Multi-level analysis of the determinants of physical domestic violence against children using longitudinal data from MINIMat mother-child cohort in Bangladesh

Objectives

Despite high levels of physical violence against children (VAC) globally (40-50%), the literature on the determinants of VAC remains inconclusive. Most of the literature on this topic is based on cross-sectional data, and the multi-level nature of the drivers of VAC is widely ignored. This leads to model specification problems and an inability to draw causal inferences. Moreover, despite the higher prevalence of VAC in low-and middle-income countries, studies from high income countries dominate the field. We examined the determinants of physical domestic VAC to address these gaps in the literature.

Methods

Data were collected between 2001 and 2020 from 762 mother-child dyads recruited in the Maternal and Infant Nutrition Interventions in Matlab (MINIMat) study in Bangladesh. We conducted multi-level logistic regression analyses to identify the determinants of physical domestic VAC.

Results

Prevalence of physical domestic violence against girls (69%) and boys (62%) was extremely high. Community-level prevalence of physical domestic VAC increased the likelihood of physical domestic VAC at the individual level across gender (girls - OR-5.66; 95% CI- 3.11-10.32; boys - OR-7.67; CI- 3.95-14.91). While physical domestic violence against mothers was not associated with physical domestic violence against girls, it reduced the likelihood of such violence against boys by 47%. Having 3 or more siblings predicted physical domestic violence against girls (OR-1.97; 95% CI- 1.01-3.81 for 3 siblings; OR-4.58; 95% CI- 2.12-9.90 for 4 or more siblings), but not against boys. While girls in Hindu families were more likely to experience this violence, the boys were not. Mother's education, employment non-governmental organization (NGO) participation and, household wealth did not predict this violence against any gender.

Conclusion

We contend that physical domestic violence against mothers reflects an emphasized patriarchal culture in a family where a boy is less likely to experience physical domestic violence. Social norms and social learning theories explain the greater likelihood of a child experiencing physical domestic violence in a village with a higher level of such violence. We conclude that social norms around physical domestic VAC and patriarchal culture need to be changed to effectively address this violence.

Factors Associated With Domestic Violence Against Women at Different Stages of Life: Findings From a 19-Year Longitudinal Dataset From the MINIMat Trial in Rural Bangladesh (2001-2020)

Despite the abundance of literature, longitudinal studies evaluating the factors associated with domestic violence (DV) at different stages and over longer periods of women's lives are rare. We evaluated factors associated with physical and sexual DV during pregnancy, at 10-year, and 18-year follow-ups after pregnancy and within a 19-year period of life using a cohort of women (n = 1,126) who participated in the Maternal and Infant Nutrition Interventions, Matlab trial in rural Bangladesh. Data on women's experience of DV, social and economic characteristics, empowerment, and family condition were recorded in a similar manner during pregnancy and at 10- and 18-year follow-ups, using standard questionnaires. Multivariate logistic regression models and generalized estimating equations were used to evaluate factors associated with women's experience of physical and sexual violence at each discrete time point and over a period of 19 years, respectively. During pregnancy, women were more likely to experience violence if they were members of microcredit programs/non-governmental organizations (NGOs), living in an extended family and had lower wealth status. At the 10- and 18-year follow-ups, higher levels of decision-making and higher wealth status were protective against the experience of violence. At the 18-year follow-up, women with larger age differences from their husbands were less likely to experience violence, while membership in microcredit programs/NGOs was associated with higher odds of experiencing violence among women. Within a period of 19 years, a higher level of education, living in an extended family, higher decision-making level and higher wealth index were protective against the experience of violence, while membership in microcredit programs/NGOs was a risk factor. In conclusion, this study showed that correlates of violence might change at different time points in women's life. Thus, policies and programs should consider the stage of women's lives while planning interventions for addressing violence against women.

The relationship between interpersonal violence in adulthood and mental health: a longitudinal study based on the Northern Swedish Cohort

BACKGROUND

Longitudinal studies evaluating the negative effects of exposure to interpersonal violence in the adulthood on the mental health of both women and men are scarce. Using longitudinal data, we evaluated the relationship between the last year experience of violence and functional somatic and depressive symptoms at the ages of 30 and 43 among participants (n = 1006; 483 women and 523 men) in the Northern Swedish Cohort. Further, the relationship between cumulative exposure to violence over a decade and mental health symptoms among participants was evaluated.

METHODS

Participants' experience of interpersonal violence and symptoms of functional somatic and depressive symptoms were evaluated with standard questionnaires at the ages of 30 and 43. General linear models were used to evaluate the relationship between the experience of interpersonal violence and mental health symptoms among the participants. The interactions between gender and violence on functional somatic and depressive symptoms were evaluated separately, and models in which the interaction was significant, were split by gender.

RESULTS

We found that the last year experience of violence at the age of 30 was related to current functional somatic symptoms among all participants and depressive symptoms only among men, (β _Adj for the experience of any violence among men: 0.21; CI: 0.12-0.29; Vs. among women: 0.06; CI: -0.04-0.16, p for interaction = 0.02). At the age of 43, last year experience of violence was related to both functional somatic and depressive symptoms in both genders. Finally, a cumulative relationship between the experience of violence over time and mental health symptoms was observed in all participants.

CONCLUSIONS

Our findings revealed that while the relationship between the experience of interpersonal violence and mental health symptoms may differ among men and women and with age, the experience of violence can be negatively related to the mental health in both genders.

Women empowerment indices and utilization of health facilities during childbirth: evidence from the 2019 Sierra Leone demographic health survey

BACKGROUND

Women empowerment is recognized as a potential enabling factor to the utilization of health facilities during childbirth. However, the association between women empowerment and utilization of health facilities is poorly studied, especially in counties with high maternal mortality. Therefore, we investigated the association between women empowerment indices and the utilization of health facilities during childbirth in Sierra Leone.

METHODS

We analyzed secondary data from the 2019 Sierra Leone Demographic and Health Survey (SLDHS). We included 5,997 married women who had given birth in the five years before the survey, and had been sampled for the women empowerment questionnaire. The study employed the gender roles framework developed by the Harvard Institute for International Development in the selection and classification of women empowerment indices, which include influencing, resource and decision-making factors. We conducted logistic regression analyses using SPSS version 25.0 complex samples package to determine the association between women empowerment indices and utilization of health facilities.

RESULTS

The overall prevalence of health facility utilization during childbirth was 84.1% (5,042/5,997): 95% CI: 83.6 to 85.4. Among the influencer domain variables, women from the southern (aOR = 2.25, 95% CI: 1.34-3.78), northern (aOR = 1.69,95% CI: 1.01-2.82) and eastern regions (aOR = 3.71, 95% CI: 2.03-6.77) had higher odds of health facility utilization compared to women in the western region, while women in polygamous marriages (aOR = 0.82, 95% CI: 0.69-0.98) had lower odds of utilizing health facilities compared to their counterparts in monogamous marriages. Furthermore, women who had their first birth when they were less than 18 years, had higher odds of utilizing health facilities (aOR = 1.22, 95% CI: 1.02-1.45) compared to those who were 18 years and above. Among the resource domain variables, women with post-primary education (aOR = 1.58, 95% CI: 1.21-2.06) had higher odds of utilizing health facilities compared to their counterparts with no education and women who belonged to the richest wealth quintile (aOR = 2.42, 95% CI: 1.31-4.46) had higher odds of utilizing health facilities compared to their counterparts belonging in the poorest quintile. None of the variables in the decision making domain was significantly associated with health facility utilization.

CONCLUSION

These findings emphasize that, successful implementation of health facility utilization interventions should prioritize women empowerment with more pragmatic efforts. Policies and programme should aim at all women with more focus on those having lower education (primary and below), belonging to the poorest wealth quintile, give birth before reaching18 years and in polygamous marriages.

Dietary diversity associated with risk of cardiovascular diseases among community-dwelling older people: A national health examination survey from Thailand

Background

Cardiovascular diseases (CVD) are the common comorbidities in older people. Healthy diet is an essential strategy to alleviate the risk of developing CVD. Dietary diversity (DD) is an indicator of diet quality. Currently, limited research exists regarding DD and CVD in older people in developing countries, such as Thailand, despite rapid growth of older population. Therefore, this study aims to determine associations of DD with the risk of CVD and the cardiometabolic risk factors among Thai older people.

Methods

This cross-sectional study used the sub-sample of the fifth Thai National Health Examination Survey conducted from 2013 to 2015. A total of 6,956 older people aged 60 years and older and no pre-existing CVD were included.

Dietary diversity score (DDS) was assessed the consumption of eight food groups using food frequency questionnaires. Each food group was scored from 0 to 4. The DDS was calculated as the sum of the scores (0–32). The risk of CVD was calculated by using a Thai cardiovascular (CV) risk score. The cardiometabolic risk factors included hypertension, diabetes mellitus (DM), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) levels. Data were adjusted for a complex survey design and analysed using linear and logistic regression models.

Results

In the adjusted model, DDS had a significant negative association with log-Thai CV risk score, with adjusted β (95% CI) values of −0.01 (−0.01, −0.01). Regarding the cardiometabolic risk factors, DDS had a significant negative association with hypertension, DM and log-TG levels, with adjusted OR (95% CI) values of 0.97 (95% CI 0.97, 0.98) for hypertension, 0.94 (0.93, 0.95) for DM, and adjusted β (95% CI) values of −0.002 (−0.004, −0.001) for log-TG level. DDS was positively associated with TC and LDL-C, with adjusted β (95% CI) values of 0.59 (0.38, 0.80) for TC and 0.59 (0.38, 0.79) for LDL-C levels, while DDS was not associated with HDL-C level.

Conclusion

Higher DD was associated with a lower risk of CVD among Thai older people. The nutritional policies or interventions should encourage a diverse food intake for the prevention of CVD in this population.

Ragging, a Form of University Violence in Sri Lanka-Prevalence, Self-Perceived Health Consequences, Help-Seeking Behavior and Associated Factors

Ragging is an initiation ritual practiced in Sri Lankan universities for generations, although research is scarce. This practice has several adverse consequences such as physical, psychological, and behavioral effects and increased university dropouts. The aim of this study was to investigate the prevalence of different types of ragging: emotional/verbal, physical and sexual ragging, self-perceived health consequences, help-seeking behavior, and factors associated with the experience of ragging. A cross-sectional study was conducted among 623, second- and third-year students from the medical, and technology faculties in Jaffna University. Bivariate associations were assessed using chi-squared tests. Logistic regression was used to evaluate factors associated with any type of ragging. Ragging was experienced by 59% of the students, emotional/verbal ragging being the most common. A total of 54% of students suffered one or more health consequences and mainly sought help from friends and family, with few seeking formal help. Factors associated with any type of ragging were faculty and year of study. This study emphasizes the urgent need to address this public health problem. It is important that there are adequate student support services, planning and implementation of effective interventions, as well as ensuring that existing policies are strengthened, to reduce or eliminate ragging in Sri Lanka.

Socio-demographic characteristics associated with the dietary diversity of Thai community-dwelling older people: results from the national health examination survey

Background

Dietary diversity (DD) is an indicator of nutrient intake and is related to health outcomes in older people. Currently, limited research exists regarding factors associated with DD in older people in developing countries, such as Thailand, despite rapid growth in this population. Therefore, this study aims to examine the association between socio-demographic characteristics and DD in Thai older people.

Methods

A cross-sectional study based on the fifth Thai National Health Examination Survey (NHES-V) conducted between 2013 and 2015 was performed. A total of 7,300 nationally representative older participants aged ≥ 60 years were included. The individual-level dietary diversity score (DDS) was assessed as the frequency of consumption of eight food groups using food frequency questionnaires. Each food group was scored from 0 to 4 according to the frequency of consumption. The DDS was calculated as the sum of the scores, ranging from 0 to 32. Socio-demographic characteristics, including age, sex, highest education level, wealth index, living conditions, and residential area, were assessed. Data were analyzed using multiple linear regression and adjusted for complex survey design.

Results

The participants had a mean age of 69.7 (SD 7.6) years. The mean DDS of participants was 18.4 (SD 3.9). In the adjusted model, a higher educational level, a higher wealth index, and living in an urban area were positively associated with DDS, with adjusted β (95% CI) values of 1.37 (1.04, 1.70) for secondary education or higher, 0.81 (0.55, 1.06) for the richest group, and 0.24 (0.10, 0.44) for living in an urban area. Nevertheless, living alone had negative associations with DDS, with a β (95% CI) of - 0.27 (- 0.53, - 0.00).

Conclusions

This study showed that a higher educational level, a higher wealth index, and living in an urban area had a positive association, whereas living alone had a negative association with DD among Thai older participants. Interventions aiming to improve dietary diversity among older people might benefit from targeting more vulnerable groups, particularly those with less education and wealth, those living alone, or those in rural areas.

What social determinants outside paid work are related to development of mental health during life? An integrative review of results from the Northern Swedish Cohort

BACKGROUND

Despite global increase in burden of mental health conditions, longitudinal studies on factors related to development of mental health are scarce. Particularly integrated understanding of how factors at each level of ecological system interact to influence mental health of individuals during their life is missing. Both work and outside work (life beyond work) spheres are two important areas in human life which can have independent effects on mental health of individuals. In this integrative review, we aimed to synthesis findings about social determinants outside paid work that are related to development of mental health during life in a 27-year prospective Swedish Cohort study by using Bronfenbrenner's Ecological Systems Theory.

METHODS

The material for this paper consists of all mental health related papers within Northern Swedish Cohort. Papers related to outside paid work exposures of life circumstances were selected. An integrative review was conducted on 27 papers and deductive qualitative content analysis in relation to Bronfenbrenner ecological framework was performed to identify the main themes.

RESULTS

The results of this review showed that class structures and gender order at macro-level permeated into all other levels and finally became embodied in the individuals as symptoms of mental health during life. At the "exo-level" neighbourhood disadvantage was related to mental ill-health of individuals. The importance of parental interaction with other settings, like school, for mental health of individuals was highlighted at "meso-level". At "micro-level" poor social relationships; social and material adversities and inequality in gender relations during adult life were related to mental ill-health.

CONCLUSION

We found mental health of individuals to be related to both unique and common factors manifesting at different socio-ecological levels. Social structures at the macro-level namely class structures and gender order permeate all other levels and eventually become embodied in the individuals as symptoms of mental health during life. Interventions addressing gender and class related inequalities might be of importance for improving mental health of individuals during their life.

Over-nutrition and associated factors among 20 to 49-year-old women in Uganda: evidence from the 2016 Uganda demographic health survey

Introduction

low- and middle-income countries are currently faced with a double burden of malnutrition. There has, however, been little focus on research and interventions for women with over-nutrition. We aimed to determine the prevalence and factors associated with over-nutrition among 20 to 49-year-old women in Uganda.

Methods

we used the Uganda demographic and health survey (UDHS) 2016 data of 4,640 women. We analysed data using SPSS (version 25), and we used multivariable logistic regression to determine factors associated with over-nutrition among 20 to 49-year-old women in Uganda.

Results

the prevalence of over-nutrition was 28.2% (95% confidence interval (CI): 26.8-29.4) with overweight at 19.3% and obesity at 8.9%. Women belonging to the poorer (adjusted odds ratio (AOR)=1.63; 95% CI: 1.17-2.28), middle (AOR=2.24; 95% CI: 1.61-3.13), richer (AOR=3.02; 95% CI: 2.14-4.25) and richest (AOR=6.35; 95% CI: 4.52-8.93) wealth index quintiles were more likely to be over-nourished compared to women in the poorest wealth index quintile. Married women (AOR=1.52; 95% CI: 1.26-1.83) were more likely to be over-nourished compared to non-married women. Older women were more likely to be over-nourished compared to younger women. Women in the Western (AOR=2.12; 95% CI: 1.66-2.71), Eastern (AOR=1.40; 95% CI: 1.04-1.88) and Central (AOR=2.25; 95% CI: 1.69-2.99) regions were more likely to be over-nourished compared to women in the Northern region.

Conclusion

the design of multi-faceted over-nutrition reduction programs with an emphasis on older, married, financially stable women, and those living in the Western, Eastern and Central regions of the country is needed.

Rural and Urban Correlates of Stunting Among Under-Five Children in Sierra Leone: A 2019 Nationwide Cross-Sectional Survey

Background

Undernutrition accounts for at least 50% of the annual global under-five mortality burden. Although disparities in the childhood stunting between urban and rural areas in Sierra Leone have been documented, information on factors associated with these differences is lacking. We aimed to determine rural-urban correlates of stunting among children under the age of 5 in Sierra Leone.

Methods

We analyzed data from 2019 Sierra Leone demographic and health survey (SLDHS) focusing on under-five children. We conducted multivariable logistic regression to examine rural-urban factors associated with childhood stunting.

Results

Prevalence of stunting was 31.6% (95% CI 29.8-33.2) in rural areas and 24.0% (95% CI 21.6-26.1) in urban areas. Within the rural areas, children of stunted mothers (aOR = 2.37; 95% CI 1.07-5.24, P < .05), younger mothers aged 15 to 19 years (aOR = 2.08; 95% CI 1.17-3.69, P < .05), uneducated mothers (aOR = 1.87; 95% CI 1.28-2.71, P < .01), as well as older children (24-59 months) (aOR = 1.83; 95% CI 1.48-2.27, P < .001), and boys (aOR = 1.37; 95% CI 1.12-1.66, P < .01) were more likely to be stunted compared to those of non-stunted, older, post-primary education mothers and those who were less than 24 months and girls respectively. While urban children whose fathers had lower education (aOR = 1.94; 95% CI 1.10-3.42, P < .05), whose mothers were more parous (para 2-4) (aOR = 1.74; 95% CI 1.03-2.95, P < .05), and boys (aOR = 1.48; 95% CI 1.06-2.08, P < .05) were more likely to be stunted compared to their counterparts with fathers that had tertiary education, mothers of low parity and girls, respectively.

Conclusions

Stunting is more prevalent in the rural areas compared to the urban areas. Sex of the child was the only significant factor in both rural and urban areas. Our study findings suggest that programs designed to reduce stunting should aim for integrated yet context specific interventions in rural and urban areas.

Maternal experience of domestic violence before and during pregnancy and children's linear growth at 15 years: Findings from MINIMat trial in rural Bangladesh

Literature concerning negative impacts of domestic violence (DV) against women on their children's health is growing; however, little is known about the long‐term effect of maternal exposure to DV before and/or during pregnancy on their children's growth. Using data from the MINIMat cohort, we have evaluated the association between maternal lifetime experience of DV, measured in late pregnancy, with their children's linear growth at 15 years (n = 2240) in rural Bangladesh. A modified version of conflict tactic scale was used to record the maternal experience of physical, sexual, emotional DV and controlling behaviour. Children's height was measured by trained nurses during their clinical visits at 15‐year follow‐up. Compared to the women with no experience of DV, children of women with experience of any physical, sexual or emotional DV before and/or during pregnancy had the significantly lower height for age Z‐scores (HAZs) at the age of 15. No significant association between maternal experience of controlling behaviour and their children's linear growth was observed in terms of HAZ. Results from this study suggest that maternal experience of DV before and/or during pregnancy might be associated with impaired long‐term linear growth within their children.

Factors associated with measles vaccination status in children under the age of three years in a post-soviet context: a cross-sectional study using the DHS VII in Armenia

BACKGROUND

The resurgence of measles globally and the increasing number of unvaccinated clusters call for studies exploring factors that influence measles vaccination uptake. Armenia is a middle-income post-Soviet country with an officially high vaccination coverage. However, concerns about vaccine safety are common. The purpose of this study was to measure the prevalence of measles vaccination coverage in children under three years of age and to identify factors that are associated with measles vaccination in Armenia by using nationally representative data.

METHODS

Cross-sectional analysis using self-report data from the most recent Armenian Demographic Health Survey (ADHS VII 2015/16) was conducted. Among 588 eligible women with a last-born child aged 12-35 months, 63 women were excluded due to unknown status of measles vaccination, resulting in 525 women included in the final analyses. We used logistic regression models in order to identify factors associated with vaccination status in the final sample. Complex sample analyses were used to account for the study design.

RESULTS

In the studied population 79.6% of the children were vaccinated against measles. After adjusting for potential confounders, regression models showed that the increasing age of the child (AOR 1.07, 95% CI: 1.03-1.12), secondary education of the mothers (AOR 3.38, 95% CI: 1.17-9.76) and attendance at postnatal check-up within two months after birth (AOR 2.71, 95% CI: 1.17-6.30) were significantly associated with the vaccination status of the child.

CONCLUSIONS

The measles vaccination coverage among the children was lower than the recommended percentage. The study confirmed the importance of maternal education and attending postnatal care visits. However, the study also showed that there might be potential risks for future measles outbreaks because of delayed vaccinations and a large group of children with an unknown vaccination status.

Development of a three-wave far-infrared laser interferometry and polarimetry diagnostic system for the C-2W field-reversed configuration plasmas

Great advancements in modern field-reversed configuration (FRC) experiments motivated the development of a 14-chord three-wave far infrared (FIR) laser interferometry and polarimetry diagnostic system, which can provide simultaneous high temporal resolution measurements of density and Faraday rotation profiles with high accuracy. The unique challenges facing FIR diagnostics in high beta FRC plasmas are the extremely small (<0.5°) Faraday rotation angles, and severe laser beam refraction effects due to high density gradient and choice of long wavelength. The diagnostic system design and development are described with methods to overcome the challenges, and initial experimental data are also presented.

Afghan migrants face more suboptimal care than natives: a maternal near-miss audit study at university hospitals in Tehran, Iran

BACKGROUND

Women from low-income settings have higher risk of maternal near miss (MNM) and suboptimal care than natives in high-income countries. Iran is the second largest host country for Afghan refugees in the world. Our aim was to investigate whether care quality for MNM differed between Iranians and Afghans and identify potential preventable attributes of MNM.

METHODS

An MNM audit study was conducted from 2012 to 2014 at three university hospitals in Tehran. Auditors evaluated the quality of care by reviewing the hospital records of 76 MNM cases (54 Iranians, 22 Afghans) and considering additional input from interviews with patients and professionals. Main outcomes were frequency of suboptimal care and the preventable attributes of MNM. Crude and adjusted odds ratios with confidence intervals for the independent predictors were examined.

RESULTS

Afghan MNM faced suboptimal care more frequently than Iranians after adjusting for educational level, family income, and insurance status. Above two-thirds (71%, 54/76) of MNM cases were potentially avoidable. Preventable factors were mostly provider-related (85%, 46/54), but patient- (31%, 17/54) and health system-related factors (26%, 14/54) were also important. Delayed recognition, misdiagnosis, inappropriate care plan, delays in care-seeking, and costly care services were the main potentially preventable attributes of MNM.

CONCLUSIONS

Afghan mothers faced inequality in obstetric care. Suboptimal care was provided in a majority of preventable near-miss events. Improving obstetric practice and targeting migrants' specific needs during pregnancy may avert near-miss outcomes.

Experiencing Lifetime Domestic Violence: Associations with Mental Health and Stress among Pregnant Women in Rural Bangladesh: The MINIMat Randomized Trial

Background

Experience of domestic violence has negative mental health consequences for women. The association of cumulative and specific forms of domestic violence, particularly emotional violence and controlling behavior, with common mental disorders and stress has rarely been studied in pregnant women. The aim of this study is to evaluate associations of specific and multiple forms of lifetime domestic violence and controlling behavior with distress and cortisol level during pregnancy in rural Bangladeshi women.

Methods and findings

In this observational sub-study of larger MINIMat trial, 3504 pregnant women were interviewed using a shortened Conflict Tactic Scale about their lifetime experience of domestic violence including physical, sexual, emotional domestic violence and controlling behavior. Women’s levels of emotional distress were assessed using the self-reported questionnaire (SRQ-20) developed by WHO, and levels of morning salivary cortisol were measured in a subsample (n = 1300) of women during week 28–32 of pregnancy. Regression analyses were used to estimate the associations of lifetime physical, sexual, emotional domestic violence and controlling behavior with levels of distress and cortisol during pregnancy. The prevalence of lifetime domestic violence was 57% and emotional distress was 35% in these pregnant women. All forms of domestic violence were associated with higher levels of emotional distress. Women who experienced either emotional violence or controlling behavior had the highest levels of emotional distress. There was a dose-response relationship between cumulative number of the different forms of domestic violence and women’s levels of emotional distress. There was no association between women’s experience of domestic violence and level of morning salivary cortisol.

Conclusion

Including emotional violence and controlling behavior as major types of violence in future research and health interventions is warranted. Furthermore, the extent of the negative impacts of domestic violence on pregnant women, multiple forms of violence and their cumulative effects need to be investigated.

A Prenatal Multiple Micronutrient Supplement Produces Higher Maternal Vitamin B-12 Concentrations and Similar Folate, Ferritin, and Zinc Concentrations as the Standard 60-mg Iron Plus 400-μg Folic Acid Supplement in Rural Bangladeshi Women

Background: The effects of prenatal food and micronutrient supplementation on maternal micronutrient status are not well known.

Objective: We compared the efficacy and effectiveness of 3 different micronutrient supplements on maternal micronutrient status when combined with food supplementation.

Methods: In the MINIMat (Maternal and Infant Nutrition Intervention, Matlab) trial in Bangladesh, 4436 pregnant women were randomly assigned to daily intake of 3 types of micronutrient capsules: 30 mg Fe and 400 μg folic acid (Fe30F), 60 mg Fe and 400 μg folic acid (Fe60F), or multiple micronutrient supplements (MMNs) combined with early (week 9 of pregnancy) or usual (week 20 of pregnancy) food supplementation in a 2 by 3 factorial design. Plasma concentrations of vitamin B-12, folate, ferritin, and zinc were analyzed before the start of micronutrient supplementation (week 14) and at week 30 of pregnancy in 641 randomly selected women. An electronic monitoring device was used to measure the number of capsules taken. The effectiveness of food and micronutrient regimens as well as efficacy per capsule in maternal micronutrient status were analyzed by ANOVA and general linear models.

Results: At week 30 of pregnancy, women in the MMN group had higher geometric mean concentrations of vitamin B-12 than women in the Fe60F group (119 compared with 101 pmol/L, respectively); no other differences in effectiveness of micronutrient and food regimens were observed. A dose-response relation between the number of capsules taken and concentrations of folate and ferritin was observed for all micronutrient supplements. Fe30F had lower efficacy per capsule in increasing ferritin concentrations within the first tertile of capsule intake than did Fe60F and MMNs. Because ferritin reached a plateau for all types of micronutrient supplements, there was no difference between the regimens in their effectiveness.

Conclusion: Compared with Fe60F, MMNs produced higher maternal vitamin B-12 and similar ferritin and folate concentrations in Bangladeshi women. The MINIMat trial was registered at isrctn.org as ISRCTN16581394.

Women's exposure to intimate partner violence and child malnutrition: findings from demographic and health surveys in Bangladesh

Domestic violence, in particular intimate partner violence (IPV), has been recognized as a leading cause of mortality and morbidity among women of reproductive age. The effects of IPV against women on their children's health, especially their nutritional status has received less attention but needs to be evaluated to understand the comprehensive public health implications of IPV. The aim of current study was to investigate the association between women's exposure to IPV and their children's nutritional status, using data from the 2007 Bangladesh Demographic and Health Survey (BDHS). Logistic regression models were used to estimate association between ever-married women's lifetime exposure to physical and sexual violence by their spouses and nutritional status of their children under 5 years. Of 2042 women in the BDHS survey with at least one child under 5 years of age, 49.4% reported lifetime experience of physical partner violence while 18.4% reported experience of sexual partner violence. The prevalence of stunting, wasting and underweight in their children under 5 years was 44.3%, 18.4% and 42.0%, respectively. Women were more likely to have a stunted child if they had lifetime experience of physical IPV [odds ratio n = 2027 (OR)adj, 1.48; 95% confidence interval (CI), 1.23-1.79] or had been exposed to sexual IPV (n = 2027 OR(adj), 1.28; 95% CI, 1.02-1.61). The present findings contribute to growing body of evidence showing that IPV can also compromise children's growth, supporting the need to incorporate efforts to address IPV in child health and nutrition programmes and policies.

Evolution: why all plumes and jets evolve to round cross sections

Turbulent curtains of smoke rise initially as flat plumes and, above a certain height, they become round plumes. The same evolution of cross-sectional shape is exhibited by jets issuing from flat nozzles. Here we predict based on principle that all such flows should evolve their cross-sectional shapes from flat to round (and not the other way) at a critical distance downstream, which is predictable. The principle is that the prevailing flow architecture provides greater access to the flow of momentum from the moving core (plume, jet) to the still surroundings. For turbulent plumes and jets, the transition distance scales with the long dimensions (L) of the two-dimensional (flat) heat sources and nozzles that drive them. For laminar jets, the transition distance scales with L Re, where Re is the Reynolds number based on nozzle velocity and the smaller dimension of the nozzle cross section. These predictions are confirmed by full numerical experiments of the three-dimensional flow fields of turbulent and laminar jets covering the Re range 10–10⁴.

Screening and identification of newly isolated cellulose-degrading bacteria from the gut of xylophagous termite Microcerotermes diversus (Silvestri)

The aim of the present study was to isolate and characterize the cellulose-degrading bacteria from the gut of the local termite, Microcerotermes diversus (Silvestri), inhabiting the Khuzestan province of Iran. The microorganisms capable of growing in the liquid medium containing cellulose as the only source of carbon were isolated and their cellulolytic activity on CMC-containing media was confirmed by the congo red clearing zone assay. The isolates were identified based on biochemical characteristics and the phylogenetic analysis of 16S rRNA gene fragments. The results of the present study show that three cellulose-degrading bacteria isolated from local termite guts belonged to the genera Acinetobacter, Pseudomonas and Staphylococcus and four cellulose-degrading bacteria belonged to Enterobacteriaceae and Bacillaceae families. Several isolates recovered from separate termite Microcerotermes diversus samples closely clustered in phylogenetic trees indicating high similarity and the abundance of particular cellulolytic strains. Bacillus B5B and Acinetobacter L9B hydrolyzed cellulose faster than the other isolates (with CMCase activity of 1.47 U/mL and 1.22 U/mL, respectively). The stability of CMCase produced by Bacillus B5B over a broad range of pH and high temperature indicated that the enzyme may be of great commercial value.

Comparative effects of conventional hormone replacement therapy and tibolone on climacteric symptoms and sexual dysfunction in postmenopausal women

OBJECTIVE

To compare the effects of tibolone with those of conventional hormone replacement therapy on climacteric symptoms and sexual function in postmenopausal women.

MATERIALS AND METHODS

In a randomized, controlled trial, 140 postmenopausal women were allocated into three groups. Of the subjects included, 47 women received 2.5 mg tibolone + one Cal+D tablet (500 mg calcium and 200 IU vitamin D) daily; 46 women received 0.625 mg conjugated equine estrogen + 2.5 mg medroxyprogesterone (CEE/MPA) + one Cal+D tablet daily; and 47 women received only one Cal+D tablet as the control group. The Greene Climacteric Scale (GCS) questionnaire was used to detect the efficacy of treatment on climacteric symptoms. Rosen's Female Sexual Function Index (FSFI) was used for sexual function evaluation. Sex hormone binding globulin (SHBG), free estradiol index (FEI) and free testosterone index (FTI) were measured before and after treatment. The women were followed up for 6 months

RESULTS

After treatment, all subscores in the GCS improved in the tibolone and CEE/MPA groups (p < 0.01), except the sexual subscore in the CEE/MPA group, compared with baseline. There were significant differences in the FSFI in the tibolone and CEE/MPA groups in comparison to the control group after treatment. Tibolone, in comparison to CEE/MPA, significantly lowered SHBG levels and increased the FTI and FEI and improved the desire, arousal and orgasm sexual domains of the FSFI (p < 0.001).

CONCLUSION

Tibolone may be an alternative to conventional hormone replacement therapy in the treatment of climacteric symptoms and sexual dysfunction in postmenopausal women.

Comparative effects of continuous combined hormone therapy and tibolone on body composition in postmenopausal women

OBJECTIVE

To compare the effects of tibolone with those of continuous combined hormone replacement therapy (HT) on body composition in postmenopausal women.

METHODS

One hundred and fifty postmenopausal women were enrolled in a randomized, controlled trial to compare the effects of tibolone with continuous combined HT on body composition. Patients were randomly allocated into three groups and followed for 9 months. Of the subjects included, 50 women received 2.5 mg tibolone plus one Cal+D tablet (500 mg calcium and 200 IU vitamin D) daily, 50 women received 0.625 mg conjugated equine estrogen and 2.5 mg medroxyprogesterone acetate (CEE/MPA) plus one Cal+D tablet daily, and the rest (50 women) received only one Cal+D tablet and served as a control group. Body composition was evaluated with measurements of body mass index (BMI), weight, waist-to-hip ratio (WHR), fat mass and fat-free mass (FFM) before and after the intervention. Measurements of body fat mass percentage, fat mass, body fat-free mass percentage and fat-free mass (FFM) were assessed by measurement of skin-fold thickness.

RESULTS

Tibolone significantly increased weight, BMI and FFM and decreased WHR after the treatment in comparison with baseline (p < 0.05). However, only weight and BMI increased significantly in the CEE/MPA group after the treatment (p < 0.05). There were significant increases in weight, BMI and fat mass in the control group after 9 months. In the comparison of the parameters after the treatment between the three groups, tibolone significantly increased FFM compared with the control and CEE/MPA groups (p < 0.01).

CONCLUSIONS

The effect of tibolone on body composition is favorable and therefore tibolone may be regarded as an alternative to continuous combined hormone therapy in postmenopausal women.

The effect of vitamin E on hot flashes in menopausal women

BACKGROUND

Hot flashes affect as many as 75% of menopausal women. Estrogen reliably reduces the severity of hot flashes and remain the single most effective treatment. Today, however, more and more women are seeking alternatives. Instead of hormonal therapy, women are turning to vitamins, and other over-the-counter products for relief from hot flashes. This study was undertaken to assess the effect of vitamin E on hot flashes.

METHOD

A placebo double blind-controlled trial was conducted. After 1 week baseline period, the enrolled patients (n = 51) received placebo (identical in appearance to vitamin E softgel) daily for 4 weeks, followed by 1 week wash out and 400 IU vitamin E (softgel cap) daily for the next 4 weeks. Diary was used to measure hot flashes before and at the end of the study.

RESULT

There were statistical significant differences in hot flashes severity score (2.37 +/- 0.74, 1.80 +/- 0.87) and their daily frequency (5.00 +/- 3.34, 3.19 +/- 2.74) after the treatments between the placebo and vitamin E therapies (p < 0.0001).

CONCLUSION

Based on our trial, vitamin E is recommended for the treatment of hot flashes.

A randomised placebo-controlled trial to determine the effect of iron supplementation on pregnancy outcome in pregnant women with haemoglobin ≥ 13.2 g/dl

OBJECTIVE

To study the effect of iron supplementation on pregnancy outcome in pregnant women with haemoglobin (Hb) > or = 13.2 g/dl.

DESIGN

A randomised, double-blind, placebo-controlled trial.

SETTING

Routine health services.

POPULATION

Seven hundred and twenty-seven pregnant women with Hb > or = 13.2 g/dl in the early stage of the second trimester.

METHODS

Each woman took one ferrous sulphate [DOSAGE ERROR CORRECTED] tablet (150 g tablet, containing 50 mg of elemental iron) [DOSAGE ERROR CORRECTED] daily in the case group (n = 370) or placebo in the control group (n = 357) throughout pregnancy.

MAIN OUTCOME MEASURES

Pregnancy outcome.

RESULTS

While there were no significant differences in demographic and obstetric characteristics between the two groups before any intervention, small-for-gestational-age birth rate and the number of women with hypertension disorder increased significantly in the case group in comparison with the control group (57 [15.7%] versus 36 [10.3%], P = 0.035, 10 [2.7%] versus 3 [8%], P = 0.05, respectively).

CONCLUSIONS

Our finding proves that routine iron supplementation in nonanaemic women is not rational and may be harmful.

Impact of early admission in labor on method of delivery

OBJECTIVE

The effect of the timing of admission in labor unit on the method of delivery was evaluated in a cohort study.

METHOD

Four hundred and sixty six low-risk nulliparous women who were admitted in the labor unit in latent phase (group 1) were compared with 329 parturient women who were admitted in the active phase (group 2) to determine rate of and reasons for cesarean section, cervical dilation at the time of cesarean, and the rate of labor augmentation.

RESULT

The number of cesarean deliveries in group 1 was greater than that in the group 2 (301 vs 80, p<0.0001 ). The main reason for cesarean section in group 1 was dystocia, and in 2, fetal distress. The rate of cesarean section in the women who were augmented was greater in group 1 than in group 2 (54% vs 23%, p<0.0001).

CONCLUSION

Later admission in labor increases the rate of spontaneous vaginal delivery in low risk nulliparous women.

Effect of the sampling sequence on the quality of Papanicolaou smear

The aim of the study was to determine whether the order of cell collection (ie, obtaining either endocervical first or ectocervical cells first) has an effect on the quality of the Papanicolaou smear. 1129 smears were obtained using an Ayre spatula and an endocervical brush. In 564 cases, the endocervical brush was used first, and in 565 cases, the spatula was used first. The number of smears obscured by blood, the smears without endocervical component, and the smears with poor fixation were compared between the two groups. More smears were partially obscured by blood when brush was used first (78, 13.8% compared with 48, 8.5%, P = 0.004). No endocervical component was found in seven (1.2%) smears from the brush-first group compared with five (0.9%) of the spatula-first group, which is an insignificant difference. There were no significant differences in the number of poor-fixated smears, too-thick smears, and satisfactory smears but limited by inflammation between the two methods. The quality of the Papanicolaou smear can be improved by using the Ayre spatula first followed by the endocervical brush. Fewer smears will be contaminated by blood which may result in more squamous intraepithelial lesions being detected.

Relationship between beta-hCG levels in cervicovaginal secretions and labor

OBJECTIVE

To determine whether levels of human beta-chorionic gonadotropin hormone (beta-hCG) in cervicovaginal secretions can predict the labor process.

METHODS

A total of 150 women admitted in active labor to the urgent delivery unit of a university hospital were enrolled in a prospective study. The beta-hCG level of each woman's cervicovaginal secretions was measured by radioimmunoassay on admission; then, beta-hCG levels were compared between 2 groups of 35 women, one in whom labor progressed normally and another in whom augmentation of labor with oxytocin was required.

RESULTS

There were significant differences in beta-hCG levels of cervicovaginal secretions between the spontaneous delivery group and the augmentation of labor group (130.72+/-64.51 mU/mL vs. 93.9+/-65.29 mU/mL) (P<0.05). A receiver-operating characteristic (ROC) curve analysis showed that the optimal cut-off value was 82 mU/mL, with a sensitivity of 66% and a specificity of 60%.

CONCLUSION

beta-chorionic gonadotropin hormone levels were significantly higher in the cervicovaginal secretions of women whose labor was progressing normally than in those who required augmentation of labor.

A randomised controlled trial of vitamin E in the treatment of primary dysmenorrhoea

OBJECTIVE

To study the effect of vitamin E in the treatment of primary dysmenorrhoea.

DESIGN

A randomised, double-blind, placebo-controlled trial.

SETTING

A secondary school in Tehran, Iran.

POPULATION

Two hundred and seventy-eight girls aged 15-17 years who suffered from primary dysmenorrhoea.

METHODS

Participants were given 200 units of vitamin E or placebo twice a day, beginning two days before the expected start of menstruation and continued through the first three days of bleeding. Treatment was continued over four consecutive menstrual periods.

MAIN OUTCOME MEASURES

The severity and duration of pain, and the amount of menstrual blood loss, at two and four months. A visual analogue scale (VAS) was used to record pain, and a validated Pictorial Blood Loss Assessment Chart (PBLAC) to measure menstrual loss.

RESULTS

In the vitamin E group, pain severity was lower with vitamin E at two months (median VAS score 3 vs 5, P > 0.001) and four months (0.5 vs 6, P > 0.001), pain duration was shorter at two months (mean 4.2 [7.1] hours vs 15 [17], P > 0.001) and at four months (1.6 [4.0] hours vs 17 [18] hours, P > 0.0001), and blood loss assessed by PBLAC score was lower at two months (54 [31] vs 70 [40], P > 0.0001) and at four months (46 [28] vs 70 [37], P > 0.0001).

CONCLUSION

Vitamin E relieves the pain of primary dysmenorrhoea and reduces blood loss.

Effect of the sampling sequence on the quality of Papanicolaou smear

The aim of the study was to determine whether the order of cell collection (ie, obtaining either endocervical first or ectocervical cells first) has an effect on the quality of the Papanicolaou smear. 1129 smears were obtained using an Ayre spatula and an endocervical brush. In 564 cases, the endocervical brush was used first, and in 565 cases, the spatula was used first. The number of smears obscured by blood, the smears without endocervical component, and the smears with poor fixation were compared between the two groups. More smears were partially obscured by blood when brush was used first (78, 13.8% compared with 48, 8.5%, P = 0.004). No endocervical component was found in seven (1.2%) smears from the brush-first group compared with five (0.9%) of the spatula-first group, which is an insignificant difference. There were no significant differences in the number of poor-fixated smears, too-thick smears, and satisfactory smears but limited by inflammation between the two methods. The quality of the Papanicolaou smear can be improved by using the Ayre spatula first followed by the endocervical brush. Fewer smears will be contaminated by blood which may result in more squamous intraepithelial lesions being detected.

Comparative study and evaluation of side effects of low-dose contraceptive pills administered by the oral and vaginal route

This was a comparative study of side effects and acceptability of low-dose pills administered by the oral and vaginal rout. In an experimental clinical trial study, undesirable side effects of nausea, dysmenorrhea, breast tenderness, gastrointestinal disorders, vertigo, headache, and breakthrough bleeding (BTB) were studied. The participants of the case and the control groups were the same women. The side effects were compared in 143 women using contraceptive pill containing 150 microg levonorgestrel and 30 microg ethinyl estradiol by vaginal and oral route. The efficacy and acceptability were evaluated. The side effects among the patients who used the contraceptive pills orally were significantly higher than among those who used the vaginal route (p < 0.0001). BTB occurred more often with the oral route, but there was no significant difference between their incidences (p = 0.267). Most participants in this study expressed a high level of acceptability with the vaginal route. There was only one unwanted pregnancy, which occurred when the participant used the contraceptive pill vaginally, but used it incorrectly. Using the contraceptive pill administered by vaginal route is a safe method with fewer side effects and more acceptability when compared with the oral route.

The effect of garlic tablet on plasma lipids and platelet aggregation in nulliparous pregnants at high risk of preeclampsia

OBJECTIVE

This study was designed to determine the effect of garlic tablet (Garlet) on plasma lipids, and platelet aggregation and the efficacy of this treatment in the prevention of preeclampsia.

STUDY DESIGN

In a randomized, single-blind, placebo-controlled study, 100 primigravidas with positive roll-over test were treated with daily doses of 800mg Garlet/day (n=50) or 800mg/day placebo (n=50) during the third trimester of pregnancy. Serum total cholesterol, LDL-and HDL-cholesterol, triglyceride, and platelet aggregation were measured before and after the treatment. Blood pressure, weight, and edema were also examined during the entire study period.

RESULTS

In the case group, there was no significant difference in the means of total cholesterol, HDL, LDL, and triglyceride before and after the experiment. Furthermore, the inhibition of platelet aggregation did not show any significant difference before and after the treatment. There were not any significant difference in the means of HDL, LDL, triglyceride, inhibition of platelet aggregation, the means of systolic and diastolic blood pressure and the mean arterial blood pressure (MAP), between the two groups, but there was a significant difference in the means of total cholesterol (P=0.038) and hypertension alone (P=0.043).

CONCLUSION

The administration of 800mg/day of Garlet during the third trimester of pregnancy was effective in reducing the occurrence of hypertension alone, but it was no effective in preventing of preeclampsia.

A randomised placebo-controlled trial to determine the effect of vitamin E in treatment of primary dysmenorrhoea

OBJECTIVE

To determine whether vitamin E is effective in the treatment of primary dysmenorrhoea.

DESIGN

A randomised placebo-controlled trial.

PARTICIPANTS

One hundred girls, aged 16-18 years old who suffered from primary dysmenorrhoea, among 1,000 students attending a public high school in Region 5 in the Greater Tehran Municipality.

METHODS

Fifty girls were given 500 units of vitamin E (five tablets) per day, and 50 were given five placebo tablets per day. The treatment began two days before the beginning of menstruation and continued through the first three days of bleeding. The severity of pain before and after the treatment was studied. Treatment in both groups was carried out in two consecutive menstrual periods.

RESULTS

The severity of pain in the two groups was reduced after treatment, but the reduction was greater in the group treated with vitamin E. These differences were maintained in the second month of therapy.

CONCLUSION

Both placebo and vitamin E are effective in relieving symptoms due to primary dysmenorrhoea, but the effects of vitamin E are more marked.