The prevalence of self-reported premenstrual symptoms and evaluation of regular exercise with premenstrual symptoms among female employees in Taiwan

ABSTRACT

Few studies have focused on premenstrual symptoms in employees. This study explored the prevalence of premenstrual symptoms in 7,193 female employees aged 18–55 years in a large electronics manufacturer in Taiwan from August 2014 to December 2014 and examined whether regular exercise was associated with premenstrual symptoms. Information was collected on demographics, lifestyle, menstrual history, menstrual pain, and premenstrual symptoms. Half of the participants reported irregular menstruation; 79.4% reported a moderate menstruation amount, and half reported little impact of menstrual pain at work. In order of prevalence, symptoms were “easy to fatigue” (24%), “backache” (21.2%), and “abdominal bloating” (17.4%). Participants who engaged in regular exercise reported fewer backaches (adjusted odds ratio [aOR] = 0.79, 95% confidence interval [CI] = 0.68–0.91), somatic discomfort (aOR = 0.78, 95% CI = 0.63–0.96), headache (OR = 0.82, 95% CI = 0.69–0.98), diarrhea (aOR = 0.76, 95% CI = 0.60–0.96), constipation (aaOR = 0.59, 95% CI = 0.44–0.78), less irritability (aOR = 0.78, 95% CI = 0.65–0.94), feeling morose and depressed (aOR = 0.75, 95% CI = 0.58–0.95), crying (aOR = 0.51, 95% CI = 0.27–0.87), and emotional lability (aOR = 0.73, 95% CI = 0.58–0.91). Regular exercise was associated with decreased menstrual pain (aOR = 0.85, 95% CI = 0.76–0.96). Our findings provide a better understanding of premenstrual symptoms in female workers, allowing for the development of premenstrual health programs to improve their health and quality of life.     

A community-based survey on Syrian refugee women’s health and its predictors in Şanliurfa,Turkey

ABSTRACT

Reproductive characteristics, mental health symptoms, micronutrient deficiencies, and symptoms of sexually transmitted infections (STIs) were determined among married Syrian refugee women aged 15–49 years who were living outside of camps in 2015, using probability sampling. Of the 458 participants, 51.3 percent married before the age of 18 years. Early-age marriages and number of desired children increased after the war. In multivariable analyses, education (adjusted odds ratio [aOR] = 1.2; 95% confidence interval [CI] = 1.2–1.3) and length of stay in ?anl?urfa (aOR = 1.2; 95% CI = 1.1–1.2) were independently associated with early marriage. Approximately 16 percent of women were pregnant, and 26.7 percent of them had not received prenatal care; 47.7 percent had had a pregnancy loss; 50.8 percent reported symptoms of STIs. Of those who were sexually active, 37.8 percent were not using contraception. The prevalence of iron, B₁₂, and folic acid deficiencies was 50 percent, 45.6 percent, and 10.5 percent, respectively. Early marriage (aOR = 2.2; 95% CI = 1.4–3.5) and number of desired children (aOR = 5.03; 95% CI = 3.2–7.9) were associated with not using contraception. Most (89.7 percent) women reported at least two mental health symptoms; lack of social support (aOR = 2.6; 95% CI = 1.3–5.3), language barrier (aOR = 2.3; 95% CI = 1.01–5.2), and B₁₂ deficiency (aOR = 1.8; 95% CI = 1.01–3.4) were associated with such symptoms. The findings demonstrate the need for reproductive health and psychosocial services.     

Factors associated with residential mobility during pregnancy

Our objective was to determine the factors associated with residential moving during pregnancy, as it may increase stress during pregnancy and affect birth outcomes. Data were obtained from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study. Participants were recruited from December 2006 to June 2011 and included 1,448 pregnant women. The average gestational age at enrollment was 23 weeks. The primary outcome of residential mobility was defined as any change in address during pregnancy. Multivariate regression was used to assess the adjusted associations of factors with residential mobility. Out of 1,448 participants, approximately 9 percent moved between baseline (enrollment) and delivery. After adjusting for covariates, mothers with lower educational attainment [less than high school (adjusted odds ratio [aOR] = 3.74, 95% confidence interval [CI] = 1.78, 7.85) and high school/technical school (aOR = 3.57, 95% CI = 2.01, 6.32) compared to college degree or higher], and shorter length of residence in neighborhood were more likely to have moved compared to other mothers. Length of residence was protective of mobility (aOR = 0.91, 95% CI = 0.86, 0.96 per year). Increased understanding of residential mobility during pregnancy may help improve the health of mothers and their children.     

Correlates of Overweight and Obesity Among American Indian/Alaska Native and Non-Hispanic White Children and Adolescents: National Survey of Children’s Health, 2007

Risk factors for overweight and obesity may be different for American Indian and Alaska Native (AI/AN) children compared to children of other racial/ethnic backgrounds, as obesity prevalence among AI/AN children remains much higher. Using data from the 2007 National Survey of Children’s Health, behavioral (child’s sport team participation, vigorous physical activity, television viewing, and computer use), household (parental physical activity, frequency of family meals, rules limiting television viewing, and television in the child’s bedroom), neighborhood (neighborhood support, perceived community and school safety, and presence of parks, sidewalks, and recreation centers in the neighborhood), and sociodemographic (child’s age and sex, household structure, and poverty status) correlates of overweight/obesity (body mass index ≥85th percentile for age and sex) were assessed among 10–17 year-old non-Hispanic white (NHW) and AI/AN children residing in Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, and South Dakota (n = 5,372). Prevalence of overweight/obesity was 29.0 % among NHW children and 48.3 % among AI/AN children in this sample. Viewing more than 2 h of television per day (adjusted odds ratio [aOR] = 2.0; 95 % confidence interval [CI] = 1.5–2.8), a lack of neighborhood support (aOR = 1.9; 95 % CI = 1.1–3.5), and demographic characteristics were significantly associated with overweight/obesity in the pooled sample. Lack of sport team participation was significantly associated with overweight/obesity only among AI/AN children (aOR = 2.7; 95 % CI = 1.3–5.2). Culturally sensitive interventions targeting individual predictors, such as sports team participation and television viewing, in conjunction with neighborhood-level factors, may be effective in addressing childhood overweight/obesity among AI/AN children. Longitudinal studies are needed to confirm these findings.     

Families matter: Social relationships and adolescent HIV testing behaviors in Ndola,Zambia

A cross-sectional survey among 550 randomly selected 16–19-year-olds in Ndola, Zambia, assessed the influence of individual (e.g., HIV knowledge), relational (e.g., discussed HIV testing with family), and environmental factors (e.g., distance) on adolescents’ use of HIV counseling and testing. A multivariable logistic regression analysis comparing respondents who have taken an HIV test to respondents who have not found that at the relational level believing that one’s family would not be upset if the youth has taken an HIV test (adjusted odds ratio [AOR] = 5.08; 95% confidence interval [CI] = 1.16–22.35); and having discussed with a family member whether or not to take an HIV test (AOR = 3.51; 95% CI = 1.08–11.47) were significantly related to adolescent testing. At the individual-level, having ever had sex (AOR = 6.43; 95% CI = 2.14–19.30) and being out-of-school (AOR = 2.95; 95% CI = 1.32–6.59) were also strongly associated with HIV testing. Environmental measures were not found to be significantly related to HIV testing. These findings support the need to examine not only individual characteristics but also relational level factors, particularly the role of families, when implementing and evaluating adolescent HIV testing strategies. Programs to increase communication about HIV testing and counseling within families should be tested in a prospective design in order to assess the impact on young people’s decisions to learn their HIV status and subsequent health seeking and protective behaviors.     

Medical Home Access Among American Indian and Alaska Native Children in 7 States: National Survey of Children’s Health

To describe the prevalence of medical home among American Indian and Alaska Native children (AIAN) compared to non-Hispanic white (NHW) children and identify areas for improvement in the provision of care within a medical home. Prevalence of medical home, defined as family-centered, comprehensive, coordinated, compassionate, culturally effective care, including a personal doctor or nurse and usual care location, was estimated using 2007 National Survey of Children’s Health data. Analyses included 1–17 year-olds in states reporting AIAN race as a distinct category (Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, and South Dakota, n = 9,764). Associations between medical home and demographic (child’s age, household education and income, and state) and health-related [child’s insurance status, special health care need status, and past year Indian Health Service (IHS) utilization] characteristics were assessed among AIAN children. Overall, the prevalence of medical home was 27 % lower among AIAN children (42.6, 95 % CI = 34.4–50.8) than NHW children (58.3, 95 % CI = 56.2–60.4). Child’s age (adjusted OR [aOR] = 2.7, 95 % CI = 1.3–5.6) was significantly associated with medical home. IHS utilization was associated with medical home among AIAN children with private insurance (aOR = 0.2, 95 % CI = 0.1–0.4), but not among uninsured or publicly insured children. Care coordination and family-centered care were noted areas for improvement among AIAN children. Less than half of AIAN children had a medical home. Future studies should further examine the intersection between insurance and IHS to determine if enhanced coordination is needed for this population, which is often served by multiple federally-funded health-related programs.     

Regional variation and demographic factors associated with knowledge of malaria risk and prevention strategies among pregnant women in Nigeria

ABSTRACT

Pregnant women and children are the most vulnerable populations for malaria infection. Yet, knowledge of risk, and preventive measures are poor among this population. Using the 2015 Nigeria Malaria Indicator Survey, we applied logit link function to estimate the associations of wealth status, educational attainment, and region of residence with malaria risk knowledge and prevention strategies (using a treated mosquito net and malaria drugs) among 739 Nigerian pregnant women aged 15–49 years. Urban women who had obtained a secondary school education (Adjusted odds ratio [aOR] = 2.12; 95% confidence interval [CI] 1.09–4) or higher (aOR = 8.31; 95% CI 3.2–22) had more knowledge of malaria risk. Urban women in the South-West (aOR = 5.02; [CI] 2.02–12.50) and South-East (aOR = 2.68; 95% CI 1.19–6.06) were more likely to use treated mosquito nets during pregnancy. Women in the urban South-West (aOR = 4.04; 95% CI 1.5–11) were more likely to use malaria drugs during pregnancy than those in the North-Central. A wide regional disparity in the knowledge of malaria risks and use of preventive measures exists. Thus, promoting equal access to malaria preventive measures as well as improving knowledge about malaria transmission by mosquitoes should be considered as essential components of ongoing malaria control and elimination efforts in Nigeria.     

Identifying variables in relation to health-related quality of life among married women of reproductive age in Sivas Turkey

ABSTRACT

A cross-sectional study was performed to identify the factors associated with health-related quality of life (HRQoL) among 1,236 married Turkish women aged 15–49 years, in the urban area of Sivas, between January and July 2017. Multiple logistic regression analyzes showed that being unemployed [adjusted odds ratio (AOR) = 1.73, 95% confidence interval (CI) = 1.18–2.25], and having an unsatisfying sexual life (AOR = 1.54, 95% CI = 1.17–2.03), a chronic illness (AOR = 1.66, 95% CI = 1.27–2.17), more than three children (AOR = 1.38, 95% CI = 1.03–1.86), and experienced domestic violence (AOR = 2.15, 95% CI = 1.55–2.98) were associated with worse mental HRQoL. Having less than a high school education (AOR = 2.00, 95% CI = 1.33–3.02), a chronic illness (AOR = 2.49, 95% CI = 1.88–3.30), a history of abortion (AOR = 1.59, CI = 1.09–2.31), and experienced domestic violence (AOR = 1.71, 95% CI = 1.21–2.40) were associated with worse physical HRQoL. These findings suggest that health care providers or policy makers should pay special attention to unemployed women who are less educated, have more than three children and those having unsatisfied sexual lives, chronic illness, domestic violence experience and abortion history to enhance their HRQoL.     

Perceived social support and psychological wellbeing of children orphaned by HIV/AIDS in Southwestern Uganda

ABSTRACT

Evidence points to a correlation between perceived social support and children’s psychological well-being globally. However, only a few studies have examined the relationship between perceived social support (PSS) from multiple sources and children’s psychological outcomes. Even fewer studies have examined the relationship between perceived social support from multiple sources and the psychological outcomes of children orphaned by HIV/AIDS in Sub-Saharan Africa (SSA). This study examines whether PSS from multiple sources (parents/caregivers, teachers, friends and classmates) and family cohesion are independently and collectively associated with the psychological well-being of children orphaned by HIV/AIDS in Uganda. This study used baseline data from a National Institute of Health (NIH)-funded Suubi-Maka (Hope for families) study, conducted in Southwestern Uganda. A total of 346 child-caregiver dyads from 10 comparable primary schools participated in the study. Multivariate and multivariable regression analyses were conducted to examine: (1) variations in PSS from multiple sources and family cohesion, and (2) the relationship between PSS, family cohesion and children’s psychological outcomes, measured by depression, hopelessness, and self-concept. Controlling for participants’ demographic and household characteristics, the combined measure of PSS from multiple sources was positively associated with self-concept (b = .32, 95% CI = .23, .41, p ≤ .001) and negatively associated with hopelessness (b = ?.19, 95% CI = ?.29, ?.09, p ≤ .001) and depressive symptoms (b = ?.13, 95% CI = ?.23, ?.03, p ≤ .01). PSS from parents/guardians and teachers was a significant predictor. In addition, family cohesion was positively associated with self-concept (b = .37, 95% CI = .15, .58, p ≤ .001) and negatively associated with depressive symptoms (b = ?.36, 95%CI = ?.59, ?.13, p≤ = .01). Findings indicate that family cohesion and perceived social support, especially from parent/caregivers and teachers were associated with better children’s psychological outcomes. In HIV-impacted communities, interventions designed to strengthen family relationships and social support are essential to offset children’s psychological well-being.     

The Impacts of Health Insurance Coverage on Access to Healthcare in Children Entering Kindergarten

To examine access to healthcare and health outcomes for kindergartners as they relate to insurance status and type. For the 2008, 2009, and 2010 school years, surveys were distributed to parents with a child entering kindergarten in the state of Nevada. Surveys asked parents to provide information about their child concerning their insurance status, routine medical care, medical conditions, and health behaviors. Compared to their insured peers, uninsured kindergartners were less likely to have had a check-up in the previous 12 months (p < .001; OR 6.14; 95 % CI 5.77–6.53), have a primary physician (p < .001; OR 14.32; 95 % CI 13.49–15.20), or have seen a dentist (p < .001; OR 3.93; 95 % CI 3.70–4.16), and were more likely to have a reported unmet medical need (p < .001; OR 2.60; 95 % CI 2.19–3.07). Additionally, compared to children with private insurance, those children with public insurance were less likely to have had a check-up (p < .001; OR 1.73; 95 % CI 1.59–1.89), have a primary care provider (p < .001; OR 3.87; 95 % CI 3.55–4.21), and were more likely to have unmet medical needs (p < .001; OR 2.27; 95 % CI 1.83–2.81). For children in early development—a deeply critical period—insurance status and type are predictors of important access to healthcare variables.     

Stigma as a barrier to health care utilization among female sex workers and men who have sex with men in Burkina Faso

Purpose

The aim of this study is to examine the prevalence and correlates of perceived health care stigma among female sex workers (FSWs) and men who have sex with men (MSM), including other stigma types, suicidal ideation, and participation in social activities.

Indoor swimming pool environments and self-reported irritative and respiratory symptoms among lifeguards

A web survey was conducted among 870 lifeguards (current and former) to assess the relationship between exposure to indoor swimming pool environments and respiratory health. Associations between respiratory symptoms and asthma with varying lengths of occupational exposure were assessed by multiple logistic regression. Lifeguards exposed more than 500 hours in the previous 12 months experienced more cough (adjustedOR = 2.54, IC95 % = 1.51–4.25), throat (aOR = 2.47, IC95 % = 1.44–4.24) and eye irritation (aOR = 4.34, IC95 % = 2.52–7.50) during this period than non-exposed lifeguards. Upper and lower respiratory symptoms while on duty were related to duration of lifetime exposure (> 500 days vs. ≤ 50 days: Upper aOR = 5.84, IC95 % = 3.60–9.50; Lower aOR = 2.53, IC95 % = 1.58–4.06). Physician-diagnosed asthma was high among lifeguards (23 %). Highly exposed asthmatic lifeguards (> 500 hours) over the previous 12 months had a significantly higher risk (aOR = 3.74, IC95 % = 1.39–10.02) of suffering from asthma attack(s) than non-exposed asthmatic subjects. Exposure to indoor swimming pool environments is related to respiratory symptoms among lifeguards.     

Dietary Diversity and Meal Frequency Practices among Children Aged 6-23 Months in Agro Pastoral Communities in Afar Region,Ethiopia: A Cross-sectional Study

ABSTRACT

Introduction: Inappropriate infant and young child feeding practices in the first two years of life are among the major causes of childhood malnutrition in developing countries, including Ethiopia. Dietary diversity refers to increasing the consumption of a variety of foods across and within the food groups. Therefore, this study aimed to assess the minimum dietary diversity and minimum meal frequency practices among children aged 6–23 months in Agro pastoral communities, Afar Region, Ethiopia.

Methods: A community-based cross-sectional study was conducted from December 1–30, 2018. A multi-stage stratified sampling followed by a systematic random sampling technique was used to select participants. An interviewer-administered questionnaire was used to collect data. Bivariate and multivariable logistic regression analysis was employed to identify factors associated with minimum dietary diversity and meal frequency. The adjusted odds ratios (AOR) together with their corresponding 95% confidence intervals (CI) were computed to see the association between the outcome and independent variables. The statistical significance was declared at p-value <0.05.

Results: The proportion of children who met the minimum dietary diversity and meal frequency were 21.8% (95% CI: 19.0%-24.7%) and 43.8% (95% CI: 40.4%-47.2%) respectively. Maternal education (AOR = 2.5, 95% CI = 1.1–5.3 and AOR = 3.9, 95% CI = 1.3–11.5), maternal occupation (AOR = 4.2, 95% CI = 2.3–7.8), sex of child (AOR = 2.6, 95% CI = 1.5–4.5) and history of postnatal care visit (AOR = 1.8, 95% CI = 1.1–3.2) were independently associated with minimum dietary diversity. Similarly, age of child (AOR = 2.8, 95% CI = 1.4–5.5 and AOR = 5.3, 95% CI = 2.3–12.4), sex of child (AOR = 2.6, 95% CI = 1.4–4.6) and history of postnatal care visit (AOR = 2.2, 95% CI = 1.3–3.8) were the factors significantly associated with minimum meal frequency practices.

Conclusions: The current study showed that the proportions of children who met the minimum dietary diversity and meal frequency were low. Increasing maternal education, being a housewife, being a male child and attending a postnatal care visit were independently associated with minimum dietary diversity. Likewise, increasing the age of a child, being a male child and attending a postnatal care visit were significantly associated with minimum meal frequency. Improving maternal education and health care utilization, health and nutrition counseling during postnatal care visits are highly recommended to improve infant and young child feeding practices.

Abbreviations ANC: Ante Natal Care, DHS: Demographic and Health Surveys, EDHS: Ethiopian Demographic and Health Surveys, RERC: Research and Ethical Review Committee, IYCF: Infant and Young Child Feeding, MDD: Minimum Dietary Diversity, MMF: Minimum Meal Frequency, PNC: Post Natal Care, WHO: World Health Organization.     

Least Explored Factors Associated with Prenatal Smoking

Poor pregnancy and birth outcomes are major problems in the United States, and maternal smoking during pregnancy has been identified as one of the most preventable risk factors associated with these outcomes. This study examines less explored risk factors of smoking among underserved African American pregnant women. A cross-sectional survey was conducted at an outpatient obstetrics-gynecology clinic of an inner-city university hospital in Virginia from March 2009 through January 2011 in which pregnant women (N = 902) were interviewed at their first prenatal care visit. Survey questions included items related to women’s sociodemographic characteristics as well as their pregnancy history; criminal history; receipt of social services; child protective services involvement; insurance status; and history of substance abuse, domestic violence, and depression. Multiple logistic regression was conducted to calculate odds ratios and 95 % confidence intervals depicting the relationship between these factors and smoking during pregnancy. The analysis reported that maternal age [OR = 1.08, 95 % CI = 1.05–1.12], less than high school education [OR = 4.30, 95 % CI = 2.27–8.14], unemployed [OR = 2.33, 95 % CI = 1.35–4.04], criminal history [OR = 1.66, 95 % CI = 1.05–2.63], receipt of social services [OR = 2.26, 95 % CI = 1.35–3.79] alcohol use [OR = 2.73, 95 % CI = 1.65–4.51] and illicit drug use [OR = 1.97, 95 % CI = 1.04–3.74] during pregnancy were statistically significant risk factors associated with smoking during pregnancy. In addition to the well known risk factors, public health professionals should be aware that criminal history and receipt of social services are important factors associated with smoking during pregnancy. Social service providers such as WIC and prisons and jails may offer a unique opportunity for education and cessation interventions during the preconception or interconception period.     

Does the Good Schools Toolkit Reduce Physical,Sexual and Emotional Violence,and Injuries,in Girls and Boys equally? A Cluster-Randomised Controlled Trial

We aimed to investigate whether the Good School Toolkit reduced emotional violence, severe physical violence, sexual violence and injuries from school staff to students, as well as emotional, physical and sexual violence between peers, in Ugandan primary schools. We performed a two-arm cluster randomised controlled trial with parallel assignment. Forty-two schools in one district were allocated to intervention (n = 21) or wait-list control (n = 21) arms in 2012. We did cross-sectional baseline and endline surveys in 2012 and 2014, and the Good School Toolkit intervention was implemented for 18 months between surveys. Analyses were by intention to treat and are adjusted for clustering within schools and for baseline school-level proportions of outcomes. The Toolkit was associated with an overall reduction in any form of violence from staff and/or peers in the past week towards both male (aOR = 0.34, 95%CI 0.22–0.53) and female students (aOR = 0.55, 95%CI 0.36–0.84). Injuries as a result of violence from school staff were also lower in male (aOR = 0.36, 95%CI 0.20–0.65) and female students (aOR = 0.51, 95%CI 0.29–0.90). Although the Toolkit seems to be effective at reducing violence in both sexes, there is some suggestion that the Toolkit may have stronger effects in boys than girls. The Toolkit is a promising intervention to reduce a wide range of different forms of violence from school staff and between peers in schools, and should be urgently considered for scale-up. Further research is needed to investigate how the intervention could engage more successfully with girls.     

Household Food Insecurity May Predict Underweightand Wasting among Children Aged 24–59 Months

The aim of this study was to examine the association between household food insecurity and nutritional status among children aged 24–59 months in Haromaya District. Children (N = 453) aged 24–59 months were recruited in a community-based cross-sectional survey with a representative sample of households selected by a multistage sampling procedure in Haromaya District. Household Food Insecurity Access Scale and anthropometry were administered. Multinomial logistic regression models were applied to select variables that are candidate for multivariable model. The prevalences of stunting, underweight, and wasting among children aged 24–59 months were 61.1%, 28.1%, and 11.8%, respectively. The mean household food insecurity access scale score was 3.34, and 39.7% of households experienced some degree of food insecurity. By logistic regression analysis and after adjusting for the confounding factors, household food insecurity was significantly predictive of underweight (AOR = 2.48, CI = 1.17–5.24, p = .05) and chronic energy deficiency (AOR = 0.47, CI = 0.23–0.97, p = .04) and marginally significant for wasting (AOR = 0.53, CI = 0.27–1.03, p = .06). It is concluded that household food security improves child growth and nutritional status.     

Health reform under the patient protection and Affordable Care Act: characteristics of exchange-based health insurance enrollees

The Affordable Care Act (ACA) reformed and expanded healthcare coverage with an exchange-based health insurance program. While millions of Americans have benefited from enrollment in ACA marketplace insurance plans, many individuals are likely to be affected by potential future policy changes. Since few studies on the features of marketplace enrollees exist, we adopted a retrospective, cross-sectional study design using 2016 National Health Interview data to identify sociodemographic and health characteristics of enrollees, comparing them to those without insurance. Chi-square tests and logistic regression examined factors associated with enrollees. Adults with multiple chronic diseases (AOR = 1.90, 95% CI = 1.44, 2.50), a history of smoking (AOR = 2.44, 95% CI = 1.82, 3.26), females, married, age 50–64 years, higher educational attainment, and retirees (AOR = 1.86, 95% CI = 1.06, 3.27) were more likely to be enrollees. Since enrollees are largely higher risk individuals with greater healthcare needs, policies that modify the ACA should take these factors into account to reduce potential adverse impacts on enrollees.     

Prevalence and Associated Factors of Intimate Partner Violence Among Pregnant Women Attending Kisumu District Hospital, Kenya

To determine prevalence and factors associated with intimate partner violence (IPV) among pregnant women seeking antenatal care. This was a cross-sectional study conducted at Kisumu District Hospital, Kenya amongst randomly selected pregnant women. A structured questionnaire was used to collect data. Participants self-reported about their own IPV experience (lifetime, 12 months prior to and during index pregnancy) and associated risk factors. Data were analyzed using Epi-info. The mean age of the 300 participants was 23.7 years. One hundred and ten (37 %) of them experienced at least one form of IPV during pregnancy. Psychological violence was the most common (29 %), followed by sexual (12 %), and then physical (10 %). Women who experienced IPV during pregnancy were more likely to have witnessed maternal abuse in childhood (aOR 2.27, 95 % CI = 1.05–4.89), been in a polygamous union (aOR 2.48, 95 % CI = 1.06–5.8), been multiparous (aOR 1.94, 95 % CI = 1.01–3.32) or had a partner who drank alcohol (aOR 2.32, 95 % CI = 1.21–4.45). Having a partner who attained tertiary education was protective against IPV (aOR 0.37, 95 % CI = 0.16–0.83). We found no association between HIV status and IPV. IPV is common among women seeking antenatal care at Kisumu District Hospital. Health care providers should be alerted to the possibility of IPV during pregnancy in women who witnessed maternal abuse in childhood, are multiparous, polygamous, have a partner who drinks alcohol or has low level education. Screening for IPV, support and referral is urgently needed to help reduce the burden experienced by pregnant women and their unborn babies.     

Food Insecurity and Risk of Depression Among Refugees and Immigrants in South Africa

South Africa’s refugee population has grown considerably over the last decade. Both food insecurity and mental illness are common in developing countries, but this relationship remains unexamined in an African refugee population. 335 adult refugees in Durban, South Africa were interviewed using a self-report of food insecurity and the Hopkins Symptom Checklist-25. The proportion of those who responded ‘often true’ to not having enough food and eating less was 23.1 and 54.3 %, respectively. The proportion of individuals with a significant level of anxiety and depressive symptomatology was 49.4 and 54.6 %, respectively. The adjusted logistic regression indicated that not eating enough was significantly associated with anxiety (aOR = 4.52, 95 % CI: 2.09–9.80) and depression (aOR = 4.51, 95 % CI: 2.01–10.09). Similarly, eating less was significantly associated with anxiety (aOR = 2.88, 95 % CI: 1.56–5.31) and depression (aOR = 2.88, 95 % CI: 1.54–5.39). The high prevalence of food insecurity, and its relationship to mental illness, highlight the importance of addressing basic needs among this population.     

Use of Fertility Treatments in Relation to the Duration of Pregnancy Attempt Among Women Who Were Trying to Become Pregnant and Experienced a Live Birth

The purpose of this study was to compare the utilization of medical help for fertility among women who reported up to a year versus more than a year of trying to become pregnant and to describe the characteristics of those women seeking early treatment. Data from the 2004–2008 Pregnancy Risk Assessment Monitoring System (PRAMS) survey were used to assess attempt duration and use of fertility treatments in a sample of 9,517 women who had a recent live birth in Utah. PRAMS respondents who were trying to become pregnant at the time of conception were asked questions about fertility treatments (sampling n = 5,238; representative n = 153,036). Univariate and bivariate analyses were used to describe and compare characteristics of women who sought treatment after attempting pregnancy for a year or less and women who waited at least a year to seek treatment. Among women who were trying to become pregnant, 9.5 % reported using some medical assistance to conceive. Among the women trying to become pregnant, 89.3 % had been trying for ≤12 months and 10.7 % reported having tried >12 months. 5.2 % of those trying to become pregnant for up to a year reported use of fertility treatment, compared with 45.8 % of those trying for a year or more. Women who had previous live births were significantly more likely to use early treatment than nulliparous women (aOR = 2.4, 95 % CI = 1.5, 3.9). The use of fertility drugs and other treatments were more common than ART among recipients of early treatment (aOR = 3.7, 95 % CI = 1.7, 7.9). Some women may be receiving fertility treatment before it is clinically indicated. Instead of invasive treatment, these women may benefit from preconception counseling on folic acid, healthy prepregnancy weight and use of ovulation monitoring to time intercourse.