East and Etsako East LGAs of Edo State, Nigeria. A total of 1408 randomly selected women of reproductive age were interviewed in their households using a pre-tested structured questionnaire. The data were analyzed with descriptive and multivariate statistical methods. The results showed antenatal care attendance rate by currently pregnant women of 62.1%, and a skilled delivery of 46.6% by recently delivered women at PHCs, while 25% of women delivered at home or with traditional birth attendants. Reasons for use and non-use of PHCs for antenatal and delivery care given by women were related to perceptions about long distances to PHCs, high costs of services and poor quality of PHC service delivery. Chi-square test of association revealed that level of education and marital status were significantly related to use of PHCs for antenatal care. The results of logistic regression for delivery care showed that women with primary (OR 3.10, CI 1.16-8.28) and secondary (OR 2.37, CI 1.19-4.71) levels education were more likely to receive delivery care in PHCs than the highly educated. Being a Muslim (OR 1.56, CI 1.00-2.42), having a partner who is employed in Estako East (OR 2.78, CI 1.04-7.44) and having more than five children in Esan South East (OR 2.00, CI 1.19-3.35) significantly increased the odds of delivery in PHCs. The likelihood of using a PHC facility was less for women who had more
García, Patricia J; Chavez, Susana; Feringa, Barbara; Chiappe, Marina; Li, Weili; Jansen, Kathrin U; Cárcamo, César; Holmes, King K
To define the prevalences and manifestations of reproductive tract infections (RTIs) in rural Peruvian women. During 1997-98, we visited 18 rural districts in coastal, highlands, and jungle regions of Peru. We administered standardized questionnaires and pelvic examinations to members of women's community-based organizations; and collected vaginal fluid for pH, amine odour, Gram stain, microscopy, and culture for Trichomonas vaginalis; cervical specimens for Chlamydia trachomatis, Neisseria gonorrhoeae; human papilloma virus (HPV) by polymerase chain reaction (PCR) assays, and blood for syphilis serology. The 754 participants averaged 36.9 years of age and 1.7 sex partners ever; 77% reported symptoms indicative of RTIs; 51% and 26% reported their symptoms spontaneously or only with specific questioning, respectively. Symptoms reported spontaneously included abnormal vaginal discharge (29.3% and 22.9%, respectively). One or more RTIs, found in 70.4% of participants, included bacterial vaginosis (43.7%), trichomoniasis (16.5%), vulvovaginal candidiasis (4.5%), chlamydial infection (6.8%), gonorrhoea (1.2%), syphilis seropositivity (1.7%), cervical HPV infection (4.9%), and genital warts or ulcers (2.8%). Of 715 adequate Pap smears, 7 revealed cancer, 4 high-grade squamous intra-epithelial lesions (SIL) and 15 low-grade SIL. Clinical algorithms had very low sensitivity and predictive values for cervical infection, but over half the women with symptoms of malodorous vaginal discharge, signs of abnormal vaginal discharge, or both, had bacterial vaginosis or trichomoniasis. Overall, 77% of women had symptoms indicative of RTIs, and 70% had objective evidence of one or more RTIs. Women with selected symptoms and signs of vaginal infection could benefit from standard metronidazole therapy.
García, Patricia J.; Chavez, Susana; Feringa, Barbara; Chiappe, Marina; Li, Weili; Jansen, Kathrin U.; Cárcamo, César; Holmes, King K.
OBJECTIVE: To define the prevalences and manifestations of reproductive tract infections (RTIs) in rural Peruvian women. METHODS: During 1997-98, we visited 18 rural districts in coastal, highlands, and jungle regions of Peru. We administered standardized questionnaires and pelvic examinations to members of women's community-based organizations; and collected vaginal fluid for pH, amine odour, Gram stain, microscopy, and culture for Trichomonas vaginalis; cervical specimens for Chlamydia trachomatis, Neisseria gonorrhoeae; human papilloma virus (HPV) by polymerase chain reaction (PCR) assays, and blood for syphilis serology. FINDINGS: The 754 participants averaged 36.9 years of age and 1.7 sex partners ever; 77% reported symptoms indicative of RTIs; 51% and 26% reported their symptoms spontaneously or only with specific questioning, respectively. Symptoms reported spontaneously included abnormal vaginal discharge (29.3% and 22.9%, respectively). One or more RTIs, found in 70.4% of participants, included bacterial vaginosis (43.7%), trichomoniasis (16.5%), vulvovaginal candidiasis (4.5%), chlamydial infection (6.8%), gonorrhoea (1.2%), syphilis seropositivity (1.7%), cervical HPV infection (4.9%), and genital warts or ulcers (2.8%). Of 715 adequate Pap smears, 7 revealed cancer, 4 high-grade squamous intra-epithelial lesions (SIL) and 15 low-grade SIL. Clinical algorithms had very low sensitivity and predictive values for cervical infection, but over half the women with symptoms of malodorous vaginal discharge, signs of abnormal vaginal discharge, or both, had bacterial vaginosis or trichomoniasis. CONCLUSION: Overall, 77% of women had symptoms indicative of RTIs, and 70% had objective evidence of one or more RTIs. Women with selected symptoms and signs of vaginal infection could benefit from standard metronidazole therapy. PMID:15508193
Jobe, Kathleen A; Downey, Robert F; Hammar, Donna; Van Slyke, Lori; Schmidt, Terri A
The study attempts to define socioeconomic, clinical, and laboratory correlates in vaginitis and other sexually transmitted infections in rural southwestern Haiti. A convenience sample of subjects recruited from a rural women's health clinic and attending an established clinic at the Haitian Health Foundation (HHF) clinic was studied. A standardized history and physical examination, including speculum examination, and collection of blood, urine, and vaginal swabs were obtained from the women at the rural clinic. Additional vaginal swab samples only for Nucleic Acid Amplification Test (NAAT) testing were obtained from women at the HHF clinic in Jérémie. Laboratory results from Leon subjects were positive for Gardnerella vaginalis in 41% (41 of 100), Trichomonas vaginalis in 13.5% (14 of 104), Candida sp. in 9% (9 of 100), Mycoplasma genitalium in 6.7% (7 of 104), Chlamydia trachomatis in 1.9% (2 of 104), and Neisseria gonorrhea in 1% (1 of 104) of patients. Human immunodeficiency virus (HIV) antibody tests were negative in 100% (103 of 103) of patients, and syphilis antibody testing was positive for treponemal antibodies in 7.7% (8 of 104) patients. For subjects from the HHF, 19.9% were positive for T. vaginalis, 11.9% were positive for C. trachomatis, 10.1% were positive for M. genitalium, and 4.1% were positive for N. gonorrhea. Infections with G. vaginalis, T. vaginalis, and Candida were the most common. N. gonorrhea, C. trachomatis, Candida sp., T. vaginalis, and M. genitalium infections were associated with younger age (less than 31 years old). © The American Society of Tropical Medicine and Hygiene.
Séraphin, Marie Nancy; Ngnie-Teta, Ismael; Ayoya, Mohamed Ag; Khan, Maria R; Striley, Catherine W; Boldon, Ellen; Mamadoultaibou, Aissa; Saint-Fleur, Jean Ernst; Koo, Leslie; Clermont, Miliane
Institutional delivery is an important factor associated with reduced maternal mortality rate (MMR). MMR in Haiti is high (350 per 100,000) and institutional delivery is low-just over 25 % of women delivered at a health facility in 2010. There also exists substantial rural-urban disparity in delivery with more hospital deliveries in urban than in rural areas. We aimed to study the prevalence and determinants of institutional delivery in a sample of women of childbearing age in rural Haiti. The study took place in Fond des Blancs and Villa, as part of a baseline assessment undertaken prior to implementation of a maternal, child health, nutrition, and water and sanitation program. From October to November 2011, women 15-49 years old (N = 575) were selected using a cross-sectional two-stage sampling strategy. We used descriptive and multivariate logistic regression analyses to assess the prevalence of and factors associated with institutional delivery. The prevalence of institutional delivery was 45.4 %; a rate higher than the national average of 25 %. In adjusted analyses, correlates of institutional delivery were younger maternal age (25 years and younger) (OR 1.82; CI 1.15, 2.90; P = 0.0112), antenatal care receipt (OR 3.70; CI 1.84, 7.43; P = 0.0003) and those who were poor according to our poverty index score classification (OR 2.04; CI 1.13, 3.69; P = 0.0187). This study shows that increased hospital delivery is likely explained by accessibility to antenatal care. Programs that improve access to antenatal care, with concurrent efforts to address structural inequalities that drive socio-economic deprivation, are likely critical to increasing institutional delivery.
Keding, Gudrun B; Msuya, John M; Maass, Brigitte L; Krawinkel, Michael B
Many developing countries are experiencing a rapid nutrition transition in urban areas. To investigate whether a nutrition transition was occurring in a rural area by examining the dietary patterns of women in rural Tanzania. A total of 252 women aged 16 to 45 years from three districts of northeastern and central Tanzania participated. During three different seasons in 2006-2007, the women were interviewed with the use of a structured, interviewer-administered questionnaire, including a 24-hour dietary recall. From these recalls, the mean intakes of 12 main food groups were calculated and used to establish five dietary patterns by principal component analysis. Data were also obtained on attitudes toward obesity, body mass index (BMI), hemoglobin level, and measures of socioeconomic status and analyzed for associations with dietary patterns. The five dietary patterns were "traditional-coast," characterized by fruits, nuts, starchy plants, and fish; "traditional-inland," characterized by cereals, oils and fats, and vegetables; "purchase," characterized by bread and cakes (usually fried in oil), sugar, and black tea; "pulses," characterized mainly by pulses, with few or no vegetables; and "animal products," characterized by a high consumption of meat, eggs, and/or milk. Significant positive associations were found, among others, between the purchase pattern and BMI (p = 0.192, p = .005) and between the animal products pattern and wealth (p = 0.168, p = .002). Differences between traditional and modern nutritional food patterns were evident. This study found the"traditional-inland" pattern to be the most healthy, while the "purchase" food pattern was the most prevalent. The purchase pattern, in particular, may provide some evidence for early stages of the nutrition transition in rural Tanzania.
Zimmermann, Kristine; Khare, Manorama M; Wright, Cherie; Hasler, Allison; Kerch, Sarah; Moehring, Patricia; Geller, Stacie
Rural populations in the United States experience unique challenges in health and health care. The health of rural women, in particular, is influenced by their knowledge, work and family commitments, as well as environmental barriers in their communities. In rural southern Illinois, the seven southernmost counties form a region that experiences high rates of cancer and other chronic diseases. To identify, understand, and prioritize the health needs of women living in these seven counties, a comprehensive gender-based community health assessment was conducted with the goal of developing a plan to improve women's health in the region. A gender-analysis framework was adapted, and key stakeholder interviews and focus groups with community women were conducted and analyzed to identify factors affecting ill health. The gender-based analysis revealed that women play a critical role in the health of their families and their communities, and these roles can influence their personal health. The gender-based analysis also identified several gender-specific barriers and facilitators that affect women's health and their ability to engage in healthy behaviors. These results have important implications for the development of programs and policies to improve health among rural women. Copyright © 2014 Elsevier Ltd. All rights reserved.
Murry, Velma M; Harrell, Amanda W; Brody, Gene H; Chen, Yi-Fu; Simons, Ronald L; Black, Angela R; Cutrona, Carolyn E; Gibbons, Frederick X
This investigation of the effects of stressful life events on rural African American women's relationship well-being, psychological functioning, and parenting included 361 married or long-term cohabiting women. Associations among stressful events, socioeconomic status, perceived racial discrimination, coping strategies, psychological functioning, relationship well-being, and parenting were tested. Stressful events were related directly to diminished relationship well-being and heightened psychological distress and indirectly to compromised parenting. The results can inform research and intervention with African American women.
Background Women’s ability to safely disclose their HIV-positive status to male partners is essential for uptake and continued use of prevention of mother-to-child transmission (PMTCT) services. However, little is known about the acceptability of potential approaches for facilitating partner disclosure. To lay the groundwork for developing an intervention, we conducted formative qualitative research to elicit feedback on three approaches for safe HIV disclosure for pregnant women and male partners in rural Kenya. Methods This qualitative acceptability research included in-depth interviews with HIV-infected pregnant women (n = 20) and male partners of HIV-infected women (n = 20) as well as two focus groups with service providers (n = 16). The participants were recruited at health care facilities in two communities in rural Nyanza Province, Kenya, during the period June to November 2011. Data were managed in NVivo 9 and analyzed using a framework approach, drawing on grounded theory. Results We found that facilitating HIV disclosure is acceptable in this context, but that individual participants have varying expectations depending on their personal situation. Many participants displayed a strong preference for couples HIV counseling and testing (CHCT) with mutual disclosure facilitated by a trained health worker. Home-based approaches and programs in which pregnant women are asked to bring their partners to the healthcare facility were equally favored. Participants felt that home-based CHCT would be acceptable for this rural setting, but special attention must be paid to how this service is introduced in the community, training of the health workers who will conduct the home visits, and confidentiality. Conclusion Pregnant couples should be given different options for assistance with HIV disclosure. Home-based CHCT could serve as an acceptable method to assist women and men with safe disclosure of HIV status. These findings can inform the design and
Tosal Herrero, B; Richart Martínez, M; Luque Plaza, M; Gutiérrez, L; Pastor García, R; Cabrero García, J; Reig Ferrer, A
To describe the evolution of the signs and more frequent gastrointestinal symptoms during the pregnancy and in the two weeks later the birth. 583 pregnant women, elects in an accidental way, interviewees between the 8 and 12 weeks of gestation (n = 133), among 18 and 22 (n = 155), among 37 and 42 (n = 203) and two weeks after the childbirth (n = 92) and coming from centers of health and hospitals of the Comunidad Valenciana and Murcia. The questionnaire, answered in a voluntary way by interview, it contained a listing on the signs and more frequent gastrointestinal symptoms during the pregnancy, and she answered on the presence or not of the same ones in the two weeks previous to the moment of the interview. The percentage of nauseas and vomits, although higher in the first trimester, stays around the 25-30% in the third gestation trimester. The heartburn is presented in 58.6% of the pregnant women in the third trimester. The sialorrea is presented in 7.7% of all the pregnant women and she stays during the whole gestation. The constipation stays constant during the gestation above at the 25-30%. The prevalence of haemorrhoids to the beginning of the gestation is over to 8% to be located in the postpartum in 53.3%. The description of the evolution of the signs and symptoms of the pregnancy described in the obstetrics manuals don't come up with our data.
Hossen, Md Abul; Westhues, Anne
Large segments of the population in developing countries are deprived of a fundamental right: access to basic health care. The problem of access to health care is particularly acute in Bangladesh. One crucial determinant of health seeking among rural women is the accessibility of medical care and barriers to care that may develop because of location, financial requirements, bureaucratic responses to the patient, social distance between client and provider, and the sex of providers. This article argues that to increase accessibility fundamental changes are required not only in resource allocation but also in the very structure of health services delivery.
Nyamathi, Adeline; Ekstrand, Maria; Srivastava, Neha; Carpenter, Catherine L; Salem, Benissa E; Al-Harrasi, Shawana; Ramakrishnan, Padma; Sinha, Sanjeev
In this focus group study, we explored the experiences of 16 rural women living with AIDS (WLA) who participated in the Asha-Life (AL) intervention to gain an understanding of the environmental, psychosocial, and cultural impact of the AL on their lives. Four themes emerged among AL participants: (a) the importance of tangible support, (b) need for social support, (c) ongoing challenges to accessing antiretroviral therapy (ART), and (d) perspectives on future programs. Our research findings support the development of future programs targeting mother-child dyads which emphasize nutritional knowledge, while reducing barriers to receiving ART, and physical, emotional, and financial support.
Yerges, April L; Stevens, Patricia E; Mkandawire-Valhmu, Lucy; Bauer, Wendy; Ng'ombe Mwenyekonde, Thokozani; Weinhardt, Lance S; Galvao, Loren W
Polygamy in sub-Saharan Africa has been linked to poverty, infant mortality, and HIV; however, it is unknown how interpersonal dynamics within polygamous households may influence population health outcomes. Findings from this postcolonial feminist study derive from interview data in a larger mixed-methods study in rural Malawi. We used thematic narrative analysis to probe 25 women's stories and applied an arts-based research technique, poetic construction, to present the results. Participants' evocative expressions, distilled and preserved in poetic form, illustrate themes of perseverance, grief, agency, and reflection. We discuss how gender relations, childrearing, tradition, economics, and health intersect in polygamous households.
Nyamathi, Adeline; Ekstrand, Maria; Srivastava, Neha; Carpenter, Catherine L.; Salem, Benissa E.; Al-Harassi, Shawana; Ramakrishnan, Padma; Sinha, Sanjeev
In this focus group study, we explored the experiences of 16 rural women living with AIDS (WLA) who participated in the Asha-Life (AL) intervention to gain an understanding of the environmental, psychosocial and cultural impact of the AL on their lives. Four themes emerged among AL participants: a) The Importance of Tangible Support, b) Need for Social Support, c) Ongoing Challenges to Accessing Antiretroviral Therapy (ART), and d) Perspectives on Future Programs. Our research findings support the development of future programs targeting mother-child dyads which emphasize nutritional knowledge, while reducing barriers to receiving ART, and physical, emotional, and financial support. PMID:26147930
Jett, Kathleen F
This study considers the meaning of aging from the perspective of a group of frail, rural African-American women living alone in north Florida. They defined aging as both an accumulation of years (eg, up-in-years old) and/or the result of functional impairment (eg, worn-out old). The former is a cause for celebration and the latter often the result of omissions or commissions on the part of the individual and society. Geronotologic nurses are encouraged to observe the client's cultural perspective and incorporate it into the plan of care and consider aging from many perspectives.
Mark, Kristen P; Crosby, Richard A; Vanderpool, Robin C
Despite known prevention and screening efforts, there are higher invasive cervical cancer rates in Appalachia than in other areas of the United States and higher mortality rates in the Appalachian region of Kentucky compared to Appalachian regions of other states. The primary purpose of this study was to investigate the association of psychosocial factors relevant to cervical cancer and the outcome of ever having a Pap test in a rural sample of women. The secondary purpose was to determine whether any of the same psychosocial factors were also associated with ever having an abnormal Pap test result among women with a self-reported history of having one or more Pap tests in their lifetime. Data were collected in fall of 2013 from 393 women in 8 economically distressed counties of rural Appalachian Kentucky. Women completed an interviewer-administered survey assessing sociodemographic and health information as well as beliefs about cervical cancer. Multivariate logistic regression results indicated that low income and greater perceived local fatalism were significant predictors of never having a Pap test. Lack of personal control over prevention, and peer and family influences were significant predictors of ever having an abnormal Pap test result. Educational efforts targeted in rural Appalachia would be supported by encouraging the benefits of early and consistent screening, altering the established norms of community fatalism and lack of personal control over prevention, and creating targeted messages through public campaigns that convince rural Appalachian women that cervical cancer is highly preventable and screenable. © 2017 National Rural Health Association.
Gust, Deborah A; Pan, Yi; Otieno, Fred; Hayes, Tameka; Omoro, Tereza; Phillips-Howard, Penelope A; Odongo, Fred; Otieno, George O
Intimate partner physical violence increases women's risk for negative health outcomes and is an important public health concern. The purpose of the present study was to determine 1) the proportion of girls (≤18 years) and women (>18 years) who experienced physical violence by a sexual partner, and 2) factors (including self-reported HIV infection) associated with girls and women who experienced physical violence by a sexual partner. Cross-sectional surveys conducted in the Gem Health and Demographic Surveillance System (HDSS) area in Siaya County, western Kenya in 2011-2012 (Round 1) and 2013-2014 (Round 2). Among 8003 unique participants (582 girls and 7421 women), 11.6% reported physical violence by a sexual partner in the last 12 months (girls: 8.4%, women: 11.8%). Three factors were associated with physical violence by a sexual partner among girls: being married or cohabiting (nearly 5-fold higher risk), low education, and reporting forced sex in the last 12 months (both with an approximate 2-fold higher risk). Predictive factors were similar for women, with the addition of partner alcohol/drug use and deliberately terminating a pregnancy. Self-reported HIV status was not associated with recent physical violence by a sexual partner among girls or women. Gender-based physical violence is prevalent in this rural setting and has a strong relationship with marital status, low education level, and forced sex among girls and women. Concerted efforts to prevent child marriage and retain girls in school as well as implementation of school and community-based anti-violence programs may help mitigate this risk.
Joshi, Ashish; Amadi, Chioma; Meza, Jane; Aguire, Trina; Wilhelm, Sue
To evaluate the impact of an interactive, computer based, bi-lingual breastfeeding educational program on breastfeeding knowledge, self-efficacy and intent to breastfeed among rural Hispanic women living in Scottsbluff, Nebraska. A two-group, repeated measures quasi-experimental study was conducted to evaluate the impact of a breastfeeding intervention. Forty six rural Hispanic women between ages 18 and 38 years were enrolled at the Regional West Medical Center in Scottsbluff, Nebraska. Study participants were randomized into intervention and control groups, with the intervention group (n=23) receiving bi-lingual (English and Spanish) breastfeeding education on a touch screen computer program, while the control group received printed educational material. Study participants were enrolled during their last six weeks of pregnancy, with follow up assessments conducted post-partum at days 3 and 7, weeks 2 and 6, and months 3 and 6. The study protocol was approved by the University of Nebraska Medical Center Institutional Review Board (IRB protocol #430-12-EP) and City University of New York Institutional Review Board (IRB protocol # 642980-1). A significant improvement in the breastfeeding knowledge and intent to breastfeed scores was seen over a 6 month period among all the study participants (p<0.05). There was a gradual increase in the breastfeeding self-efficacy scores till week 6 followed by a decrease in self-efficacy scores at month 3 (p=0.46), and month 6 (P=0.54). Breastfeeding knowledge scores differed significantly between the study participants in the control and intervention groups at week 6 (p=0.03). There were no significant differences in the breastfeeding knowledge between the control and intervention groups at other time points. The control group showed gradual decline in their self-efficacy scores at month 3 and month 6 compared to the intervention group that showed a gradual increase in their self-efficacy scores at different time points during
Santibáñez, Miguel; Paz-Zulueta, Maria; Ruiz, María; Castro, Irene; Llorca, Javier
to examine the association and interaction between language proficiency, social risk factors and lack of adherence to antenatal care in African immigrant women (AIW). retrospective cohort study. Two hundred and thirty-one AIW with delivery dates from 2007 to 2010 were identified, and data were collected on knowledge of Spanish, referral to a social worker because of social risk factors, and adequacy of antenatal care using the Kessner Index (KI) and the authors' own index (OI). The Spanish-born population sample was obtained by simple random sampling in a 1:3 ratio. Odds ratios (OR) were estimated by non-conditional logistic regression. The term 'language*referral to social worker' was included in the logistic models to study interaction. eighty-four per cent of AIW had insufficient knowledge of Spanish, and 47% had been referred to a social worker. Of the AIW who had not been referred to a social worker, the association between poor knowledge of Spanish and inadequate antenatal care was weak and not significant (OR for KI 1.31). On the contrary, of the AIW who had been referred to a social worker, the association was stronger and significant (OR for KI 8.98; p interaction=0.026). Social risk factors were the main independent factors associated with inadequate antenatal care in Spanish women (adjusted OR 3.17; 95% confidence interval 1.42-7.06). this study found that the main factor associated with inadequate antenatal care in AIW is insufficient language proficiency, but only in the presence of social risk factors, which have also been associated with worse antenatal care in Spanish women. Copyright © 2014 Elsevier Ltd. All rights reserved.
Juarez Bartola, M; Garcia Ventura, H; De Jesus Leon, M J
Mexico's peasant sector is undergoing great change as a result of the insertion of capitalist relations into areas that were previously remote. The traditional peasant subsistence economy has been displaced, and peasants have been forced to adopt a series of new strategies for survival, entailing proletarianization or selling of labor. Women in the community of San Nicolas Zoyapetlayoca, in the municipio of Tepeaca, have lived in a situation of poverty and precariousness for some time. Most of the population historically depended on the neighboring haciendas for their livelihood. Women and children also worked there, mistreated and without social protection. The lands that were distributed after the Revolution are insufficient to support the community, and most families must look elsewhere for employment. Incomes are insufficient to cover all the necessities of education, health, nutrition, and other aspects of life. Most women are educated no farther than the primary level. They spend most of their time preparing food, carrying water, washing clothes, caring for their children, and in other domestic chores. Some women work for wages as laborers, factory workers, or domestics. Rural women are disadvantaged by poor working conditions, insufficient education, low levels of health and nutrition, limited participation in social and political life, poor housing and lack of services, and frequently by their own attitudes of traditionalism or fatalism.
Conroy, Amy A; Tsai, Alexander C; Clark, Gina M; Boum, Yap; Hatcher, Abigail M; Kawuma, Annet; Hunt, Peter W; Martin, Jeffrey N; Bangsberg, David R; Weiser, Sheri D
Gender-based power imbalances place women at significant risk for sexual violence, however, little research has examined this association among women living with HIV/AIDS. We performed a cross-sectional analysis of relationship power and sexual violence among HIV-positive women on anti-retroviral therapy in rural Uganda. Relationship power was measured using the Sexual Relationship Power Scale (SRPS), a validated measure consisting of two subscales: relationship control (RC) and decision-making dominance. We used multivariable logistic regression to test for associations between the SRPS and two dependent variables: recent forced sex and transactional sex. Higher relationship power (full SRPS) was associated with reduced odds of forced sex (AOR = 0.24; 95 % CI 0.07-0.80; p = 0.020). The association between higher relationship power and transactional sex was strong and in the expected direction, but not statistically significant (AOR = 0.47; 95 % CI 0.18-1.22; p = 0.119). Higher RC was associated with reduced odds of both forced sex (AOR = 0.18; 95 % CI 0.06-0.59; p < 0.01) and transactional sex (AOR = 0.38; 95 % CI 0.15-0.99; p = 0.048). Violence prevention interventions with HIV-positive women should consider approaches that increase women's power in their relationships.
Sample, P L; Darragh, A R
To examine care access among women with brain injuries, a qualitative, phenomenological study was conducted. Twenty-one women with acquired brain injuries were recruited for the inquiry, representing rural and urban regions of Colorado. The phenomenological approach allowed the investigators to examine the shared experiences of women with brain injuries as they sought rehabilitative supports and services, and attempted to re-enter their lives and communities. Each woman was interviewed one or two times, the interviews were transcribed and then coded and analysed by both authors separately. Thematic analysis of the data revealed two major emergent themes: issues surrounding diagnosis and barriers to accessing care. A total of 10 women interviewed experienced difficulty obtaining a diagnosis of brain injury and experienced serious personal and professional consequences as a result. All the women experienced barriers to accessing care, including problems with service providers and service systems, financial challenges, travelling for services, lack of information or services in their area, lack of care coordination and funneling. Some of the barriers cannot be changed secondary to cost, efficiency and logistics. Other barriers, could be changed through education, training and policy making.
Schuler, S R; Hashemi, S M; Badal, S H
This ethnographic study examined the sociocultural context of domestic violence in 6 rural villages in Bangladesh, and the prevalence of wife-beating and its association with women's empowerment in income generation programs (IGPs). Data were obtained from interviews conducted during 1990-96. Four villages had IGPs, and 2 villages did not have credit programs. Over 66% of women reported having been beaten at one time or another. In one village 87% reported beatings. 38% reported beatings in the preceding year (a range of 14-60%). Men beat their wives over trivial matters or frustrations over problems for which wives were not responsible. Beatings were attributed to mens' desire to control behavior and reassert their authority when challenged or to exploit their wives for financial gain. Some of the most severe beatings were linked with dowry. Both husbands and wives considered the beatings legitimate. The highest level of violence was in villages that were experiencing the most changes in gender roles and that had the most women contributing to family support. The lowest levels of violence were in villages with the fewest contributing to family support. Interviews, case studies, and observations yielded ambivalent evidence about the influence of credit programs on domestic violence. Credit programs have the potential to increase women's status and to disseminate anti-violence messages among both men and women.
Introduction Anemia is a public health concern among women in rural Baja California, Mexico. The purpose of this study was to identify the individual and community factors contributing to the disproportionately high prevalence of anemia among women in this region. Methods A cross-sectional study of 118 women (15–49 years) was performed in a rural colonia (small settlement) in Baja California, Mexico in 2012. Participants completed a survey comprised of demographic, socioeconomic, health, and dietary questions and provided a capillary blood sample. A portable HemoCue was used to measure hemoglobin and diagnose anemia. Anemic participants provided a venous blood sample for laboratory testing to elucidate the etiology of anemia. Anemic participants received vitamin supplements and nutritional counseling. Assessments of six local tiendas (community grocery stores) were performed to ascertain the types of food available for purchase within the community. Results Prevalence of anemia was 22% among women; laboratory tests revealed iron deficiency was the primary etiology in 80.8% of anemia cases. Other causes of anemia in women included vitamin B-12 deficiency (11.5%) and combined iron and vitamin B-12 deficiency (7.7%). Women from low SES households and women enrolled in the government assistance program Prospera were significantly more likely to be anemic (OR = 3.48, 95% CI 1.35–8.98 and OR = 2.49, 95% CI 1.02–6.09, respectively). Vitamin supplementation was significantly more common among non-anemic women (OR = 0.12, 95% CI 0.02–0.94). Dietary assessments showed limited consumption of iron absorption enhancing foods such as fruits and vegetables. Assessments of local tiendas revealed at least one type of meat and citrus fruit available for purchase at each store; however, leafy green vegetables were only available for purchase at one store. Conclusion All cases of anemia were due to nutritional deficiencies. While vitamin supplementation is a temporary solution
Moor, Molly A; Fraga, Miguel A; Garfein, Richard S; Rashidi, Hooman H; Alcaraz, John; Kritz-Silverstein, Donna; Elder, John P; Brodine, Stephanie K
Anemia is a public health concern among women in rural Baja California, Mexico. The purpose of this study was to identify the individual and community factors contributing to the disproportionately high prevalence of anemia among women in this region. A cross-sectional study of 118 women (15-49 years) was performed in a rural colonia (small settlement) in Baja California, Mexico in 2012. Participants completed a survey comprised of demographic, socioeconomic, health, and dietary questions and provided a capillary blood sample. A portable HemoCue was used to measure hemoglobin and diagnose anemia. Anemic participants provided a venous blood sample for laboratory testing to elucidate the etiology of anemia. Anemic participants received vitamin supplements and nutritional counseling. Assessments of six local tiendas (community grocery stores) were performed to ascertain the types of food available for purchase within the community. Prevalence of anemia was 22% among women; laboratory tests revealed iron deficiency was the primary etiology in 80.8% of anemia cases. Other causes of anemia in women included vitamin B-12 deficiency (11.5%) and combined iron and vitamin B-12 deficiency (7.7%). Women from low SES households and women enrolled in the government assistance program Prospera were significantly more likely to be anemic (OR = 3.48, 95% CI 1.35-8.98 and OR = 2.49, 95% CI 1.02-6.09, respectively). Vitamin supplementation was significantly more common among non-anemic women (OR = 0.12, 95% CI 0.02-0.94). Dietary assessments showed limited consumption of iron absorption enhancing foods such as fruits and vegetables. Assessments of local tiendas revealed at least one type of meat and citrus fruit available for purchase at each store; however, leafy green vegetables were only available for purchase at one store. All cases of anemia were due to nutritional deficiencies. While vitamin supplementation is a temporary solution, improved individual nutrition knowledge and
Estévez-López, Fernando; Camiletti-Moirón, Daniel; Aparicio, Virginia A; Segura-Jiménez, Víctor; Álvarez-Gallardo, Inmaculada C; Soriano-Maldonado, Alberto; Borges-Cosic, Milkana; Acosta-Manzano, Pedro; Geenen, Rinie; Delgado-Fernández, Manuel; Martínez-González, Luis J; Ruiz, Jonatan R; Álvarez-Cubero, María J
Candidate-gene studies on fibromyalgia susceptibility often include a small number of single nucleotide polymorphisms (SNPs), which is a limitation. Moreover, there is a paucity of evidence in Europe. Therefore, we compared genotype frequencies of candidate SNPs in a well-characterised sample of Spanish women with fibromyalgia and healthy non-fibromyalgia women. A total of 314 women with a diagnosis of fibromyalgia (cases) and 112 non-fibromyalgia healthy (controls) women participated in this candidate-gene study. Buccal swabs were collected for DNA extraction. Using TaqMan™ OpenArray™, we analysed 61 SNPs of 33 genes related to fibromyalgia susceptibility, symptoms, or potential mechanisms. We observed that the rs841 and rs1799971 GG genotype was more frequently observed in fibromyalgia than in controls (p = 0.04 and p = 0.02, respectively). The rs2097903 AT/TT genotypes were also more often present in the fibromyalgia participants than in their control peers (p = 0.04). There were no differences for the remaining SNPs. We identified, for the first time, associations of the rs841 (guanosine triphosphate cyclohydrolase 1 gene) and rs2097903 (catechol-O-methyltransferase gene) SNPs with higher risk of fibromyalgia susceptibility. We also confirmed that the rs1799971 SNP (opioid receptor μ1 gene) might confer genetic risk of fibromyalgia. We did not adjust for multiple comparisons, which would be too stringent and yield to non-significant differences in the genotype frequencies between cases and controls. Our findings may be biologically meaningful and informative, and should be further investigated in other populations. Of particular interest is to replicate the present study in a larger independent sample to confirm or refute our findings. On the other hand, by including 61 SNPs of 33 candidate-genes with a strong rationale (they were previously investigated in relation to fibromyalgia susceptibility, symptoms or potential mechanisms), the present
Mediano, Pilar; Fernández, Leónides; Rodríguez, Juan M; Marín, María
The purpose of this study was to identify potential predisposing factors associated with human infectious mastitis. We conducted a case-control study among breastfeeding women, with 368 cases (women with mastitis) and 148 controls. Data were collected by a questionnaire designed to obtain retrospective information about several factors related to medical history of mother and infant, different aspects of pregnancy, delivery and postpartum, and breastfeeding practices that could be involved in mastitis. Bivariate analyses and multivariate logistic regression model were used to examine the relationship between mastitis and these factors. The variables significantly- and independently-associated with mastitis were cracked nipples (P < 0.0001), oral antibiotics during breastfeeding (P < 0.0001), breast pumps (P < 0.0001), topical antifungal medication during breastfeeding (P = 0.0009), mastitis in previous lactations (P = 0.0014), breast milk coming in later than 24 h postpartum (P = 0.0016), history of mastitis in the family (P = 0.0028), mother-infant separation longer than 24 h (P = 0.0027), cream on nipples (P = 0.0228) and throat infection (P = 0.0224). Valuable factors related to an increased risk of infectious mastitis have been identified. This knowledge will allow practitioners to provide appropriate management advice about modifiable risk factors, such as the use of pumps or inappropriate medication. They also could identify before delivery those women at an increased risk of developing mastitis, such as those having a familial history of mastitis, and thus develop strategies to prevent this condition.
Background The purpose of this study was to identify potential predisposing factors associated with human infectious mastitis. Methods We conducted a case–control study among breastfeeding women, with 368 cases (women with mastitis) and 148 controls. Data were collected by a questionnaire designed to obtain retrospective information about several factors related to medical history of mother and infant, different aspects of pregnancy, delivery and postpartum, and breastfeeding practices that could be involved in mastitis. Bivariate analyses and multivariate logistic regression model were used to examine the relationship between mastitis and these factors. Results The variables significantly- and independently-associated with mastitis were cracked nipples (P < 0.0001), oral antibiotics during breastfeeding (P < 0.0001), breast pumps (P < 0.0001), topical antifungal medication during breastfeeding (P = 0.0009), mastitis in previous lactations (P = 0.0014), breast milk coming in later than 24 h postpartum (P = 0.0016), history of mastitis in the family (P = 0.0028), mother-infant separation longer than 24 h (P = 0.0027), cream on nipples (P = 0.0228) and throat infection (P = 0.0224). Conclusions Valuable factors related to an increased risk of infectious mastitis have been identified. This knowledge will allow practitioners to provide appropriate management advice about modifiable risk factors, such as the use of pumps or inappropriate medication. They also could identify before delivery those women at an increased risk of developing mastitis, such as those having a familial history of mastitis, and thus develop strategies to prevent this condition. PMID:24902596
Nyamathi, Adeline; Ekstrand, Maria; Heylen, Elsa; Ramakrishna, Padma; Yadav, Kartik; Sinha, Sanjeev; Hudson, Angela; Carpenter, Catherine L; Arab, Lenore
We conducted a cross-sectional examination of the physical and psychological factors related to ART adherence among a sample of 400 women living with HIV/AIDS in rural India. Interviewer-administered measures assessed adherence, internalized stigma, depressive symptoms, quality of life, food insecurity, health history and sociodemographic information. CD4 counts were measured using blood collected at screening. Findings revealed that adherence to ART was generally low, with 94% of women taking 50% or less of prescribed medication in past month. Multivariate analyses showed a non-linear association between numbers of self-reported opportunistic infections (OIs) in past 6 months (p = 0.016) and adherence, with adherence decreasing with each additional OI for 0-5 OIs. For those reporting more than 5 OIs, the association reversed direction, with increasing OIs beyond 5 associated with greater adherence.
Costa, Marta Cocco; Lopes, Marta Julia Marques; Soares, Joannie Dos Santos Fachinelli
We analyze the social representations of violence against women from the perspective of city managers, professionals and health workers in rural settings of the southern half of Rio Grande do Sul. The study has a qualitative approach and adds a theoretical/methodological perspective of social representations. The data were generated by means of the associative method, question-stimulus of words and expressions emergence. The analysis of word association was performed with EVOC software, considering frequency and order of association with inducing terms. Participants recognize violence against women as gender destination that induces consent, resignation, guilt and fear, and results in naturalization and trivialization of this social phenomenon. We highlight the need to produce ruptures in established and traditional forms of health care, in the conservative and stereotypical views of violence, favoring access to friendly service and avoiding the reproduction of gender inequalities.
Maretzki, Audrey N
With funding provided by the Center for Higher Education of the United States Agency for International Development, The Pennsylvania State University and Tuskegee University collaborated with the University of Nairobi in establishing women's NutriBusiness Cooperatives in the Rift Valley and Central Provinces of Kenya. Between 1992 and 1999, the cooperatives were established, facilities and equipment were supplied and extensive participatory training was provided by university-affiliated investigators and project staff. This initiative enabled approximately 2500 rural Kenyan women farmers to add value to their crops by processing and locally marketing nutritious, convenient, culturally-appropriate weaning food mixes. Implementation of the NutriBusiness model is described and challenges of cultural engagement are highlighted.
Within the overall aim of poverty alleviation, development efforts have included credit and self-employment programmes. In Bangladesh, the major beneficiaries of such group-based credit programmes are rural women who use the loans to initiate small informal income-generating activities. This paper explores the benefits of women's participation in credit programmes on their own health seeking. Using data from a sample of 1798 households from rural Bangladesh, conducted in 1991-1992 through repeated random sampling of 87 districts covered by Grameen Bank, Bangladesh Rural Advancement Committee (BRAC) and Bangladesh Rural Development Board (BRDB), this paper addresses the question: does women's participation in credit programmes significantly affect their use of formal health care? A non-unitary household preference model is suggested to test the hypothesis that women's empowerment through participation in these programmes results in greater control of resources for their own demand for formal health care. The analysis controls for endogeneity due to self-selection and other unobserved village level factors through the use of a weighted two stage instrumental variable approach with village level fixed effects. The findings indicate a positive impact of women's participation in credit programmes on their demand for formal health care. The policy simulations on the results of this study highlight the importance of credit programmes as a health intervention in addition to being a mechanism for women's economic empowerment.
Bai, Yang; Liu, Qing; Chen, Xinguang; Gao, Yanduo; Gong, Huiyun; Tan, Xiaodong; Zhang, Min; Tuo, Jiyu; Zhang, Yuling; Xiang, Qunying; Deng, Fenghua; Liu, Guiling
Despite the significance of cervical cancer screening, motivating more women to participate remains a challenge in resource-limited settings. In this study, we tested the protection motivation theory (PMT) in predicting screening intentions. Participants were women from Wufeng, a typical rural county in China. Participants (n = 3000) with no cervical cancer history were recruited from 10 randomly selected villages. As mediating variables, 6 PMT constructs (Perceived Risk, Fear Arousal, Perceived Severity, Response Efficacy, Response Cost, and Self-Efficacy) were measured using the standardized questionnaire. Structural equation modeling (SEM) method was employed to test PMT-based prediction models. Of the total sample, 57.77% believed that regular screening may reduce cervical cancer risk, and 45.26% agreed that women should be screened regularly. Our data fit the PMT model well (GFI = 0.95, AGFI = 0.93, CFI = 0.90, RMSEA = 0.06, SRMR = 0.04, Chi-square/df = 2.47). Knowledge of screening was directly and positively associated with screening intention. Age, annual income, and awareness of and prior experience with screening were significantly associated with screening intention by enhancing cervical cancer risk perception and by reducing response cost (P<0.05 for both). PMT can be used as guidance to investigate cervical cancer screening intentions among rural women in China with focus on cancer knowledge, some demographic factors, and awareness of and previous experience with screening. These findings, if verified with longitudinal data, can be used for intervention program development. Copyright © 2017 John Wiley & Sons, Ltd.
CHIANG, CHIFA; ADLY LABEEB, SHOKRIA; HIGUCHI, MICHIYO; GHAREDS MOHAMED, ASMAA; AOYAMA, ATSUKO
ABSTRACT This cross-sectional study examined potential demand-side barriers to women’s use of basic health services in rural southern Egypt (Upper Egypt). Face-to-face interviews with a structured questionnaire were carried out on 205 currently-married women, inquiring about their use of health facilities: regular antenatal care (ANC) during the last pregnancy and medical treatment services when they suffered from common illness. Questions about their perceptions of barriers to the use of health services were categorized into three primary dimensions: structural, financial, and personal/cultural barriers. Distance and transportation to health facilities (structural barriers) prevented about 30 % of the women from seeing a doctor. Forty-two percent of them felt the difficulty paying for health services (financial barriers). Approximately a quarter of women answered that gaining family permission, allocating time to go to health facilities, or concern about lack of female physicians (personal/cultural barriers) was a big problem for them. After controlling for potential confounding factors, structural barriers showed an inverse association with the use of health services. Financial barriers indicated a strong association (OR=0.18, P<0.001) with the use of curative services (medical treatment), but not with the use of preventive services (regular ANC). Contrary to our expectation, personal/cultural barriers had no statistical significance with women’s use of health services. Although the Egyptian government had successfully extended basic health service delivery networks throughout the country, women in rural Upper Egypt were still facing various barriers to the use of the services, especially structural and financial barriers. PMID:24640178
Hossain, Mohammad Shakhawat; Kypri, Kypros; Rahman, Bayzidur; Arslan, Iqbal; Akter, Shahnaz; Milton, Abul Hasnat
To estimate the prevalence and identify correlates of smokeless tobacco consumption among married rural women with a history of at least one pregnancy in Madaripur, Bangladesh. We conducted a cross-sectional survey using an interviewer administered, pre-tested, semi-structured questionnaire. All women living in the study area, aged 18 years and above with at least one pregnancy in their lifetime, who were on the electoral roll and agreed to participate were included in the study. Information on socio-demographic characteristics and smokeless tobacco consumption was collected. Smokeless tobacco consumption was categorized as 'Current', 'Ever but not current' and 'Never'. Associations between smokeless tobacco consumption and the explanatory variables were estimated using simple and multiple binary logistic regression. 8074 women participated (response rate 99.9%). The prevalence of 'Current consumption', 'Ever consumption but not current', and 'Never consumption' was 25%, 44% and 31%, respectively. The mean age at first use was 31.5 years. 87% of current consumers reported using either Shadapata or Hakimpuree Jarda. Current consumption was associated with age, level of education, religion, occupation, being an income earner, marital status, and age at first use of smokeless tobacco. After adjustment for demographic variables, current consumption was associated with being over 25 years of age, a lower level of education, being an income earner, being Muslim, and being divorced, separated or widowed. The prevalence of smokeless tobacco consumption is high among rural women in Bangladesh and the age of onset is considerably older than that for smoking. Smokeless tobacco consumption is likely to be producing a considerable burden of non-communicable disease in Bangladesh. Smokeless tobacco control strategies should be implemented.
Leeman, Jennifer; Skelly, Anne H; Burns, Dorothy; Carlson, John; Soward, April
The purpose of this study was to tailor a diabetes management intervention to the cultural and age-related needs and preferences of older, rural African American women. Findings from exploratory research, clinical experience, and review of the literature were used to inform the development of a culture- and function-specific intervention. Findings informed the design of the intervention, format of intervention delivery, format of intervention materials, and training provided to interventionists. Intervention materials were reviewed by a community advisory board, and the intervention was pilot tested with 43 women. The intervention's delivery was tailored to the needs of older African American women through the use of 1-hour, in-home sessions that used a storytelling format to share information. The design of the intervention individualized its content to each woman's symptom experience, self-care practices, and coping strategies. Extensive training sensitized intervention nurses to coping strategies (spirituality, church, family) and barriers to self-care (functional limitations, stress, the multi-caregiver role) that are common among older African American women. Intervention materials were culturally sensitive and in large-print format. African American women's cultural background may have a strong influence on health behaviors and beliefs. Older women's health behaviors are further influenced by changes in their functional abilities. Therefore, the authors tailored a diabetes self-care management intervention to be specific to older African American women's cultural and functional differences. An initial pilot of the intervention found high levels of participant satisfaction with the intervention, improvements in diabetes self-care practices, and a trend toward greater metabolic control.
Johnson, Derek C; Lhaki, Pema; Bhatta, Madhav P; Kempf, Mirjam-Colette; Smith, Jennifer S; Bhattarai, Pankaj; Aryal, Shilu; Chamot, Eric; Regmi, Kiran; Vermund, Sten H; Shrestha, Sadeep
In April 2014 we investigated the association of migration of a woman's husband with her high-risk human papillomavirus (HR-HPV) infection status and her abnormal cervical cytology status in the Achham district of rural Far-Western Nepal. Women were surveyed and screened for HR-HPV during a health camp conducted by the Nepal Fertility Care Center. Univariate and multivariable statistical tests were performed to determine the association of a husband's migration status with HR-HPV infection and cervical cytology status. In 265 women, the prevalence of HR-HPV was 7.5% (20/265), while the prevalence of abnormal cervical cytology, defined using the Bethesda system as atypical glandular cells of undetermined significance or worse, was 7.6% (19/251). Half of the study participants (50.8%, 130/256) had husbands who had reported migrating for work at least once. Women aged ≤34 years were significantly less likely to test positive for HR-HPV than women aged >34 years (OR 0.22, 95% CI 0.07 to 0.71). HR-HPV infection and abnormal cervical cytology status were not directly associated with a husband's migration. Older women were found to have a higher prevalence of HPV than younger women. It is possible that a husband's migration for work could be delaying HR-HPV infections in married women until an older age. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: email@example.com.
Richardson, Robin A; Nandi, Arijit; Jaswal, Surinder; Harper, Sam
High work demands might be a determinant of poor mental health among women in low- and middle-income countries, especially in rural settings where women experience greater amounts of labor-intensive unpaid work. Research originating from such settings is lacking. We estimated the cross-sectional association between work demands and mental distress among 3177 women living in 160 predominantly tribal communities in southern Rajasthan, India. A structured questionnaire captured the number of minutes women spent on various activities in the last 24 h, and we used this information to measure women's work demands, including the total work amount, nature of work (e.g., housework), and type of work (e.g., cooking). Mental distress was measured with the Hindi version of the 12-item General Health Questionnaire. We used negative binomial regression models to estimate the association between work demands (amount, nature, and type) and mental distress. On average, women spent more than 9.5 h a day on work activities. The most time, intensive work activity was caring for children, the elderly, or disabled (149 min). In adjusted models, we found a U-shaped association between work amount and mental distress. High amounts of housework were associated with higher distress, whereas paid work and farmwork amount were not. Certain types of housework, including collecting water and cleaning, were associated with increased distress scores. We found an association between aspects of work demands and mental distress. Research in other contexts where women perform high amounts of unpaid work, particularly within the home or farm, is warranted.
King, Sue; Passey, Megan; Dickson, Rumona
Maternal mortality remains exceptionally high in Papua New Guinea (PNG) at 733 per 100,000 live births. There has been little, if any, improvement in maternal mortality or maternity services since the 1980s. In 1992-1993 a survey of 550 women in rural coastal areas of Madang Province was undertaken to investigate the prevalence of maternal risk factors and parous women's utilization of and attitudes towards the existing health services. Women were classified as at risk on the basis of previous obstetric complications, parity, stillbirths and neonatal deaths. On this basis 67% of women were classified as being at risk in a future pregnancy. High rates of obstetric complications were reported, with only 42% of women delivering their most recent child in a health facility. There was no statistical difference between those not at risk and those at risk in terms of their use of antenatal care or having been referred for a health centre delivery. The most common reason given for not utilizing the existing health services was lack of access. Most commonly expressed positive perceptions of a health centre delivery were the availability of medical help (59%) and the physical comfort of the health centre (48%). Most common negative views expressed were lack of physical comfort (29%) and the attitudes of staff (11%). Women's opinion on village births was divided. Many (47%) thought that there was nothing good about a village birth and the same percentage cited lack of medical care if problems arose. On the other hand 36% of women thought there was nothing wrong with a village delivery, and 30% cited the care and respect received from relatives as a positive aspect. When asked for suggestions on how services could be improved only a minority of respondents expressed an opinion. Those who did wanted better access, more information on family planning and improved care and respect from staff.
Gust, Deborah A; Pan, Yi; Otieno, Fred; Hayes, Tameka; Omoro, Tereza; Phillips–Howard, Penelope A; Odongo, Fred; Otieno, George O
Background Intimate partner physical violence increases women’s risk for negative health outcomes and is an important public health concern. The purpose of the present study was to determine 1) the proportion of girls (≤18 years) and women (>18 years) who experienced physical violence by a sexual partner, and 2) factors (including self–reported HIV infection) associated with girls and women who experienced physical violence by a sexual partner. Methods Cross–sectional surveys conducted in the Gem Health and Demographic Surveillance System (HDSS) area in Siaya County, western Kenya in 2011–2012 (Round 1) and 2013–2014 (Round 2). Findings Among 8003 unique participants (582 girls and 7421 women), 11.6% reported physical violence by a sexual partner in the last 12 months (girls: 8.4%, women: 11.8%). Three factors were associated with physical violence by a sexual partner among girls: being married or cohabiting (nearly 5–fold higher risk), low education, and reporting forced sex in the last 12 months (both with an approximate 2–fold higher risk). Predictive factors were similar for women, with the addition of partner alcohol/drug use and deliberately terminating a pregnancy. Self–reported HIV status was not associated with recent physical violence by a sexual partner among girls or women. Conclusions Gender–based physical violence is prevalent in this rural setting and has a strong relationship with marital status, low education level, and forced sex among girls and women. Concerted efforts to prevent child marriage and retain girls in school as well as implementation of school and community–based anti–violence programs may help mitigate this risk. PMID:28959439
Gao, Haoyue; Stiller, Caroline K.; Scherbaum, Veronika; Biesalski, Hans Konrad; Wang, Qi; Hormann, Elizabeth; Bellows, Anne C.
Micronutrient deficiencies and imbalanced dietary intake tend to occur during the reproductive period among women in China. In accordance with traditional Chinese culture, pregnant women are commonly advised to follow a specific set of dietary precautions. The purpose of this study was to assess dietary intake data and identify risk factors for nutritional inadequacy in pregnant women from urban and rural areas of Deyang region, Sichuan province of China. Cross-sectional sampling was applied in two urban hospitals and five rural clinics (randomly selected) in Deyang region. Between July and October 2010, a total of 203 pregnant women in the third trimester, aged 19–42 years, were recruited on the basis of informed consent during antenatal clinic sessions. Semi-structured interviews on background information and 24-h dietary recalls were conducted. On the basis of self-reported height and pre-pregnancy weight, 68.7% of the women had a pre-pregnancy body mass index (BMI) within the normal range (18.5 ≤ BMI < 25), 26.3% were found to be underweight with a BMI <18.5 (20.8% in urban vs. 35.6% in rural areas), while only 5.1% were overweight with a BMI ≥30. In view of acceptable macronutrient distribution ranges (AMDRs) the women’s overall dietary energy originated excessively from fat (39%), was low in carbohydrates (49.6%), and reached the lower limits for protein (12.1%). Compared to rural areas, women living in urban areas had significantly higher reference nutrient intake (RNI) fulfillment levels for energy (106.1% vs. 93.4%), fat (146.6% vs. 119.7%), protein (86.9% vs. 71.6%), vitamin A (94.3% vs. 65.2%), Zn (70.9% vs. 61.8%), Fe (56.3% vs. 48%), Ca (55.1% vs. 41%) and riboflavin (74.7% vs. 60%). The likelihood of pregnant women following traditional food recommendations, such as avoiding rabbit meat, beef and lamb, was higher in rural (80%) than in urban (65.1%) areas. In conclusion, culturally sensitive nutrition education sessions are necessary for both
Pérez-Aguado, María del Carmen; Brugues, Eulalia; de Leiva-Perez, Alejandra; de Leiva, Alberto
The outbreak of the Spanish Civil War in 1936 had repercussions throughout the world. Even though Western democracies had signed a Non-Intervention Agreement, thousands of foreign volunteers fought on the Republican side. This paper briefly summarizes the issues that directly led to the war, and focuses on the intervention of the International Brigades, the origins of the International Sanitary Service (ISS) and the role played by women at the ISS. These women implemented and collaborated in important and innovative procedures in military medicine, that we analyze below.
Carnahan, Leslie R; Zimmermann, Kristine; Peacock, Nadine R
Living in a rural food desert has been linked to poor dietary habits. Understanding community perspectives about available resources and feasible solutions may inform strategies to improve food access in rural food deserts. The objective of our study was to identify resources and solutions to the food access problems of women in rural, southernmost Illinois. Fourteen focus groups with women (n = 110 participants) in 4 age groups were conducted in a 7-county region as part of a community assessment focused on women's health. We used content analysis with inductive and deductive approaches to explore food access barriers and facilitators. Similar to participants in previous studies, participants in our study reported insufficient local food sources, which they believe contributed to poor dietary habits, high food prices, and the need to travel for healthful food. Participants identified existing local activities and resources that help to increase access, such as home and community gardens, food pantries, and public transportation, as well as local solutions, such as improving nutrition education and public transportation options. Multilevel and collaborative strategies and policies are needed to address food access barriers in rural communities. At the individual level, education may help residents navigate geographic and economic barriers. Community solutions include collaborative strategies to increase availability of healthful foods through traditional and nontraditional food sources. Policy change is needed to promote local agriculture and distribution of privately grown food. Understanding needs and strengths in rural communities will ensure responsive and effective strategies to improve the rural food environment.
Pradeep, Johnson; Isaacs, Anton; Shanbag, Deepthi; Selvan, Sumithra; Srinivasan, Krishnamachari
Background & objectives: Depression remains largely undiagnosed in women residing in rural India and consequently many do not seek help. Moreover, among those who are diagnosed, many do not complete treatment due to high rates of attrition. This study was aimed to compare the effectiveness of enhanced care with usual care in improving treatment seeking and adherence to antidepressant medication in women with depression living in rural India. Methods: Six villages from rural Bangalore were randomized to either community health worker supported enhanced care or usual care. A total of 260 adult depressed women formed the final participants for the analysis. The outcome measures were number of women who sought and completed treatment, number of clinic visits, duration of treatment with antidepressant, changes in severity of depression (HDRS) and changes in quality of life [WHO-QOL (Brev) scale]. Results: A significantly greater number of women from the treatment intervention (TI) group completed the treatment and were on treatment for a longer duration compared to the treatment as usual (TAU) group. However, there were no significant differences in the severity of depression or quality of life between the TI and the TAU groups or between treatment completers and treatment dropouts at six months. Interpretation & conclusions: Enhanced care provided by the trained community health workers to rural women with major depression living in the community resulted in greater number of women seeking help and adhering to treatment with antidepressants. However, despite enhanced care a significant number of rural women diagnosed with depression either did not seek help or discontinued treatment prematurely. These findings have significant public health implications, as untreated depression is associated with considerable disability. PMID:24718398
Nanthamongkolchai, Sutham; Pitikultang, Supachai
Background: Sterilization is most widely used fertility regulation method in Nepal. However, prevalence of uptake of female sterilization in central hilly region is less than the national average. The objective of the study was to explore the number and factors related to intention of married women to undergo female sterilization in rural Kathmandu which lies within central hilly region. Materials and Methods: This is a community based cross-sectional survey research conducted in rural area of Kathmandu valley. Two hundred and forty currently married women with at least one child of any age were interviewed using a structured pre-tested questionnaire. Results: More than four-fifth of the respondents intended to undergo sterilization. Almost two-third of them wanted to limit their family size by taking this option. More than one-third of women not-intending to undergo sterilization feared weakness after sterilization. Age of the respondents, duration of marriage, and number of living children were significantly associated with intention to undergo sterilization. 15-24 years age group were six times more likely to have the intention for sterilization (OR 6.79, CI 2.28-20.19) compared to age 35 years and above group. Mothers with less than 3 living children are about three times more likely to have the intention to undergo sterilization (OR 2.87, CI 1.3-6.33) compared to women with more than 2 living children. Women married for 6 to 10 years were three times more likely to have the intention (OR 3.0, CI 1.09-8.27). However, gender of the living children was not associated with intention to undergo sterilization. Conclusion: There were significant numbers of women intending to undergo sterilization. Age of the mother, number of living children and the duration of marriage were found to be significantly influencing the intention to undergo sterilization. However, as intention refers to future plan, the respondents’ intention may change over time. The national family
Dhungana, Adhish; Nanthamongkolchai, Sutham; Pitikultang, Supachai
Sterilization is most widely used fertility regulation method in Nepal. However, prevalence of uptake of female sterilization in central hilly region is less than the national average. The objective of the study was to explore the number and factors related to intention of married women to undergo female sterilization in rural Kathmandu which lies within central hilly region. This is a community based cross-sectional survey research conducted in rural area of Kathmandu valley. Two hundred and forty currently married women with at least one child of any age were interviewed using a structured pre-tested questionnaire. More than four-fifth of the respondents intended to undergo sterilization. Almost two-third of them wanted to limit their family size by taking this option. More than one-third of women not-intending to undergo sterilization feared weakness after sterilization. Age of the respondents, duration of marriage, and number of living children were significantly associated with intention to undergo sterilization. 15-24 years age group were six times more likely to have the intention for sterilization (OR 6.79, CI 2.28-20.19) compared to age 35 years and above group. Mothers with less than 3 living children are about three times more likely to have the intention to undergo sterilization (OR 2.87, CI 1.3-6.33) compared to women with more than 2 living children. Women married for 6 to 10 years were three times more likely to have the intention (OR 3.0, CI 1.09-8.27). However, gender of the living children was not associated with intention to undergo sterilization. There were significant numbers of women intending to undergo sterilization. Age of the mother, number of living children and the duration of marriage were found to be significantly influencing the intention to undergo sterilization. However, as intention refers to future plan, the respondents' intention may change over time. The national family planning program also needs to identify the key factors in
Cornell, C E; Littleton, M A; Greene, P G; Pulley, L; Brownstein, J N; Sanderson, B K; Stalker, V G; Matson-Koffman, D; Struempler, B; Raczynski, J M
The Uniontown, Alabama Community Health Project trained and facilitated Community Health Advisors (CHAs) in conducting a theory-based intervention designed to reduce the risk for cardiovascular disease (CVD) among rural African-American women. The multiphased project included formative evaluation and community organization, CHA recruitment and training, community intervention and maintenance. Formative data collected to develop the training, intervention and evaluation methods and materials indicated the need for programs to increase knowledge, skills and resources for changing behaviors that increase the risk of CVD. CHAs worked in partnership with staff to develop, implement, evaluate and maintain strategies to reduce risk for CVD in women and to influence city officials, business owners and community coalitions to facilitate project activities. Process data documented sustained increases in social capital and community capacity to address health-related issues, as well as improvements in the community's physical infrastructure. This project is unique in that it documents that a comprehensive CHA-based intervention for CVD can facilitate wide-reaching changes in capacity to address health issues in a rural community that include improvements in community infrastructure and are sustained beyond the scope of the originally funded intervention.
Miller, Stephania T
To describe diabetes self-care behaviors, diabetes-related distress, depressive symptoms, and diabetes-related needs among rural African American women with type 2 diabetes ages 21-50. A cross-sectional survey, including questionnaires and a single, open-ended question, was used to assess constructs of interest. Taking medication was the most frequently reported (5.5 days/week) self-care activity and exercise the least (3.0 days/week). Nearly half (44%) reported worrying about diabetes complications. Approximately one-third (31%) felt guilty about inconsistent self-care or fearful about living with diabetes. Seventy percent had a depression score suggestive of significant depressive symptomatology. Most diabetes-related concerns were about diet (34%) (i.e., what to eat), exercise (30%), taking medications (10%), and finances (8%). Future research should explore specific diabetes self-care barriers/enablers and interventions should provide women with diabetes education, barrier management, and psychological support. Innovative delivery strategies are needed to provide this support in resource-limited rural communities.
Shin, Sanghyuk S; Wan, Xia; Wang, Qian; Raymond, H Fisher; Liu, Huilin; Ding, Ding; Yang, Gonghuan; Novotny, Thomas E
Smoking may be a coping mechanism for psychosocial stress caused by discrimination. We conducted a cross-sectional survey of rural-to-urban migrant women working as restaurant/hotel workers (RHWs) and those working as sex workers (FSWs) in 10 Chinese cities to investigate whether perceived discrimination is associated with smoking. We interviewed RHWs at medical examination clinics and FSWs at entertainment venues. Modified Poisson regression was used to estimate prevalence ratios. Of the 1,696 RHWs and 532 FSWs enrolled, 155 (9.1%) and 63 (11.8%) reported perceived discrimination, respectively. Perceived discrimination was independently associated with ever tried smoking (prevalence ratio [PR], 1.71; 95% confidence interval [CI], 1.31-2.23) and current smoking (PR, 2.52; 95% CI, 1.32-4.79) among RHWs and ever tried smoking (PR, 1.36; 95% CI, 1.16-1.61) and current smoking (PR, 1.63; 95% CI, 1.28-2.06) among FSWs. Perceived discrimination is associated with higher prevalence of smoking among rural-to-urban migrant women in China.
Siedner, Mark J; Tsai, Alexander C; Dworkin, Shari; Mukiibi, Nozmo F B; Emenyonu, Nneka I; Hunt, Peter W; Haberer, Jessica E; Martin, Jeffrey N; Bangsberg, David R; Weiser, Sheri D
Inequality within partner relationships is associated with HIV acquisition and gender violence, but little is known about more pervasive effects on women's health. We performed a cross-sectional analysis of associations between sexual relationship power and nutritional status among women in Uganda. Participants completed questionnaires and anthropometric measurements. We assessed sexual relationship power using the Sexual Relationship Power Scale (SRPS). We performed logistic regression to test for associations between sexual relationship power and poor nutritional status including body mass index, body fat percentage, and mid-upper arm circumference. Women with higher sexual relationship power scores had decreased odds of low body mass index (OR 0.29, p = 0.01), low body fat percentage (OR 0.54, p = 0.04), and low mid-upper arm circumference (OR 0.22, p = 0.01). These relationships persisted in multivariable models adjusted for potential confounders. Targeted interventions to improve intimate partner relationship equality should be explored to improve health status among women living with HIV in rural Africa.
CHIANG, CHIFA; HASSAN ELSHAIR, INASS HELMY; KAWAGUCHI, LEO; MONEIM FOUAD, NAWAL ABDEL; ABDOU, NAGAH MAHMOUD; HIGUCHI, MICHIYO; BANNA, SANEYA RIZK EL; AOYAMA, ATSUKO
ABSTRACT This research investigated the association between the household status of women and their use of maternal health services in rural Egypt. Face-to-face interviews with a structured questionnaire to 201 married women were carried out in a village, posing questions about their health service utilization and their household socio-economic status. The association between service utilization and other variables was statistically analysed. Older ages at first marriage and higher education levels showed significant positive associations with the three outcome variables—regular antenatal care (ANC), deliveries attended by skilled health professionals, and deliveries at heath facilities—of the use of maternal health services. Women who had not experienced physical assaults by husbands and had knowledge of community activities were more likely to receive ANC regularly; however, there were no significant association with the other two outcome variables. Participation in household decision-making and availability of assistance with household chores had no significant linkage to the use of maternal health services. Marriages to husbands with secondary or higher levels of education and residence in extended families were significantly associated with greater maternal health service usage. Our results suggest that the improved status of women in the household and moral support from family members contributes to an increase in the use of maternal health services. PMID:23092096
Hossain, Md Kamal; Mondal, Md Nazrul Islam; Akter, Mst Nazniz
Background This study evaluated the reproductive health rights, women empowerment and gender equity in a rural area of Bangladesh. Methods Three hundred married women of reproductive age (15-49 years) in Meherpur District, Bangladesh were interviewed using a structured questionnaire and purposing sampling techniques. The logistic regression analysis was used to determine the dominating factors affecting reproductive health rights. To fulfill the objectives of the study the two main factors, age at marriage and family planning acceptance of the respondents, were regarded as the determinants. Results The study results revealed that almost all the respondents were housewives (82.3%), one-third (31.0%) did not avail any modern facility, and their yearly income was very low. Moreover, about half of the women (52.7%) were very young (≤30 years), most of them (79.0%) had married early (<18 years) and about half of them (53.3%) had taken contraceptives based on their husbands’ choice. Finally, multi-variate analysis identified the relationship between the profession of the respondents, yearly income, number of family members, and the availability of modern facilities with age at marriage (Model 1). The study also identified the relationship between the age of respondents, education, occupation, yearly income, and the total number of family members with family planning acceptance (Model 2). Conclusion Regarding the results of this study, women's reproductive health rights, marriage after the age of 18 and family planning acceptance among couples needs to be enhanced in Mehrpur District in Bangladesh. PMID:23926496
Hossain, Md Kamal; Mondal, Md Nazrul Islam; Akter, Mst Nazniz
This study evaluated the reproductive health rights, women empowerment and gender equity in a rural area of Bangladesh. Three hundred married women of reproductive age (15-49 years) in Meherpur District, Bangladesh were interviewed using a structured questionnaire and purposing sampling techniques. The logistic regression analysis was used to determine the dominating factors affecting reproductive health rights. To fulfill the objectives of the study the two main factors, age at marriage and family planning acceptance of the respondents, were regarded as the determinants. The study results revealed that almost all the respondents were housewives (82.3%), one-third (31.0%) did not avail any modern facility, and their yearly income was very low. Moreover, about half of the women (52.7%) were very young (≤30 years), most of them (79.0%) had married early (<18 years) and about half of them (53.3%) had taken contraceptives based on their husbands' choice. Finally, multi-variate analysis identified the relationship between the profession of the respondents, yearly income, number of family members, and the availability of modern facilities with age at marriage (Model 1). The study also identified the relationship between the age of respondents, education, occupation, yearly income, and the total number of family members with family planning acceptance (Model 2). Regarding the results of this study, women's reproductive health rights, marriage after the age of 18 and family planning acceptance among couples needs to be enhanced in Mehrpur District in Bangladesh.
López del Valle, Lydia M; Riedy, Christine A; Weinstein, Phil
The purpose of this study was to examine women's views on beliefs, preferences, and behaviors relevant to children's oral health. Women of childbearing age and mothers of women of childbearing age were recruited from 2 rural Puerto Rican communities to participate in 24 focus groups. One hundred fifty women participated. Participants were asked about their awareness and knowledge of childhood decay and their child-feeding and oral care attitudes and practices. Analysis consisted of a comprehensive content review of participant's responses. Participants used a variety of infant and toddler feeding practices, including breastfeeding and prolonged bottle use. Children progressed through feeding stages based on mother's experience, older relatives' advice, and child readiness. Grandmothers were considered trusted and reliable sources of information. Many believed that dental disease did not affect infants and were unaware of el síndrome del biberón (baby bottle tooth decay, SIB). Participants believed that decay was caused by too much sugar and prolonged bottle use and only affected children. Dental visits were rare in very young children, unless conspicuous decay or pain was present. Mothers' dental experiences influenced seeking children's preventive and treatment visits. This study highlights caregivers' perceptions, which are inconsistent with maximizing children's oral health. This information can be used to develop culturally appropriate, community based oral health programs.
The first postpartum week is a high-risk period for mothers and newborns. Very few community-based studies have been conducted on patterns of maternal morbidity in resource-poor countries in that first week. An intervention on postpartum care for women within the first week after delivery was initiated in a rural area of Rajasthan, India. The intervention included a rigorous system of receiving reports of all deliveries in a defined population and providing home-level postpartum care to all women, irrespective of the place of delivery. Trained nurse-midwives used a structured checklist for detecting and managing maternal and neonatal conditions during postpartum-care visits. A total of 4,975 women, representing 87.1% of all expected deliveries in a population of 58,000, were examined in their first postpartum week during January 2007-December 2010. Haemoglobin was tested for 77.1% of women (n=3,836) who had a postnatal visit. The most common morbidity was postpartum anaemia--7.4% of women suffered from severe anaemia and 46% from moderate anaemia. Other common morbidities were fever (4%), breast conditions (4.9%), and perineal conditions (4.5%). Life-threatening postpartum morbidities were detected in 7.6% of women--9.7% among those who had deliveries at home and 6.6% among those who had institutional deliveries. None had a fistula. Severe anaemia had a strong correlation with perinatal death [p<0.000, adjusted odds ratio (AOR)=1.99, 95% confidence interval (CI) 1.32-2.99], delivery at home [p<0.000, AOR=1.64 (95% CI 1.27-2.15)], socioeconomically-underprivileged scheduled caste or tribe [p<0.000, AOR=2.47 (95% CI 1.83-3.33)], and parity of three or more [p<0.000, AOR=1.52 (95% CI 1.18-1.97)]. The correlation with antenatal care was not significant. Perineal conditions were more frequent among women who had institutional deliveries while breast conditions were more common among those who had a perinatal death. This study adds valuable knowledge on postpartum
Rollins, Nigel C; Coovadia, Hoosen M; Bland, Ruth M; Coutsoudis, Anna; Bennish, Michael L; Patel, Deven; Newell, Marie-Louise
To describe pregnancy outcomes among clade C HIV-infected and uninfected women in South Africa. A longitudinal cohort study. Pregnant women attending 9 rural/urban antenatal clinics were prospectively recruited and followed up. Women were seen at the clinic or at home after delivery on 4 occasions after enrollment: 2 times within the first 2 weeks of the newborn's life at home, and every 2 weeks thereafter until their first health clinic visit when the infant was 6 weeks old. A total of 3465 women were enrolled; 615 withdrew after delivery, moved away, or had a missing or indeterminate HIV status, leaving 2850 women (1449 HIV-infected women). Six women died after delivery and there were 17 spontaneous abortions and 104 stillbirths. An adverse pregnancy outcome was independently associated with HIV infection (adjusted odds ratio [AOR] = 1.63; P = 0.015), urban enrollment (AOR = 0.39; P = 0.020), and nonhospital delivery (AOR = 13.63; P < 0.001) as well as with a CD4 count <200 cells/mL among HIV-infected women (AOR = 1.86; P = 0.127). Among 2529 singleton liveborn babies, birth weight was inversely associated with maternal HIV (AOR = 1.45; P = 0.02) and maternal middle upper arm circumference (AOR = 0.93; P < 0.001). Early infant mortality was not significantly associated with maternal HIV (hazard ratio [HR] = 1.18; P = 0.52) but was with urban sites (HR = 0.34; P = 0.045). Low birth weight substantially increased mortality (AOR = 8.3; P < 0.001). HIV status of infants by 8 weeks of age (14.6%, 95% confidence interval: 12.5% to 17.0%) was inversely associated with maternal CD4 cell count and birth weight. HIV-infected women are at a significantly increased risk of adverse pregnancy outcomes. Low-birth-weight infants of HIV-infected and uninfected women are at substantially increased risk of dying.
Hartley, Chelsey M.; Barroso, Nicole; Rey, Yasmin; Pettit, Jeremy W.; Bagner, Daniel M.
Background Although a number of studies have examined the factor structure of the Edinburgh Postnatal Depression Scale (EPDS) in predominately White or African American samples, no published research has reported on the factor structure among Hispanic women who reside in the United States. Objective The current study examined the factor structure of the EPDS among Hispanic mothers in the United States. Method Among 220 Hispanic women, drawn from a pediatric primary care setting, with an infant aged 0 to 10 months, 6 structural models guided by the empirical literature were evaluated using confirmatory factor analysis. Results Results supported a 2-factor model of depression and anxiety as the best fitting model. Multigroup models supported the factorial invariance across women who completed the EDPS in English and Spanish. Conclusion These findings provide initial support for the 2-factor structure of the EPDS among Hispanic women in the United States. PMID:24807217
Hartley, Chelsey M; Barroso, Nicole; Rey, Yasmin; Pettit, Jeremy W; Bagner, Daniel M
Although a number of studies have examined the factor structure of the Edinburgh Postnatal Depression Scale (EPDS) in predominately White or African American samples, no published research has reported on the factor structure among Hispanic women who reside in the United States. The current study examined the factor structure of the EPDS among Hispanic mothers in the United States. Among 220 Hispanic women, drawn from a pediatric primary care setting, with an infant aged 0 to 10 months, 6 structural models guided by the empirical literature were evaluated using confirmatory factor analysis. Results supported a 2-factor model of depression and anxiety as the best fitting model. Multigroup models supported the factorial invariance across women who completed the EDPS in English and Spanish. These findings provide initial support for the 2-factor structure of the EPDS among Hispanic women in the United States. © 2014 Wiley Periodicals, Inc.
Masand, Deepa Lokwani; Patel, Jaya; Gupta, Sweta
Symptomatic vaginal discharge is the most frequent symptom in women of reproductive age group. Owing to social stigma majority of affected women hesitate to seek medical consultation. Therefore the actual incidence of vaginal discharge is much more than what is reported. The aim of the study is to determine the microbiological profile of symptomatic vaginal discharge in rural area and its utility in the management of genital tract infection. This was a descriptive type of observational study, conducted in sexually active women of reproductive age group (18-45 years) attending the OPD/IPD of Obstetrics and Gynaecology Department of National Institute of Medical Sciences, Shobhanagar, Jaipur (Rajasthan), over a period of 18 months from June 2012 to December 2013. Hundred sexually active non pregnant women of reproductive age group (18-45 years) were included in the study. After taking consent general physical examination along with pelvic examination was performed. Two high vaginal swabs and blood sample were collected for various tests. Hanging drop preparation was immediately made. This was followed by gram staining and culture. Chlamydia trachomatis IgM antibody was detected by ELISA method. Out of 100 women with symptomatic vaginal discharge, specific diagnosis was obtained in 89% of cases whereas no specific aetiology was found in 11% cases. Mean age was 32.60 years. Fifty-three percent patient had Bacterial vaginosis, candidiasis was found in 14% cases, 16% had Chlamydia trachomatis infection while Trichomonas vaginalis infection was detected in 6% cases. Homogenous discharge was most prevalent (52%), followed by mucopurulant discharge in 23% of women. Patient with symptomatic vaginal discharge need to be actively managed with appropriate antimicrobial agents. Judicious management may be helpful in prevention of HIV, HPV, CIN and post infection sequelae.
Wyatt, Gail E; Davhana-Maselesele, Mashudu; Zhang, Muyu; Wong, Lauren H; Nicholson, Fiona; Sarkissian, Alissa Der; Makhado, Lufuno; Myers, Hector F
Sexual assaults against women are a global health crisis, with alarmingly high rates in South Africa. However, we know very little about the circumstances and the aftermath of these experiences. Further, there is limited information about how factors specific to the rape (e.g., fighting back) versus those that are specific to the individual-and potentially modifiable-influence mental health outcomes. This study examined how situational characteristics of rape as well as individual and situational factors confer risk for symptoms of depression, posttraumatic stress disorder (PTSD), and dysfunctional sexual behavior at 12-month follow-up. Two hundred nine (N = 209) South African women were recruited from rural rape clinics in the Limpopo Province (LP) and North West Province (NWP) of South Africa. Interviews were conducted at baseline (within 6 months of the rape incident) and at 6 and 12 months by trained staff at the clinics in English or the women's native languages. Women were interviewed after services were provided in a private room. One hundred thirty-two (n = 132) women were lost to follow-up at 12 months, resulting in 77 women with interview data for all time points. Undermining by the survivor's social support system and an increased belief in myths about rape were associated with increased dysfunctional sexual practices and symptoms of depression. These findings demonstrate the need for interventions that address the most pervasive effects of rape over time. These behaviors can increase risks for revictimization and reduce psychological well-being in the aftermath of rape. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Shakya, Sunila; Karmacharya, Biraj Man; Afset, Jan Egil; Bofin, Anna; Åsvold, Bjørn Olav; Syversen, Unni; Tingulstad, Solveig
The main purpose of this study was to assess the knowledge of cervical cancer among women in rural Nepal and explore the feasibility and impact of a community-based awareness program on cervical cancer. Community-based educational meetings on cervical cancer and its prevention were conducted among women's groups in rural Nepal. Through a questionnaire, the women's baseline knowledge of risk factors, symptoms, and perceived risk of cervical cancer were identified. The willingness to participate in cervical cancer screening was compared before and after the educational meeting. The meetings were followed by a cervical cancer screening program. Among the 122 participants at the educational meeting, only 6 % had heard of cervical cancer. Their baseline knowledge of risk factors and symptoms was poor. The proportion of women willing to participate in cervical screening increased from 15.6 to 100 % after attending the educational meeting. All the study subjects participated in the screening program. Additionally, the study participants recruited a further 222 of their peers for screening. Poor knowledge of cervical cancer among women in rural Nepal highlights the urgency of public awareness programs for cervical cancer at a national level. A community-based awareness program can change women's attitude to cervical screening, and women's groups can play a major role in promoting participation in cervical cancer screening programs.
Shidhaye, Rahul; Patel, Vikram
There are few population-based studies from low- and middle-income countries that have described the association of socio-economic, gender and health factors with common mental disorders (CMDs) in rural women. Population-based study of currently married rural women in the age group of 15-39 years. The baseline data are from the National Family Health Survey-II conducted in 1998. A follow-up study was conducted 4 years later in 2002-03. The outcome of CMD was assessed using the 12-item General Health Questionnaire (GHQ-12). Due to the hierarchical nature and complex survey design, data were analysed using mixed-effect logistic regression with random intercept model. A total of 5703 women (representing 83.5% of eligible women) completed follow-up. The outcome of CMD was observed in 609 women (10.7%, 95% confidence interval 9.8-11.6). The following factors were independently associated with the outcome of CMD in the final multivariable model: higher age, low education, low standard of living, recent intimate partner violence (IPV), husband's unsatisfactory reaction to dowry, husband's alcohol use and women's own tobacco use. Socio-economic and gender disadvantage factors are independently associated with CMDs in this population of women. Strategies that address structural determinants, for example to promote women's education and reduce their exposure to IPV, may reduce the burden of CMDs in women.
Hilliard, Starr; Bukusi, Elizabeth; Grabe, Shelly; Lu, Tiffany; Hatcher, Abigail M; Kwena, Zachary; Mwaura-Muiru, Esther; Dworkin, Shari L
The current study focuses on a community-led land and property rights program in two rural provinces in western Kenya. The program was designed to respond to women's property rights violations to reduce violence against women and HIV risks at the community level. Through in-depth interviews with 30 women, we examine the perceived impact that this community-level property rights program had on violence against women at the individual and community level. We also examine perceptions as to how reductions in violence were achieved. Finally, we consider how our findings may aid researchers in the design of structural violence-prevention strategies. © The Author(s) 2016.
Rao, Shobha; Joshi, Smita; Bhide, Pradnya; Puranik, Bhairavi; Kanade, Asawari
To examine various sociodemographic aspects related to consumption of micronutrient-rich foods like green leafy vegetables (GLV), which will be helpful in modifying dietary habits, a strategy that merits consideration for prevention of anaemia. Cross-sectional study for collecting data on socio-economic and anthropometric (weight, height) variables, Hb, dietary pattern (FFQ) and peripheral smear examination for classifying nutritional and iron-deficiency anaemia (IDA). Three villages near Pune city, Maharashtra, India. Rural women (n 418) of childbearing age (15-35 years). Mean Hb was 11·07 g/dl. Seventy-seven per cent of the women were anaemic (Hb < 12 g/dl) and 28 % had IDA, indicating that a large proportion of the women had nutritional anaemia. Higher prevalence of IDA was associated with several sociodemographic and maternal parameters, but multiple logistic regression analysis showed significant (P < 0·05) risk of IDA with lower body weight (<40 kg), short maternal height (<145 cm), younger age at marriage (<19 years) and higher parity (≥ 2). Various socio-cultural reasons associated with low consumption of GLV included non-cultivation of GLV, priority for selling them rather than home consumption, dislike of GLV by husband and children, and lack of awareness about different recipes for GLV. Our findings highlight that low consumption of GLV, which are treasures of micronutrients including Fe, is associated with genuine social reasons. This indicates a need for developing action programmes to improve nutritional knowledge and awareness leading to enhanced consumption of Fe-rich foods for preventing anaemia in rural India.
Ford, Cassandra D; Kim, Mi Ja; Dancy, Barbara L
This study aimed to describe the perceptions of Southern, rural, African American women regarding personal and environmental factors that affect their hypertension. A purposive sample of 25 African American women aged 40-74 years, who lived in rural Alabama, participated in seven Talking Circles for 60 minutes. Most felt that hypertension was a "common occurrence" and that it was "typical in the African American community." They associated hypertension with stroke and heart attacks and referred to hypertension as the "silent killer." Barriers to following the treatment plan were low income, high medical expenses, and lack of insurance. Barriers to medication were cost, dislike for taking medication, running out of medication, side effects, forgetting, and being tired; and barriers to exercise were being tired, busy schedule, and safety. Walking paths, fitness centers, or malls to walk around were not available in all communities, and not all sidewalks were well-lit, limiting their walking exercise opportunities after work hours. Healthcare facilities were accessible, but it was easier to get an appointment and receive respect from healthcare providers if the women had money or insurance. Blood pressure monitors were available in their homes, at grocery stores and at Wal-Mart. No church health programs were available, but some churches had nurses on duty who offered blood pressure and cholesterol screening; however, no medication was provided. Grocery stores were accessible, and they had a flea market with fresh fruits and vegetables. Social environment/support by families and friends for persons with hypertension was not always positive. The findings of this study indicate that personal and environmental factors play important roles in hypertensive status. The modified ecological framework used in this study may help us explore perspectives of family members and friends regarding their support for persons with hypertension. More serious efforts and resources need
Parreira, Bibiane Dias Miranda; Goulart, Bethania Ferreira; Haas, Vanderlei José; Silva, Sueli Riul da; Monteiro, Juliana Cristina Dos Santos; Gomes-Sponholz, Flávia Azevedo; Parreira, Bibiane Dias Miranda; Goulart, Bethania Ferreira; Haas, Vanderlei José; Silva, Sueli Riul da; Monteiro, Juliana Cristina Dos Santos; Gomes-Sponholz, Flávia Azevedo
Identifying the prevalence of Common Mental Disorders and analyzing the influence of sociodemographic, economic, behavioral and reproductive health variables on Common Mental Disorders in women of childbearing age living in the rural area of Uberaba-MG, Brazil. An observational and cross-sectional study. Socio-demographic, economic, behavioral and reproductive health instruments were used, along with the Self-Reporting Questionnaire (SRQ-20) to identify common mental disorders. Multiple logistic regression was used for multivariate data analysis. 280 women participated in the study. The prevalence of Common Mental Disorders was 35.7%. In the logistic regression analysis, the variables of living with a partner and education level were associated with Common Mental Disorders, even after adjusting for the other variables. Our findings evidenced an association of social and behavioral factors with Common Mental Disorders among rural women. Identification and individualized care in primary health care are essential for the quality of life of these women. Identificar a prevalência do transtorno mental comum e analisar a influência de variáveis sociodemográficas, econômicas, comportamentais e de saúde reprodutiva sobre o transtorno mental comum em mulheres em idade fértil, residentes na zona rural do município de Uberaba-MG, Brasil. Estudo observacional e transversal. Foram utilizados instrumentos de caracterização sociodemográfica, econômica, comportamental e de saúde reprodutiva, e o Self-Reporting Questionnaire (SRQ-20) para identificar os transtornos mentais comuns. Na análise multivariada dos dados, foi utilizada a regressão logística múltipla. Participaram do estudo 280 mulheres. A prevalência do transtorno mental comum foi de 35,7%. Na análise de regressão logística, as variáveis convivência com o companheiro e escolaridade, associaram-se ao transtorno mental comum, mesmo após o ajuste para as demais variáveis. Os achados evidenciaram a
G K, Poomalar; Arounassalame, Bupathy
The overall health and well-being of middle-aged women has become a major public health concern around the world. More than 80% of the women experience physical or psychological symptoms in the years when they approach menopause, with various distresses and disturbances in their lives, leading to a decrease in the quality of life. The aim of our study was to assess the quality of life and the impact of hormonal changes in perimenopausal and postmenopausal women and to correlate the prevalence of the symptoms with their duration since menopause. A cross- sectional study was done at Sri Manakula Vinayagar Medical College and Hospital, Puducherry, from January 2012 to April 2012. Five hundred women who were in the age group of 40-65 years, who came from rural areas to our hospital, were included in the study. The women who were receiving hormonal treatment and those who refused to participate in the study were excluded. The data such as the socio-demographic information and the menstruation status, which were based on the reported length of time since the last menstrual period and the experience of the symptoms, as were tested in the Menopause Specific Quality of Life (MENQOL) questionnaire, were collected from each patient. The women who were included in the study were divided into three groups as the menopause transition, early postmenopausal and the late postmenopausal groups. All the data which were gathered were analyzed by using SAS 9.2. The Chi square test and the relative risk and the confidence interval calculations were applied to compare the frequencies of the symptoms among the women with different menopausal statuses. A p-value of less than 0.05 was considered to be statistically significant. Mean menopausal age in the study group was 45 years. The most common symptom within study subjects were low back ache (79%) and muscle-joint pain (77.2%). The least frequent symptoms were increase in facial hair (15%) and feeling of dryness during intimacy (10
The first postpartum week is a high-risk period for mothers and newborns. Very few community-based studies have been conducted on patterns of maternal morbidity in resource-poor countries in that first week. An intervention on postpartum care for women within the first week after delivery was initiated in a rural area of Rajasthan, India. The intervention included a rigorous system of receiving reports of all deliveries in a defined population and providing home-level postpartum care to all women, irrespective of the place of delivery. Trained nurse-midwives used a structured checklist for detecting and managing maternal and neonatal conditions during postpartum-care visits. A total of 4,975 women, representing 87.1% of all expected deliveries in a population of 58,000, were examined in their first postpartum week during January 2007–December 2010. Haemoglobin was tested for 77.1% of women (n=3,836) who had a postnatal visit. The most common morbidity was postpartum anaemia—7.4% of women suffered from severe anaemia and 46% from moderate anaemia. Other common morbidities were fever (4%), breast conditions (4.9%), and perineal conditions (4.5%). Life-threatening postpartum morbidities were detected in 7.6% of women—9.7% among those who had deliveries at home and 6.6% among those who had institutional deliveries. None had a fistula. Severe anaemia had a strong correlation with perinatal death [p<0.000, adjusted odds ratio (AOR)=1.99, 95% confidence interval (CI) 1.32-2.99], delivery at home [p<0.000, AOR=1.64 (95% CI 1.27-2.15)], socioeconomically-underprivileged scheduled caste or tribe [p<0.000, AOR=2.47 (95% CI 1.83-3.33)], and parity of three or more [p<0.000, AOR=1.52 (95% CI 1.18-1.97)]. The correlation with antenatal care was not significant. Perineal conditions were more frequent among women who had institutional deliveries while breast conditions were more common among those who had a perinatal death. This study adds valuable knowledge on postpartum
Agueda, Lídia; Bustamante, Mariona; Jurado, Susana; Garcia-Giralt, Natalia; Ciria, Manel; Saló, Guillem; Carreras, Ramon; Nogués, Xavier; Mellibovsky, Leonardo; Díez-Pérez, Adolfo; Grinberg, Daniel; Balcells, Susana
LRP5 encodes the low-density lipoprotein receptor-related protein 5, a transmembrane protein involved in Wnt signaling. LRP5 is an important regulator of osteoblast growth and differentiation, affecting bone mass in vertebrates. Whether common variations in LRP5 are associated with normal BMD variation or osteoporotic phenotypes is of great relevance. We used a haplotype-based approach to search for common disease-associated variants in LRP5 in a cohort of 964 Spanish postmenopausal women. Twenty-four SNPs were selected, covering the LRP5 region, including the missense changes p.V667M and p.A1330V. The SNPs were genotyped and evaluated for association with BMD at the lumbar spine (LS) or femoral neck (FN) and with osteoporotic fracture, at single SNP and haplotype levels, by regression methods. Association with LS BMD was found for SNP 1, rs312009, located in the 5'-flanking region (p = 0.011, recessive model). SNP 6, rs2508836, in intron 1, was also associated with BMD, both at LS (p = 0.025, additive model) and FN (p = 0.031, recessive model). Two polymorphisms were associated with fracture: SNP 11, rs729635, in intron 1, and SNP 15, rs643892, in intron 5 (p = 0.007 additive model and p = 0.019 recessive model, respectively). Haplotype analyses did not provide additional information, except for haplotype "GC" of the block located at the 3'end of the gene. This haplotype spans intron 22 and the 3' untranslated region and was associated with FN BMD (p = 0.029, one copy of the haplotype versus none). In silico analyses showed that SNP 1 (rs312009) lies in a putative RUNX2 binding site. Electro-mobility shift assays confirmed RUNX2 binding to this site.
Clèries, Ramon; Buxó, Maria; Martínez, José M; Espinàs, Josep A; Dyba, Tadeusz; Borràs, Josep M
Changes in the burden of cancer mortality are expected to be observed among Spanish