Browsing by Subject "Women's health"
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Item Open Access A Systems Thinking, Community-Based Exploration of Health Equity and Agency: Women’s Migraine as a Paradigmatic Case(2017) Befus, DeannaBackground. Creating health equity—“the attainment of the highest level of health for all people”— is a core tenet of public health (American Public Health Association, 2015; United States Department of Health and Human Services, 2011, p. 1). Achieving health equity requires the identification and amelioration of patterns of systemic disadvantage and the elimination of health disparities (Gostin & Powers, 2006; United States Department of Health and Human Services, 2011). To do this, health researchers must address social determinants of health (SDOH) and of equity. I have selected women with migraine as a paradigmatic case for this exploration of health equity and agency.
Migraine is a common and debilitating neurobiological disorder without a cure (Goadsby, 2012). It affects almost three times as many women as men, and disproportionately disables women occupying low social locations, that is, occupying a low position on the social hierarchy (Burch, Loder, Loder, & Smitherman, 2015b; Stewart, Roy, & Lipton, 2013). A dearth of effective and affordable treatment options has rendered non-pharmacological self-management a crucial part of living with migraine, yet clinical treatment guidelines consistently emphasize pharmacological intervention (Becker et al., 2015; Diamond et al., 2007; Raphael, 2012). Much of migraine research is epidemiological (Burch et al., 2015b; Buse et al., 2013; Lipton, Serrano, Holland, et al., 2013). The resulting gap in knowledge around the experiences and needs of women navigating the complexities of life with migraine is especially pronounced for those who are less likely or able to access systems that document and treat the condition.
Objective and Methods. The overall purpose of this dissertation is to develop knowledge on the effects of social and structural determinants on the experiences of women living with migraine, with attention to their strategies and priorities for self-management through a systems thinking lens. To do this in the context of this dissertation, I first explore the benefits of critical systems approaches for health equity research (Chapter 2), followed by a description of the development and use of two systems thinking tools for data collection in community focus groups of women with migraine (Chapter 3). Our study team used the system support map tool (SSM) to identify and describe migraine triggers and features, self-management strategies, and the needs and outcomes associated with self-management (Chapter 4). The connection circle (CC) tool explored the relationships between triggers and features, self-management strategies, and outcomes (Chapter 5).
We conducted seven focus groups with 19 women with migraine from diverse social locations and analyzed the data using qualitative content analysis, dimensional analysis, and measures of complexity. We examined variation by social location in the data from both tools.
Findings. The tools we developed allowed us to feasibly and effectively collect rich and nuanced data from community-based women with migraine. One of the tools—the CC— may be more effective when coupled with problem solving techniques when used with women in low social locations (Chapter 3).
The SSM data underscored the distinctions in migraine experience by social location (Chapter 4). While women from all social locations identified stress as a top migraine trigger, descriptions and definitions of stress varied. Women in low social locations were more likely to engage in isolating and avoidant self-management activities, and women in higher social locations were more likely to use proactive, complementary, and integrative approaches. Women in low social locations had lower expectations for self-management and were more interested in pain management than women in higher social locations, who were more interested in self-improvement.
The CC data revealed that ‘conceptualization of complexity,’ or the way and degree to which participants contemplated dynamic interrelationships, was a key dimension in understanding how women in diverse social locations identified relationships between different aspects of their migraine experiences. There were clear differences in the conceptualizations of and capacities for complexity by social location. Women in high social locations demonstrated greater depth, breadth, and structure of this key dimension than women in low social locations.
Discussion and Conclusions. As a non-fatal, but highly disabling, condition with limited and costly treatment options, migraine provides an excellent paradigmatic case for exploring health equity. Ability to have a high quality of life with migraine may be deeply entwined with one’s social location. Therefore, to improve the experiences of the group most affected by migraine—women in low social locations—we cannot limit our research and treatment to the biological and behavioral. We need to think in terms of the social and structural. Creating equitable outcomes, wherein everyone has an equal opportunity for a fulfilling and healthy life, requires that we intervene on multiple levels, engage with affected women, and explicitly commit to addressing social and structural determinants of health AND equity.
Item Open Access An Exploration of Social Relationships over the Life Course among African American Women Aging with HIV.(2017) Moore, ElizabethIntroduction: In the fourth decade of the HIV epidemic, African American women continue to be disproportionately affected by HIV across all age ranges in the U.S. African American women make up only 13% of the female population in the U.S. yet account for 64% of HIV infections among women (Aitcheson et al., 2014). African American women face multiple challenges that intersect to influence how they effectively age into older adulthood and manage their health. Due to the increased challenges experienced by older African American women across the life course, it is imperative to identify factors that may mitigate the challenges of aging with the disease. Scant research exists focusing specifically on older African American women with HIV and thus our understanding of their experiences is still quite limited. Examining the personal strengths and social resources utilized to curb the deleterious effects of aging is necessary to improve health and well-being in this population.
Purpose and Methods: The purpose of this dissertation was to advance our understanding of the experiences of African American women with HIV aging across the life course with particular attention paid to the influence of the role of social relationships on health and well-being. The purpose was achieved through exploring the challenges of aging with HIV as an African American woman and the importance of utilizing the life course perspective (Elder & Giele, 2009) to explore their experiences over time; examining the literature on the relationship between social relationships and health; and presenting two papers from the findings of a qualitative descriptive study conducted with older African American women that explored their experiences over the life course. Eighteen African American women over the age of 50 participated in this qualitative study that utilized in-depth life history interviews and timelines as the primary means of data elicitation. In the first paper, we analyzed the data for experiences with social relationships across the life course. In the second paper, we analyzed trajectories and turning points across the life course.
Results: Findings from the first paper highlight that developing and maintaining relationships over time was influenced by a variety of life course themes at the personal, relational, and structural level presented over three developmental time periods (childhood/adolescence, young/middle adulthood, and older adulthood). Women described tremendous barriers to relationship development and maintenance in both childhood/adolescence and young/middle adulthood including child sexual abuse, crack cocaine addiction, intimate partner violence, and HIV-related stigma. Women also reported having large social networks in younger years but not many important relationships. In contrast, older adulthood was described as a time with more positive social relationships, especially for those who were addicted to crack cocaine in their youth. As women aged, they built supportive networks with people they valued.
Findings from the trajectories and turning points paper show that while trajectories across participants were diverse, they were categorized into three main patterns: anchored; early struggling and upward progression; and continuously struggling. Life experiences were most dissimilar between women who experienced crack cocaine addiction compared to women who never used to drugs. The syndemic impact of substance abuse, violence, and HIV (Singer, 2009) was also important as was the cyclical nature of these co-occurring epidemics over time. Our study provides evidence that a traumatic event in early life may be the first step in the syndemic cycle.
Item Open Access Black Femininity through the White Speculum: The Implications of Medicosocialism and the Disproportionate Regulation of Black Women’s Reproductive Autonomy(2016-09-02) Smith, Imari Zhané; Smith, ImariAt the crux of health disparities for women of color lies a history of maltreatment based on racial difference from their white counterparts. It is their non-whiteness that limits their access to the ideologies of “woman” and “femininity” within dominant culture. As the result of this difference, the impact of the birth control movement varied among women based on race. This project explores how the ideology attributed to the black female body limited black women’s access to “womanhood” within dominant culture, and analyzes the manners in which their reproductive autonomy was compromised as the result of changes to that ideology through time. This project operates under the hypothesis that black women’s access to certain aspects of femininity such as domesticity and motherhood reflected their roles in slave society, that black women’s reproductive value was based on the value of black children within slave culture, and that both of these factors dictated the manner in which their reproductive autonomy was managed by health professionals. Black people’s worth as a free labor force within dominant culture diminished when the Reconstruction Amendments were added to the constitution and slavery was deemed unconstitutional—resulting in the paradigmatic shift from the promotion of black fertility to its recession. America’s transition to the medicosocial regulation of black fertility through Eugenics, the role of the black elite in the movement, and the negative impact of this agenda on the reproductive autonomy of black women from low socioeconomic backgrounds are enlisted as support. The paper goes on to draw connections between post-slavery ideology of black femininity and modern-day medicosocial occurrences within clinical settings in order to advocate for increased bias training for medical professionals as a means of combating current health disparities. It concludes with the possibility that this improvement in medical training could persuade people of color to seek out medical intervention at earlier stages of illness and obtain regular check-ups by actively countering physicians’ past transgressions against them.Item Open Access Exploration of Multiple Perceived Obstacles to Abortion Access for Women in North Carolina(2019-12-06) Jaffe, StephanieExisting research shows that legislation such as mandatory waiting periods, restriction of federal funding to pay for abortion services, and regulations causing clinic closures can make it more difficult for women to get an abortion. In 2019, North Carolina was one of the 29 states in the US considered to be extremely hostile to abortion rights based on legislative abortion restrictions, and in 2014, 90% of women in North Carolina had no clinics that provided abortions in their counties. Thus, women in North Carolina are likely to experience many challenges in attaining abortions. This qualitative study of multiple obstacles to abortion among a sample of women in North Carolina adds to existing literature on the impact of obstacles to accessing abortion by assessing the cumulative effect of multiple obstacles on women’s perceptions of obtaining an abortion. I collected survey data and conducted qualitative interviews with women in North Carolina who had recently received an abortion and analyzed this data to find four key themes in women’s experiences: cost obstacles, logistical obstacles, access to information, and personal/emotional obstacles. These themes reveal that multiple obstacles experienced at once interact to influence women’s perceptions of their experiences in getting abortions, and that these experiences vary based on external factors, such as income, profession, upbringing, and support networks. This research demonstrates the importance of highlighting women’s narratives when advocating changes in abortion policy.Item Open Access Healthcare Experiences, Needs, and Strategies of Survivors of Violence(2018) Reeves, Elizabeth AnneThe long-term and multi-faceted consequences of trauma are well documented and health conditions associated with traumatic life events are often those that benefit from early and regular attention from a healthcare provider. However, for many trauma-exposed women, seeking out and receiving healthcare is associated with physical and psychological intrusions that are linked to their traumatic experiences. Implementing trauma-informed care, based in knowledge and understanding of trauma that sensitively meets the needs of survivors, is an effective way to improve trauma survivors’ healthcare experiences. However, implementing such changes in practice to improve care for survivors is often made difficult by the current prevailing characteristics of patient-provider relationships and the U.S. healthcare system. Further, relying on providers to change practice is a disempowering position for survivors; supporting survivors to advocate for their needs within healthcare interactions and the healthcare system could be an efficient, effective and empowering solution to attaining widespread trauma-informed care.
This dissertation addresses current knowledge deficits through: 1) description and comparison of lifetime trauma exposure among community-based women from diverse locations and backgrounds; 2) examination of existing trauma-informed care practices for survivors of physical and sexual violence; and 3) descriptions of the healthcare experiences, needs, and strategies of female survivors of physical and sexual violence with regard to navigating healthcare experiences, provider interactions, and the healthcare system. A descriptive, correlational analysis and a synthesis of current literature were used to address the first and second research aims. Original qualitative interview and participatory Photovoice studies were conducted to address the third research aim.
Findings from the statistical analysis of trauma exposure among four community-based samples of women in Colombia, Hong Kong, and the United States indicate that trauma exposure is more similar than different and that trauma and its effects are pervasive in the lives of women across diverse locations. The synthesis of literature elucidates five thematic elements of trauma-informed care including: sensitive and universal screening, provider-patient relationships, minimizing distress, maximizing autonomy, and providing appropriate collaboration and referral. Findings from the qualitative interview and participatory Photovoice studies highlight imbalances in power dynamics and lack of mutual belief and trust as the most significant challenges to positive provider-patient relationships and healthcare experiences. These findings also indicate that survivors of violence use a variety of strategies to navigate healthcare encounters in the face of system-, agency- and provider-level barriers to positive healthcare experiences.
This dissertation adds to existing evidence on trauma exposure and trauma-informed care, and data on the engagement behaviors and healthcare strategies of survivors of violence addresses substantive gaps in the literature. Further, these findings generate useful frameworks and foundations for future research to continue to explore survivors’ healthcare desires, provider-survivor relationships, and provider- and survivor-led interventions to support the implementation of trauma-informed care.
Item Open Access Incidence of postpartum hypertension among Kenyan women with preeclampsia: a prospective cohort study(2020) Lumsden, RebeccaBackground: The burden of cardiovascular disease (CVD) is rising in sub-Saharan Africa (SSA). Preeclampsia, a type of hypertensive disorder of pregnancy, is a unique risk factor for CVD among women, yet little is known about the postpartum cardiovascular risk among women with preeclampsia in SSA. Objective: To determine the incidence of hypertension, a major risk factor for CVD, at 6-months postpartum among Kenyan women with preeclampsia. Methods: This prospective cohort study included all pregnant or recently postpartum women with preeclampsia who were admitted to a national, referral hospital in western Kenya from January 20, 2020-March 19, 2020, when the study was unexpectedly paused due to the COVID-19 pandemic. Using home blood pressure monitoring technique, we described the trajectory of blood pressure after delivery. Bivariate and multivariable regression analyses were performed to investigate for risk factors associated with hypertension at 6-month follow-up. Results: Eight-six women with preeclampsia were enrolled prior to March 19, 2020, when the study was unexpected paused due to the COVID-19 pandemic. Among the 50 women who completed follow up, 38% (n=19) had hypertension. Blood pressure normalized for all women by 6 weeks after delivery but rose again beyond 12 weeks among those with hypertension at follow up. Maternal age, parity and history of preeclampsia in prior pregnancy or a previous pregnancy complication (preterm delivery or stillbirth) were associated with hypertension at follow up. Overall, rates of routine, postpartum clinic follow up were low (64%) among women despite nearly all (97%) attending clinic for infant immunizations following delivery. Conclusion: There is a high incidence of hypertension at 6-months postpartum among Kenyan women with preeclampsia, though low rates of postpartum follow up care indicate a potential missed opportunity for early CVD identification and prevention among this high risk-population.
Item Embargo Mathematical Modeling of Topical Drug Delivery in Women’s Health(2023) Adrianzen Alvarez, Daniel RobertoOur lab focuses on developing and optimizing drug delivery systems for applications in women’s health. In this field, development of drugs and drug delivery systems is hindered by a heavy reliance on empirically derived data, usually obtained from non-standardized, highly variable in vitro and in vivo animal experiments. Further, without a mechanistic understanding of the various phenomena progressing during drug delivery, experiments tend to explore complex parameter spaces blindly and randomly. Deterministic mathematical models can improve the efficiency of this process by informing rational drug and product design. In this work, we were interested in two applications: 1. drug delivery of topically applied anti-HIV microbicides to the female reproductive tract; and 2. Localized intratumoral injections of ethanol-ethyl cellulose mixtures for treatment of cervical lesions. Development of topically applied anti-HIV microbicides to prevent sexual HIV transmission is inefficient, with in vitro and in vivo tests having limited applicability to real product use. This issue is exacerbated by the dependence of drug performance on adherence and drug-administration conditions, which are not tested until clinical trials. Further, the lack of a standardized pharmacodynamic (PD) metric that is dependent on the heterogenous dynamics of viral transport and infection makes it difficult to identify the most promising drug candidates. Here we develop a deterministic mathematical model that incorporates drug pharmacokinetics (PK) and viral transport and dynamics to estimate the probability of infection (POI) as a PD metric that can be computed for a variety of anti-HIV drugs in development. The model reveals key mechanistic insights into the spatiotemporally dependent dynamics of infection in the vaginal mucosa, including susceptibility to infection at different phases in the menstrual cycle. Further, it and can be used as a platform to test novel drugs under several conditions, such as the timing of drug administration relative to the time of HIV exposure. Localized injections of ablative agents, immunotherapeutics and chemotherapeutics have potential for increased therapeutic efficacy against tumors and reduced systemic effects. However, injection outcomes thus far have been largely unsatisfactory, due to unintended leakage of the active pharmaceutical ingredients (APIs) to non-target tissues. Adding a gelling or precipitating agent to the injection can help ameliorate this limitation, by acting to contain the API within the target tissue. One such example is injection of ethanol-ethyl cellulose mixtures. Due to the insolubility of ethyl cellulose in water, this polymer phase-separates in the aqueous tumor environment, forming a fibrous gel that helps contain ethanol, the current ablating agent (and chemotherapeutic drugs in the future), within the boundaries of the tumor. Our collaborators have shown that this strategy can be an effective low-cost treatment strategy for superficial solid tumors, with cervical cancer and cervical dysplasia, and liver cancer, being promising targets. Here we present a mathematical model that enables characterization of the injection process. Our model uses Cahn Hilliard theory to model the phase separation of a precipitating or gelling agent during injection into poroelastic tissue. This theory is linked to the soft mechanics of tissue deformation during the injection, and to mass transport theory for the API. The model predicts key elements of the injection process, including the pressure field, the soft tissue displacement field, the phase constitution of the precipitating or gelling agent in the tissue, and the concentration distribution of the API in the tissue. The model enables us to explore relationships between these elements and fundamental injection and tissue parameters. This can inform design of optimized injection protocols. Select model predictions include that larger injection volumes do not significantly affect cavity volumes but do lead to faster transport of the API to target tumor tissue. However, although higher flow rates lead to larger cavities – in the absence of tissue fracture, and when injected volume is held constant – they also lead to slower delivery of the API into the target tumor tissue. This is due to the shorter injection times. Importantly, concentration distributions of the API are not sensitive to the speeds of precipitation of the precipitating agents or to diffusion coefficients of the API in the dense (gelled) phase of the injectate material. The model presented here enables first-pass exploration of injection parameter space for select tissue types (properties). This can aid in optimization of localized therapeutic injections in a range of applications.
Item Open Access Novel Biophotonic Imaging Techniques for Assessing Women's Reproductive Health(2013) Drake, Tyler KaineEven though women make up over half the population in the United States, medical advancements in areas of women's health have typically lagged behind the rest of the medical field. Specifically, two major threats to women's reproductive health include human immunodeficiency virus (HIV), and cervical cancer with accompanying human papillomavirus (HPV) infection. This dissertation presents the development and application of two novel optical imaging technologies aimed at improving these aspects of women's reproductive health.
The presented work details the instrumentation development of a probe-based, dual-modality optical imaging instrument, which uses simultaneous imaging of fluorimetry and multiplexed low coherence interferometry (mLCI) to measure in vivo microbicide gel thickness distributions. The study explores the optical performance of the device and provides proof of concept measurements on a calibration socket, tissue phantom, and in vivo human data. Once the instrument is fully characterized, it is applied in a clinical trial in which in vivo human vaginal gel thickness distributions. The gel distribution data obtained by the modalities are compared in order to assess the ability of mLCI making accurate in vivo measurements. Differences between the fluorimetry and mLCI modalities are then exploited in order to show a methodology for calculating the extent of microbicide gel dilution with the dual-modality instrument data.
Limitations in cervical cancer screening are then addressed as angle-resolved low coherence interferometry (a/LCI) is used in an ex vivo pilot study to assess the feasibility of a/LCI in identifying dysplasia in cervical tissues. The study found that the average nuclear diameter found by a/LCI in the basal layer of ectocervical epithelium showed a statistically significant increase in size in dysplastic tissue. These results indicate that a/LCI is capable of identifying cervical dysplasia in ectocervical epithelium. The results of the work presented in this dissertation show that dual-modality optical imaging with fluorimetry and mLCI, and the a/LCI technique show promise in advancing technologies that are used in the field of women's reproductive health.
Item Open Access Predictors of Successful Treatment Acquisition Among HPV Positive Women in Western Kenya(2018) Novak, Carissa AshleyAbstract
Background: While highly preventable cervical cancer remains a leading cause of
cancer in women globally. Sub-Saharan Africa is disproportionately affected, and in
Kenya specifically, over 4,800 new cervical cancer cases are diagnosed and over 2,000
deaths occur each year. While screening for human papillomavirus (HPV) is a more
cost-effective screening strategy with the potential to increase screening uptake, there is
substantial lost to follow-up (LTFU) for treatment following a positive HPV screen. This
study aimed to identify the predictors of successful treatment acquisition and explore
the barriers and facilitators to seeking treatment among HPV positive women.
Methods: This mixed-methods study was integrated into an ongoing clusterrandomized
trial of implementation strategies in rural western Kenya. This study
randomly selected 100 HPV positive women from the original study database and
conducted a treatment acquisition behavior survey. The study sought a 50/50 ratio of
women who were treated and LTFU, but obtained data from 61 treated women and 39
LTFU women. A subset of 10 women in each group were then selected for in-depth
interviews. Analysis included descriptive statistics to compare treated and LTFU
women’s responses to the survey questionnaire. Interview transcripts were coded and
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analyzed through code-by-code comparisons of women who were treated and women
who were LTFU.
Results: Cost of transportation and distance to the health facility were the most
common challenges in seeking treatment among both treated and LTFU women. Among
women who sought treatment, 67% (n=41) reported that their peers knew their HPV test
result, whereas among LTFU women only 38% (n=15) reported that their peers knew
their HPV test result (p=0.007). There was a significant difference in knowing their peers’
HPV result between treated and LTFU women (p=0.03). Partner support was described
by treated and LTFU women similarly, in that most women reported that they relied on
their partners for transportation money, and that men not understanding the disease
may prevent them from supporting their wives in seeking treatment. Additional barriers
included fear of the treatment process, stigma within their community, logistical
barriers, and lack of information on the disease and treatment. Facilitators to treatment
seeking included peer encouragement, support and encouragement of their children,
involving men in educational sessions, bringing facilities closer and providing
transportation to the health facility.
Conclusions: Cost of transportation, distance to the treatment facility, support of
partners and children, feelings of fear and stress, stigma within the community and
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logistical barriers were reported similarly across treated and LTFU groups. The greatest
disparity between the two groups was a lack of social support among LTFU women.
Given the potential impact of involving men and women in the community in
educational sessions, and promoting treatment seeking in groups, interventions that use
these treatment facilitators are needed.
Item Open Access Psychobiological, Clinical, and Sociocultural Factors that Influence Black Women to Seek, Initiate, and Complete Treatment for Infertility: A Mixed Methods Study(2020) Cebert, MorineBlack women in the U.S. have twice the prevalence of infertility (14%) than non-Hispanic white women (7%) yet are twice as less likely to seek initial evaluation for infertility. Disparities in infertility treatment use among Black women are crucial to address in order to promote health and wellness in this population. Childbearing is a culturally central component of Black families and Black women with infertility experience notable alterations to their self and gender identity, high levels of isolation, silence, and negative medical experiences related to their fertility status. Despite these negative experiences among Black women, the literature fails to highlight reasons for lower uptake of infertility treatment beyond highlighting the sociodemographic characteristics of those who seek, initiate, and complete treatment as mainly affluent, highly educated, and older Non-Hispanic White women. Research on the health seeking process for Black women with infertility is scarce and provide incomplete understanding of their reproductive experiences. Since little is known about what factors influence the processes of seeking, initiating, and completing treatment for infertility for Black women, the purpose of this dissertation was to generate knowledge of the multi-dimensional influences that Black women may experience during the their journey to family building.
The aim of this dissertation study was to understand the psychobiological, clinical, and sociocultural factors that influence Black women’s decisions to seek, initiate, and complete the recommended treatment plan for infertility within three different chapters. Chapter 2 reviewed the state of the science regarding the psychobiological, clinical, and sociocultural factors that influenced women in the U.S to seek treatment for their infertility symptoms and experiences. Chapter 3 analyzed and described psychobiological, clinical, and social data collected from a retrospective cohort chart review that examined 391 Black women who sought a reproductive endocrinology evaluation and determined what factors influenced initiation and completion of the recommended treatment plan for infertility. In, Chapter 4, quantitative data from Chapter 3 was merged with qualitative data from 13 semi-structured interviews in a convergent parallel mixed methods study to provide a comprehensive understanding of what psychobiological, clinical, and sociocultural experiences influenced Black women to seek and initiate treatment for infertility.
Psychobiological, clinical, and sociocultural factors are associated with seeking, initiating, and completing infertility treatment among Black women. Multi-dimensional barriers across these domains influence the entire health seeking process for women causing delays in access, reduced uptake in treatment, and ultimate completion of treatment. Black women would benefit from future research that target modifiable factors by way of intervention development and policy modifications that increase safe, affordable, and culturally sensitive access to reproductive endocrinology services to reduce these disparities affecting Black women with infertility.
Item Open Access Psychological Sequelae of Obstetric Fistula in Tanzanian Women(2015) Wilson, Sarah MosherUp to two million women worldwide have obstetric fistula, a maternal morbidity prevalent in developing countries that causes uncontrollable leaking of urine and/or feces and a persistent bad odor. There is both theoretical and empirical evidence for psychopathology in patients presenting for fistula surgery, albeit with methodological limitations. The current studies sought to improve on past limitations of study design. Study A compared psychological symptoms and social support between fistula patients and a comparison group recruited from gynecology outpatient clinics. Measures included previously validated psychometric questionnaires, administered orally by data collectors. Results showed that compared to gynecology outpatients, fistula patients had significantly higher levels of depression, traumatic stress, somatic symptoms and avoidant coping, and had lower social support. Study B investigated changes in psychological symptoms, stigma and social support between the time of admission for fistula repair and 3 months after discharge from the hospital. At follow-up, fistula patients reported significant improvements in all study outcome variables. Exploratory analysis revealed that the extent of leaking was associated with depression and PTSD. These results indicate the potential benefit of mental health interventions for this population. Additionally, future research may clarify the relationship between residual leaking after fistula surgery, and its effect on post-surgery mental health outcomes.
Item Open Access Understanding sexual and reproductive health among orphaned and separated adolescent girls in five low- and middle-income countries(2023) Singh, PoojaAdolescent girls' sexual and reproductive health (SRH) is a significant public health issue, but little is known about the SRH outcomes of orphaned and separated adolescent girls, who face a higher risk of abuse and neglect in the absence of parental guidance, underscoring the critical need for research. This study examines the SRH outcomes (early pregnancy and condom use) and their predictors among adolescent girls aged 15 to 21 in five low- and middle-income countries, including orphaned and separated children. We conducted a cross-sectional analysis of 933 participants during the latest round of data collection from a longitudinal cohort study to assess predictors of early pregnancy and condom use. We first used bivariable logistic regression to identify potential predictors of each outcome. Potential predictors included education level, abuse, working status, relationship status, and age. Predictors that were significant (p<=0.10) in crude analyses were added to a multivariable model to assess associations in the presence of other predictors. In bivariable analysis, we found that education, marital status, history of abuse, work status, and age are associated with early pregnancy. However, we did not find a significant association for condom use with any predictors. It should be noted that the findings may be imprecise due to the small sample sizes and exclusion of children under 16 years old. Further research is needed to explore targeted interventions aimed at reducing early pregnancy and promoting condom use. Addressing education, work, and relationship status may enhance the effectiveness of such interventions.