Cambodian Women Research Articles

Association between place of birth and timely breastfeeding initiation among Cambodian women: a population-based study

BackgroundEnhancing timely breastfeeding initiation within the first hour postpartum is a goal the WHO’s Early Essential Newborn Care (EENC) and Baby-friendly Hospital Initiative (BFHI) aim to achieve globally. However, many health professionals and facilities have yet to adopt these guidelines in Cambodia, impeding timely initiation progress and maternal-infant health goals.MethodsThis secondary data analysis used the 2014 Cambodia Demographic and Health Survey (CDHS) data of 2,729 women who gave birth in the two years preceding the survey to examine the association between place of birth and timely breastfeeding initiation. Descriptive statistics, chi-square test and multivariable logistic regression were performed. Pairwise interaction terms between place of birth and each covariate were included in the regression model to examine the presence of multiplicative effect modification.ResultsThe prevalence of timely breastfeeding initiation was 62.9 percent. Most women gave birth in public health facilities (72.8%) followed by private health facilities (15.9%) and at home (11.2%). The proportions of timely breastfeeding initiation differ by place of birth (p < 0.001). In the multivariable model, there was a significant interaction between place of birth and household wealth index and between place of birth and residence on timely initiation. Among women who reside in poor households, the odds of timely initiation were lower among women who gave birth at home compared to those who gave birth in public health facilities, adjusted odds ratio (95% confidence interval) 0.43 (0.21, 0.88). For urban settings, the odds of timely breastfeeding initiation were lower among women who gave birth in private health facilities compared to those who gave birth in public health facilities 0.52 (0.36, 0.75). For rural settings, the odds of timely breastfeeding initiation were lower among women who gave birth at home compared to those who gave birth in public health facilities 0.55 (0.31, 0.97).ConclusionsWealth index and residence moderated the association between place of birth and timely breastfeeding initiation in Cambodia. To improve breastfeeding outcomes and eliminate practices impeding timely initiation, breastfeeding advocacy programs need greater integration and follow-up in Cambodia’s health systems, including among home birth attendants and private health facilities.

Cambodia’s gender policy: An analysis of women and girls’ education strategies under the Neary Rattanak IV Strategic Plan (2014-2018)

In 1999, Cambodia’s Ministry of Women’s Affairs established the first Neary Rattanak Strategic Plan to build Cambodian women’s capacity by offering them more opportunities and access to education. From early 1998 to 2017, Cambodia showed good progress in increasing girls’ school enrolment. Later in 2018, the final year of Neary Rattanak IV’s implementation, the percentage of girls’ enrolment in Cambodia’s primary schools declined. This study analyzes the implementation of education strategies in Neary Rattanak IV by using the seven steps of Mintrom’s (2012) policy implementation analysis to examine whether the strategies have been well implemented. From the analysis, it seems that the education strategies have indeed been successful in their implementation and have reached their targets. However, the study has discovered some potential obstacles and shortcomings that the government may have to act upon through its education and gender policy. Those shortcomings and difficulties, including traditional norms, discrimination against women in employment, and safety issues, have impacted the implementation of the education of women and girls in the Neary Rattanak IV Strategic Plan.

Effects of Trauma and Postmigration Stress on Refugee Women's Health: A Life Course Perspective.

Trauma exposure and postmigration stress are associated with adverse health outcomes among refugees, yet the relative effect of these factors for subgroups of refugees and those resettled long-term remains unclear. Drawing on life course theory, this study evaluated the associations between war trauma, postmigration stress, and health among Southeast Asian refugee women in the United States, and whether these patterns differ across the life span. A community sample of Vietnamese and Cambodian refugee women aged 30-72 years (N = 293) reported mental and physical health outcomes, conflict-based trauma exposure, and postmigration measures of discrimination and community violence. Both trauma exposure and discrimination were associated with mental and physical health problems, with the relative effect of each stressor varying across specific health outcomes; community violence was associated with poorer mental health. Age moderated the effect of trauma exposure across health outcomes, with stronger associations between trauma and health for older women in particular. Findings provide support for the influence of trauma exposure and the importance of postmigration stressors on health across the life span for refugees. Attending to age group differences in the effects of these stressors, and to subgroups such as women, has implications for interventions addressing the long-term health of refugee populations.

Credit, land and survival work in rural Cambodia: Rethinking rural autonomy through a feminist lens

AbstractThis article explores the trajectory of three rural, precarious Cambodian women as they deploy land as a means of undertaking survival work in Cambodia. Using a gendered lens vis‐à‐vis the concept of autonomy, this article rethinks distress sales of land and collateralized land for microfinance borrowing as forms of everyday autonomy. By highlighting women's central role in undertaking social reproductive labour to reproduce the rural household, these acts of distress land sale and debt‐taking are understood as forms of ‘survival work’, acts that ensure the day‐to‐day survival of the household and form the basis for broader projects of autonomy. Although we remain ambivalent about the long‐term prospects for resistance through credit‐taking in particular, we ultimately highlight the need for greater attention to variegated oppositional agency in the path to autonomy to understand the gendered labour of everyday survival in rural life.

Abstract #1184071: Knowledge and awareness of osteoporosis among young Cambodian women at Calmette hospital

To evaluate the level of knowledge and awareness about osteoporosis among young Cambodian women We conveniently selected 144 women (hospitalized patients or accompanied persons) based on the selecting criteria. They were interviewed face to face, using a structured questionnaire. The average age of the participants was 28.43 (±4.42) years. Self-employed represented a large proportion among the participants. The study showed that only one fourth of participants went to a superior education. Most of the participants stated that they have known about osteoporosis while friends or family was the most common source of information. Only 16.67% have known osteoporotic patients. Most of them have a moderately bone-friendly lifestyle. Their calcium source depended largely on green vegetable. The average mean score of knowledge was 9.34 (±3.08) (range from 0 to 20). However, a half of them worried about suffering of osteoporosis in their later years of life. Around two thirds of the participants wanted to undergo an osteoporosis screening test. A majority was interested in osteoporosis prevention. Social media and community outreach were recommended as sensitizing measures. The osteoporosis knowledge was only correlated significantly (P- value: 0.007) with educational level. Despite of low level of knowledge about osteoporosis, young Cambodian women was interested in osteoporosis screening and preventive measures. Educational interventions, such as public awareness programs regarding a bone-friendly lifestyle and osteoporosis screening, are crucial in sensitizing the general population about osteoporosis and complications.

The best-worse scaling approach: prioritizing burdensome menopause symptoms among Cambodian women

ABSTRACT The objective of this study was to prioritize the most burdensome menopause symptoms among Cambodian women utilizing the best-worst scale (BWS). In total, 180 women aged 40–60 who lived in a community setting were recruited from four regions of Cambodia via convenience sampling. Using the BWS, 12 choice sets were prepared by combining 11 symptoms from the menopause rating scale (MRS), and the BWS choice sets were generated with the orthogonal main effects design (OMED). Counting approach determined the women’s health priorities and calculated the best-minus-worst (BW) score. The modeling approach measured each respondent’s basic utility function. Of the 180 participants, 41.1% were between the ages of 40 and 49, and 25.0% were over 50. The counting and modeling approaches revealed that heart discomfort was the most burdensome symptom (coefficient 0.739, p < .001) followed by joint and muscular discomfort (coefficient 0.606, p < .001) and sleep problems (coefficient 0.507, p < .001), whereas vaginal dryness was the least burdensome symptoms (coefficient −0.164, p = .018). This study revealed that the most burdensome menopause symptom among Cambodian women was heart discomfort while vaginal dryness was the least burdensome. The BWS enabled to prioritize the burdensome menopausal symptoms which warrants future studies using the BWS.

Gendered repertoires of contention: women’s resistance, authoritarian state formation, and land grabbing in Cambodia

ABSTRACT This article was named the winner of the 2020 Enloe Award. The committee commented:This article embodies the spirit of the Enloe Award in providing a feminist understanding of the everyday experiences and strategies of poor women’s social movements against the authoritarian regime in Cambodia. It traces the co-constitution of gendered formations of the state and women’s collective action through an account of four distinct types of “gendered repertoires of contention” used by the women to protest Cambodia’s land grab. The critical-reflexive understanding of social movements offered here illuminates strategies of feminist resistance to authoritarian state power in Cambodia and beyond. The article stood out for its clarity and evidence-based narrative, and we are delighted that it has won the award. As strongmen and autocrats become increasingly visible in global politics, what gendered resistances arise and how do these contend with repressive regimes? Since 2017, following a severe purge of his critics, Cambodia’s longstanding Prime Minister Hun Sen has put the country under a near total form of authoritarian rule. His regime has been bolstered by a distinct mode of accumulation involving large-scale land transfers to foreign and domestic allies, which have systematically evicted and dispossessed a large number of the country’s smallholder farmers and the urban poor of their homes and agricultural lands. Amid this surge of “land grabbing,” Cambodian women from across the country have led and sustained public protests to reclaim their lands. In this article, I study the routines and performances of poor women’s collective action against the state and outline four distinct types of “repertoires of contention” used by women in their protests: strategic positioning, anti-politics, self-sacrifice, and solidarity. I argue that these repertoires are embedded in and enact the authoritarian state that they contest and advance the notion of the “gendered authoritarian state” that is made visible in contentious interactions between the state and its dispossessed citizens.

Writing on Domesticity, Thinking about Politics: Women Organising during Decolonisation in Cambodia, 1948–52

AbstractBy examining the intellectual renderings of previously marginalised voices in mid‐twentieth‐century Cambodian history, this article reconstructs notions of who is a political agent and what constitutes the ‘political’ in tumultuous moments of decolonisation. In 1948, Cambodian women founded the Samāgam Khmaer Sahajīvinī (SKS), or Association of Khmer Female Comrades/Companions, and produced the first Khmer‐language magazine for women, Dassanāvaṭti Nārī (Women's Magazine). The organisation was structured around four committees representing interests in clothing, food, good manners and publishing, and organisers engaged in issues related to visions of governance, ethnic difference and modernisation. These gendered organising efforts occurred alongside political in‐fighting among male politicians in the turbulent years prior to gaining independence from the French Union in 1953. Due to their lack of electoral rights prior to 1955, women were excluded from political institutions. Yet, when the organising women founded the SKS and committed to producing a magazine from 1949 to 1952, they asserted women as political agents with important perspectives on Cambodian politics and society. Centring the efforts and writings of the SKS provides new insights into how decolonisation was not just a male‐dominated and top‐down movement but rather a multitude of organising and intellectual contributions.

‘Re-existence’ of women Cambodian religious leaders: decolonial possibilities using insights from feminist relational theory and postsecular feminism

ABSTRACT Feminist relational theory can provide a theoretical framework for understanding and affirming the agency of women Cambodian religious leaders; an agency that can be overlooked if one assumes it comes from an individual whose core essence can be found apart from her relationships. In this paper, I draw on ethnographic fieldwork to spotlight the lives and values of two Cambodian women. These women are recognized as acting subjects in their communities due to their multiple relationships on interpersonal, institutional, and structural levels. Through analysis of participant observations and interviews with these women, I show the power of employing feminist relational theory’s explanation of the agential subject while affirming the possibility of non-oppositional agency. The move to the latter is characteristic of postsecular feminist scholarship, which decouples resistance from agency. Using these two theoretical lenses to analyze Cambodian women’s experience reveals how these women are flourishing apart from hegemonic structures and logics. This flourishing has been named ‘re-existence’ in decolonial thought, and it might also be thought of as a postsecular analogue to a secular resistance.

Gender Differences in Access to Health Care among the Elderly: Evidence from Southeast Asia

Populations become increasingly feminized with age. Since older women are more vulnerable to poverty, they may find it more difficult than men to access health care. This study examines factors that may constrain older persons in Southeast Asia from meeting their health-care needs when sick. Our analysis of household survey data from Cambodia, the Philippines, and Viet Nam shows that women are more likely to have reported sickness or injury than men, a difference that is meaningful and statistically significant. While women in Cambodia and the Philippines are more likely to seek treatment than men, the gender difference is reversed in Viet Nam where the stigma and discrimination associated with some diseases may more strongly deter women. The probability of seeking treatment rises with age more sharply for women than men in all countries. However, for the subsample of elders, the gender difference is not significant.

Association between type of cooking fuel and body mass index among women in Cambodia

Introduction: Solid cooking fuel is the primary source of energy for almost half of the world’s population. Studies have examined the association between solid cooking fuel and respiratory and cardiovascular disease, negative pregnancy outcomes, and shortened life expectancy. However, no study has examined the association between solid cooking fuel and Body Mass Index (BMI) among women in Cambodia. Methods: Data was taken from the 2014 Cambodia Demographic and Health Survey (N=3249), women aged 15-49 years. Multivariable logistic regression analysis was used to determine the association between type of cooking fuel and BMI, controlling for age, education, marital status, parity, employment status, kitchen being a separate room, location of cooking food, and household wealth index. Results: Compared to younger women, older women were more likely to be overweight/obese shown by multivariable adjusted odds ratio (95% confidence interval) for women aged 25-34 years 2.64 (1.80, 3.86), and for women aged 35-49 years 4.97 (3.20, 7.72). Compared to women who reside in poor households, the odds of being overweight/obese were higher for women residing in a middle household wealth index 2.62 (1.52, 4.52), and women residing in rich household wealth index 2.78 (1.83, 4.24). When adjusting for potential confounding variables, the association between type of cooking fuel and BMI observed in the unadjusted model disappeared (p = 0.103). Conclusion: These findings indicate that type of cooking fuel is not significantly associated with BMI in a nationally representative sample of women in Cambodia.

Attitudes toward Menopause in HIV-Infected Cambodian Women.

(1) Background: Attitudes toward menopause are believed to play a potential role in the experience of menopause, including its perceived severity. However, the studies available on the perspectives of women living with human immunodeficiency virus (HIV) on menopause in Cambodia are very limited. This study aimed to evaluate the attitudes toward menopause of Cambodian women living with HIV. (2) Methods: A cross-sectional study was conducted among 189 women using a questionnaire titled Attitude toward Menopause Scale and socio-demographics. (3) Results: The study analysis showed that the participants had slightly negative attitudes toward menopause with the mean attitude score of 86.81 ± 10.79 (Range 35–140). Postmenopausal women displayed more positive attitudes than premenopausal women. Older age, higher education, and a non-drinking habit were independently associated with a positive attitude toward menopause. (4) Conclusions: The results suggest the need for a multidisciplinary team of health care experts that would address the special needs of this population marked by the menopausal transition.

Comparing Three Approaches to Salt Intake Assessment Among Lactating Women in Rural Cambodia

ObjectivesMonitoring population salt intake is a critical component of implementing salt fortification programs. In Cambodia, salt is being considered as a vehicle for thiamine fortification to prevent infantile beriberi among breastfed infants. However, salt intake among lactating mothers is not known. The gold standard for assessing sodium intake is repeat 24-hr urinary sodium concentrations. This method has logistical barriers, especially in low-resource settings, and other methods have not been trialed in this population. Here we compare three methods of assessing salt intake in lactating Cambodian women: repeat 24-hr urinary sodium concentrations (USC), repeat 12-hr observed weighed intake records (OWIR), and household salt disappearance (HSD). MethodsData from trial: NCT03616288. Salt intake was assessed using the three methods in a subsample of lactating women (n = 104) between 8 and 22 weeks postpartum. Women were asked to collect two 24-hour urine samples within 7 days. Repeat 12-hr OWIR were collected from women. Household salt disappearance was recorded fortnightly, and was divided by the number of household members to estimate individual intakes. Descriptive household salt use was also recorded. Differences in estimated salt intake from each method were compared using a Kruskal-Wallis test. ResultsMean (95%CI) estimated salt intakes from repeat 24-hr USC, repeat 12-hr OWIR, and HSD were: 9.0 (8.3, 9.8) g/day, 9.1 (7.9, 10.3) g/day, and 10.9 (9.8, 11.9) g/day, respectively. Estimated intakes from HSD were significantly higher than both 24-hr USC (p = 0.009) and 12-hr OWIR (p = 0.002). Estimated intakes from 24-hr USC and 12-hr OWIR were not statistically different (p = 0.6). Salt was being used for purposes other than consumption, such as cleaning fish and vegetables, in 26% of fortnightly visits. ConclusionsRepeat 24-hr USC and 12-hr OWIR are both acceptable and logistically feasible methods of salt intake assessment among lactating women in rural Cambodia. While HSD is a less resource-intensive approach, this method over-estimated salt intake. Salt being used for purposes other than consumption may contribute to over-estimation using this method. Funding SourcesBill & Melinda Gates Foundation, New York Academy of Sciences, Canadian Institutes of Health Research, Research Nova Scotia.

Daily Oral Supplementation with 60 mg of Elemental Iron for 12 Weeks Alters Blood Mitochondrial DNA Content, but Not Leukocyte Telomere Length in Cambodian Women.

There is limited evidence regarding the potential risk of untargeted iron supplementation, especially among individuals who are iron-replete or have genetic hemoglobinopathies. Excess iron exposure can increase the production of reactive oxygen species, which can lead to cellular damage. We evaluated the effect of daily oral supplementation on relative leukocyte telomere length (rLTL) and blood mitochondrial DNA (mtDNA) content in non-pregnant Cambodian women (18–45 years) who received 60 mg of elemental iron as ferrous sulfate (n = 190) or a placebo (n = 186) for 12 weeks. Buffy coat rLTL and mtDNA content were quantified by monochrome multiplex quantitative polymerase chain reaction. Generalized linear mixed-effects models were used to predict the absolute and percent change in rLTL and mtDNA content after 12 weeks. Iron supplementation was not associated with an absolute or percent change in rLTL after 12 weeks compared with placebo (ß-coefficient: −0.04 [95% CI: −0.16, 0.08]; p = 0.50 and ß-coefficient: −0.96 [95% CI: −2.69, 0.77]; p = 0.28, respectively). However, iron supplementation was associated with a smaller absolute and percent increase in mtDNA content after 12 weeks compared with placebo (ß-coefficient: −11 [95% CI: −20, −2]; p = 0.02 and ß-coefficient: −11 [95% CI: −20, −1]; p= 0.02, respectively). Thus, daily oral iron supplementation for 12 weeks was associated with altered mitochondrial homeostasis in our study sample. More research is needed to understand the risk of iron exposure and the biological consequences of altered mitochondrial homeostasis in order to inform the safety of the current global supplementation policy.

Baseline Hemoglobin, Hepcidin, Ferritin, and Total Body Iron Stores are Equally Strong Diagnostic Predictors of a Hemoglobin Response to 12 Weeks of Daily Iron Supplementation in Cambodian Women.

The WHO recommends daily iron supplementation for all women in areas where the population-level anemia prevalence is≥40%, despite the fact that hemoglobin (Hb) concentration is generally considered to be a poor prognostic indicator of iron status. In this secondary analysis, we investigated the predictive power of ten baseline hematological biomarkers towards a 12-week Hb response to iron supplementation. Data were obtained from a randomized controlled trial of daily iron supplementation in 407 nonpregnant Cambodian women (18-45 years) who received 60mg elemental iron as ferrous sulfate for 12 weeks. Ten baseline biomarkers were included: Hb, measured with both a hematology analyzer and a HemoCue; inflammation-adjusted ferritin; soluble transferrin receptor; reticulocyte Hb; hepcidin; mean corpuscular volume; inflammation-adjusted total body iron stores (TBIS); total iron binding capacity; and transferrin saturation. Receiver operating characteristic (ROC) curves from fitted logistic regression models were used to make discrimination comparisons and variable selection methods were used to construct a multibiomarker prognostic model. Only 25% (n=95/383) of women who completed the trial experienced a 12-week Hb response ≥10g/L. The strongest univariate predictors of a Hb response were Hb as measured with a hematology analyzer, inflammation-adjusted ferritin, hepcidin, and inflammation-adjusted TBIS (AUCROC=0.81, 0.83, 0.82, and 0.82, respectively), and the optimal cutoffs to identify women who were likely to experience a Hb response were 117g/L, 17.3μg/L, 1.98nmol/L, and 1.95mg/kg, respectively. Hb as measured with a hematology analyzer, inflammation-adjusted ferritin, and hepcidin had the best combined predictive ability (AUCROC=0.86). Hb measured with the HemoCue had poor discrimination ability (AUCROC=0.65). Baseline Hb as measured with a hematology analyzer was as strong a predictor of Hb response to iron supplementation as inflammation-adjusted ferritin, hepcidin, and inflammation-adjusted TBIS. This is positive given that the WHO currently uses the population-level anemia prevalence to guide recommendations for untargeted iron supplementation.

Determinants of Modern Contraceptive Utilization among Women of Reproductive Age in Cambodia

Background: Contraceptive uptake remains a public health concern in Cambodia. Therefore, the aim ofthis study was to determine the modern contraceptive use pattern and itsassociated factors among women ofreproductive age in Cambodia.Method: A cross-sectional study used the data from the Cambodia Demographic and Health Survey. Thissurvey adopted a two-stage stratified random sampling process to select respondents to respond a structuredquestionnaire interview. The multiple logistic regression was applied to determine the association.Results: Of the total 7,606 women, 51.04% used modern contraceptives.Themultivariable analysis indicatedthe use of modern contraceptives was strongly associated with fertility preferences, ideal number of children,number of living children, husband’s desire for children,age at first marriage, number of induced abortions,and marriage to a first birth interval. Health service factors including sources of family planning information,visited health facilities, inaccessibility to health service as well as sociodemographic factors such as women’sage, occupation, and geographical regions also significantly associated with modern contraceptive use.Conclusions: About half of women in Cambodia used modern contraceptives. Reproductive, health serviceand sociodemographic factorswere essential for modern contraceptive utilization.

Barriers and enablers of contraceptive use among adolescent girls and women under 30 years of age in Cambodia: a qualitative study

Objective Unintended pregnancy and an unmet need for modern contraception remain high among adolescent girls and women in Cambodia. Qualitative descriptive research was conducted to explore the barriers to contraceptive use among young women in urban Cambodia. Methods Semi-structured interviews were conducted among 30 adolescent girls and women aged 16–27 years, using purposive and snowball sampling strategies until data saturation was achieved. The audio-recorded interviews were transcribed verbatim and quality-checked. Inductive thematic data analysis was conducted. The results are presented using Bronfenbrenner’s theoretical social ecological model. Results The emerging major and minor themes indicate misconceptions about hormonal contraception as well as women’s preference for using oral contraceptive pills for family planning after an unintended pregnancy. Women had low autonomy in choosing a contraceptive method, as their partners or husbands tended to prefer the withdrawal method. Young women faced cultural and supply chain barriers in accessing short- and long-acting reversible modern contraceptive methods at health centres. Conclusion Cambodian women aged 16–27 years are a vulnerable group who have low autonomy and sexual and reproductive health literacy and also face gender inequality.

Gender Differences in Access to Health Care Among the Elderly: Evidence from Southeast Asia

Populations become increasingly feminized with age. Since older women are more vulnerable to poverty, they may find it more difficult than men to access health care. This study examines factors that may constrain older persons in Southeast Asia from meeting their health-care needs when sick. Our analysis of household survey data from Cambodia, the Philippines, and Viet Nam shows that women are more likely to have reported sickness or injury than men, a difference that is meaningful and statistically significant. While women in Cambodia and the Philippines are more likely to seek treatment than men, the gender difference is reversed in Viet Nam where stigma and discrimination associated with some diseases may more strongly deter women. The probability of seeking treatment rises with age more sharply for women than men in all countries. However, for the subsample of elders, the gender difference is not significant.

Can Automated Hematology Analyzers Predict the Presence of a Genetic Hemoglobinopathy? An Analysis of Hematological Biomarkers in Cambodian Women.

Genetic hemoglobinopathies are the most common single-gene disorder worldwide. Some automated hematology analyzers have the capability of flagging individuals who may have hematological disorders based on complete blood count (CBC) biomarkers. We aimed to evaluate the accuracy of a hematology analyzer in identifying genetic hemoglobinopathies in Cambodian women and to determine which hematological biomarkers are the best predictors. A CBC was completed using a Sysmex XN-1000 analyzer and hemoglobinopathies were determined with capillary hemoglobin electrophoresis for 808 nonpregnant Cambodian women. Sysmex XN-1000 Interpretive Program (IP) messages, which flag potential hematological disorders, were produced from CBC results. Then, 2 × 2 tables were used to determine sensitivity and specificity of the IP message “Hemoglobin defect” to detect a genetic hemoglobinopathy. Receiver operating characteristic (ROC) analyses assessed the diagnostic ability of six CBC biomarkers to predict a genetic hemoglobinopathy. In total, 74% of women had a hemoglobinopathy (predominantly Hb E and α-thalassemia). “Hb defect” IP message sensitivity and specificity for genetic hemoglobinopathy detection were 10.4% and 98.6%, respectively. Variable selection strategies yielded a two-variable model including mean corpuscular volume (MCV) and red blood cell (RBC) count (AIC = 99.83, AUCROC = 0.98 (95% CI: 0.97, 0.99)) for the prediction of a homozygous EE disorder. Sensitivity and specificity values do not justify the use of Sysmex XN-1000 IP flag messages for identification of genetic hemoglobinopathies in Cambodian women. Development of an algorithm based on MCV and RBC biomarkers may optimize the screening ability of automated hematology analyzers.

Multilevel analysis of the role of women\u2019s empowerment on use of contraceptive methods among married Cambodian women: evidence from demographic health surveys between 2005 and 2014

BackgroundThe use of contraceptives is an essential public health concept that improves overall safe motherhood and infant health. Women empowerment has been reported to influence health behaviors in women. With recent efforts to increase access to contraceptive methods, uptake of the same remains a challenge in Cambodia. There are limited studies that have examined the role of women’s empowerment at both individual- and community- level on contraceptive use in Cambodia. This study examined the individual- and community-level factors associated with contraceptive use among Cambodian married women between 2005 and 2014.MethodsData from 2005, 2010, and 2014 Cambodia Demographic and Health Surveys were used to analyze 2211; 10,505; and 10,849 women, respectively. Multilevel binary and multinomial logistic regression models were applied to assess the association between individual- and community- level factors, and the use of contraceptive methods.ResultsThe prevalence of using modern contraceptive methods increased over time (i.e., 29.0, 38.1, and 42.3% in 2005, 2010, and 2014, respectively). At the individual level, women who attained secondary and higher education were more likely to use any contraceptives [adjusted odds ratio (aOR) = 1.43, 95% confidence interval (CI) = 1.22–1.68, and aOR = 1.23, 95% CI = 1.05–1.44 in 2010 and 2014, respectively] compared with those with no formal education. Similarly, having a high workforce participation level was significantly associated with increased likelihood of using any contraceptive methods [aOR = 1.12, 95% CI = 1.00–1.26, aOR = 1.44, 95% CI = 1.29–1.60 and in 2010 and 2014, respectively]. Other factors such as age at first marriage, residence, and having a health insurance were associated with contraceptive use. The proportional change in variance showed that about 14.3% of total variations in the odds of contraceptive use across the communities were explained by both individual- and community-level factors. Moreover, the intraclass correlation showed that about 5.2% of the total variation remained unexplained even after adjustments.ConclusionBoth individual- and community- level factors influenced contraceptive use in Cambodia. When designing programs to improve contraceptive use, contextual influences should be taken into account for the effectiveness of the programs.