Women In Low-income Countries Research Articles

Bibliometric Analysis on of the Impact of Screening to Minimize Maternal Mental Health on Neonatal Outcomes: A Systematic Review

(1) Background: Prenatal depression, maternal anxiety, puerperal psychosis, and suicidal thoughts affect child welfare and development and maternal health and mortality. Women in low-income countries suffer maternal mental health issues in 25% of cases during pregnancy and 20% of cases thereafter. However, MMH screening, diagnosis, and reporting are lacking. The primary goals of the present study are twofold, as follows: firstly, to evaluate the importance of screening maternal mental health to alleviate perinatal depression and maternal anxiety, and, secondly, to analyze research patterns and propose novel approaches and procedures to bridge the current research gap and aid practitioners in enhancing the quality of care offered to women exhibiting symptoms of perinatal depression. (2) Methods: We conducted a bibliometric analysis to analyze the research topic, using the bibliometric tools Biblioshiny and VOSviewer, as well as the R statistical programming language. To accomplish our goal, we obtained a total of 243 documents from the Scopus and PubMed databases and conducted an analysis utilizing network, co-occurrence, and multiple correlation approaches. (3) Results: Most of the publications in the field were published between the years 2021 and 2024. The results of this study highlight the significance of shifting from conventional screening methods to digital ones for healthcare professionals to effectively manage the symptoms of maternal mental health associated with postpartum depression. Furthermore, the results of the present study suggest that digital screening can prevent maternal physical morbidity, contribute to psychosocial functioning, and enhance infant physical and cognitive health. (4) Conclusions: The research indicates that it is crucial to adopt and include a computerized screening practice to efficiently and immediately detect and clarify the signs of prenatal to neonatal depression. The introduction of digital screening has led to a decrease in scoring errors, an improvement in screening effectiveness, a decrease in administration times, the creation of clinical and patient reports, and the initiation of referrals for anxiety and depression therapy.

Sandwich enzyme-linked aptamer-based assay for the detection of Trichomonas vaginalis

Trichomoniasis is the most prevalent curable, non-viral sexually transmitted infection (STI), with an estimated 156 million new infections in 2020. It can potentially result in adverse birth outcomes as well as infertility in men, whilst it also increases the risk of acquiring HIV and contracting other vaginal infections. It is mostly prevalent among women in low-income countries and especially in Africa and the Americas. This STI is caused by Trichomonas vaginalis (TV) and a robust, cost-effective, sensitive, specific and rapid diagnostic test is urgently required. We report the screening of 6 full-length and 4 truncated aptamers previously selected in our group for use in a microplate-based sandwich assay. The combination of dual aptamers comprising a short 14-mer truncated capture aptamer (termed A1_14mer) and a full-length non-truncated reporter aptamer (A6) was elucidated to be the optimum pair for a sensitive sandwich enzyme-linked aptamer assay (ELAA) for the detection of TV achieving a detection limit of 3.02 × 104 TV cells/mL. The results obtained with the A1_14mer-A6 ELAA correlate excellently with wet-mount microscopy for the detection of TV in clinical specimens, cervicovaginal lavages and vaginal swabs, highlighting the potential clinical application of this assay for cost-effective population screening and subsequent prevention of the onset of complications associated with undiagnosed and untreated TV.

Safety and effectiveness of a recombinant hepatitis E vaccine in women of childbearing age in rural Bangladesh: a phase 4, double-blind, cluster-randomised, controlled trial

Hepatitis E virus (HEV) leads to high mortality in pregnant women in low-income countries. We aimed to evaluate the safety of a HEV vaccine and its effectiveness in preventing hepatitis E during pregnancy. In this phase 4, double-blind, cluster-randomised trial, 67 villages in Matlab, Bangladesh, were randomised 1:1 to receive HEV239 (a recombinant HEV vaccine) or a control vaccine (Hepa-B, a hepatitis B vaccine), using block randomisation with random number tables and blocks of size eight, stratified by cluster population size. Eligible non-pregnant women (aged 16-39 years) were vaccinated intramuscularly on day 0, at 1 month, and at 6 months, and followed up for 2 years after the last immunisation. The primary endpoint was hepatitis E in the pregnant, per-protocol population (those who received all three doses within 2 days of the scheduled dates), while safety was a secondary endpoint, assessed in the intention-to-treat (ITT) population (participants who received at least one dose). Solicited adverse events were recorded for the first 7 days after each dose, and unsolicited events until 2 years after a participant's final dose. Pregnancy-related safety outcomes were assessed in the pregnant ITT population. This study is registered with ClinicalTrials.gov (NCT02759991). Between Oct 2, 2017, and Feb 28, 2019, 19 460 participants were enrolled and received either HEV239 (9478 [48·7%] participants, 33 clusters) or Hepa-B (9982 [51·3%] participants, 34 clusters), of whom 17 937 (92·2%) participants received three doses and 17 613 (90·5%) were vaccinated according to protocol (8524 [48·4%] in the HEV239 group and 9089 [51·6%] in the control group). No pregnant participants were confirmed to have hepatitis E in either treatment group. HEV239 showed a mild safety profile, similar to Hepa-B, with no difference in the proportion of solicited adverse events between groups and no severe solicited events. Pain was the most common local symptom (1215 [12·8%] HEV239 recipients and 1218 [12·2%] Hepa-B recipients) and fever the most common systemic symptom (141 [1·5%] HEV239 recipients and 145 [1·5%] Hepa-B recipients). None of the serious adverse events or deaths were vaccine related. Among pregnant participants, the HEV239 group had a higher risk of miscarriage (136 [5·7%] of 2407 pregnant participants) compared with the control group (102 [3·9%] of 2604; adjusted odds ratio 1·54 [95% CI 1·15-2·08]). The effectiveness of HEV239 in pregnant women remains uncertain. HEV239 was safe and well tolerated in non-pregnant women, but findings regarding miscarriage warrant further investigation. Research Council of Norway; Innovax.

Inequality gaps in modern contraceptive use and associated factors among women of reproductive age in Nigeria between 2003 and 2018

BackgroundInequalities in modern contraceptive use among women in low-income countries remain a major public health challenge. Eliminating or reducing the inequalities in modern contraceptive use among women could accelerate the achievement of Sustainable Development Goals, Targets 3.7 & 5.6. Thus, this study examined the inequality gaps in modern contraceptive use and associated factors among women of reproductive age in Nigeria between 2003 and 2018.MethodsThis study employed the World Health Organisation’s Health Equity Assessment Toolkit to analyse the 2003 and 2018 Nigeria Demographic Health Surveys. Modern contraceptive use was aggregated using five equity stratifiers: age, economic status, educational level, place, and region of residence among women of reproductive aged 15 to 49, with a sample size of 5,336 and 29,090 for 2003 and 2018, respectively. Inequality was measured in this study using difference (D), ratio (R), population-attributable risk (PAR), and a population-attributable fraction (PAF).ResultsThe study shows an increase in modern contraceptive use among women of reproductive age in Nigeria from 8.25% in 2003 to 12.01% in 2018, with the use being more prominent among women of reproductive age 20–49 and those in the richest economic quintile. In both surveys, women with primary education showed the most upward increase in modern contraceptive use. Women residing in the urban areas also show an upward use of modern contraceptives use. The study further highlights inequality gaps, with age being a substantial factor, while economic status and sub-national regions showed mild to marginal inequality gaps. Finally, the educational level of women of reproductive age in Nigeria significantly shows inequality in modern contraceptive use, with a PAF of 129.11 in 2003 and 65.39 in 2018.ConclusionThe inequality gap in modern contraceptive use among women of reproductive age in Nigeria between 2003 and 2018 reported in this study includes age, education, wealth quintile, residence, and region-related inequalities. The study highlights the need for policies and programmes that target the groups with low use of modern contraceptives to promote equity in family planning services.

Does COVID-19 Influence the Urban Household’s Food Security in Horo Guduru Wollega Zone, Ethiopia?

Household food insecurity is an important variable for understanding the nutritional status of children and women in low-income countries. This study was therefore initiated to determine household food insecurity status and to analyse the impact of COVID-19 on household food security in a selected number of households in the Horo Guduru Wollega Region of Ethiopia. Multistage sampling methods were used in this study. First, 4 were randomly selected from 12 found in the Horo Guduru Wollega area. The population/size ratio is then used to select households in each city. Finally, the eligible households for the study were randomly selected. Accordingly, 360 sample data were collected from 5,710 poor households in four urbans in the Horo Guduru Wollega zone. Both qualitative (in-depth interview) and quantitative data (structured questionnaires) were included in this study. The data collected were analysed using the propensity score matching model. The result of the concordant estimation of the propensity score showed supportive indications for improving the food security standard of living. All consistent test methods used for analysis showed that there was a statistically significant difference in the assessment of dietary diversity between safe and unsafe foods. This study concludes that the COVID-19 pandemic is affecting household food security in the study area. Therefore, all concerned bodies are responsible to overcome the problem of food insecurity that occurred due to the COVID-19 in the region and nationally. The data analysed to know impact COVID-19 on food security in the study area. The propensity score matching estimation result has shown supportive evidence about the improvements of the living standard of food security. All of the matching test methods employed for the analysis showed that there was statistically significant dietary diversity scores difference between food secure and insecure. In general, this study revealed that COVID-19 pandemic affects household food insecurity status in study area.

Cytomorphological Changes in Patients Undergoing Taxanes Formation in Breast Cancer at Oncology and Cancer Research Center in Shendi Town, Sudan

Background: Breast cancer is the most commonly diagnosed cancer in women worldwide and the most frequent cause of cancer death in women in low-income countries. Cytotoxic chemotherapy drugs called taxanes alter the cellular mechanisms that allow cancer cells to divide their microtubules. In a typical cell cycle, microtubules are formed by the cell at the start of division and disassembled after the cell stops dividing. Taxanes stabilize the microtubules, preventing them from breaking down normally. This causes the cancer cells to stop dividing, potentially slowing the growth of cancer or killing the cells. Taxane causes neutropenia and thrombocytopenia, as well as fatigue, nausea and vomiting, hair loss, diarrhea, mouth ulcers, and muscle pain. According to the literature, chemotherapy causes nuclear atypia and other cellular changes in buccal mucosa cells. There was no published data regarding the effect of taxane on buccal mucosa cells. This study aimed to detect cytomorphological changes among breast cancer patients receiving taxane chemotherapy. Materials and methods: This is a comparative cross-sectional study conducted during the period from December 2022 to February 2024, involved 50 buccal smears from breast cancer patients included as a case group versus 50 buccal smears from apparently healthy females. All smears were processed through conventional cytological methods. Results: Forty percent of patients have had a family history of breast cancer. We observed that in 80% of patients with advanced age (46 years old and older), our results indicated that there was a significant statistical difference between cases and controls regarding cellular changes in buccal mucosa. We also observed an increase in the significant correlation of cellular changes and the number of taxane doses, as the p value was less than 0.05. Conclusion: We concluded that taxane chemotherapy may cause buccal cellular changes as the incidence of nuclear atypia, infection, and degenerative changes is higher in cases than in controls.

Aerobic vaginitis, bacterial vaginosis, and vaginal candidiasis among women of reproductive age in Arba Minch, southern Ethiopia

Reproductive tract infections (RTIs) are a persistent public health threat worldwide, particularly among women in low-income countries of Africa, including Ethiopia, where drug resistance is also a growing problem. It is crucial to address this problem to ensure women's health and well-being. A cross-sectional study was carried out among a cohort of 398 women of reproductive age who sought medical attention at the Gynecology Department of the Arba Minch General Hospital, southern Ethiopia, from January to June 2020. They were chosen through systematic random sampling, and a pre-tested structured questionnaire was used to collect the data. The collection of vaginal and/or cervical swabs were done to diagnose bacterial vaginosis (BV) and aerobic vaginitis (AV) using Nugent and AV score analyses, respectively. The swabs were subjected to standard microbiological culture techniques to detect the isolates causing AV and vaginal candidiasis (VC). The susceptibility profiles of the causative agents of AV were checked by the Kirby-Bauer disc diffusion technique. Descriptive and inferential statistical analyses were also done. Aerobic vaginitis was the predominantly diagnosed RTI (n = 122, 30.7%), followed by BV (n = 117, 29.4%) and VC (n = 111, 27.9%). The prominent bacteria of AV were Escherichia coli (n = 36, 34.2%) and Klebsiella pneumoniae (n = 30, 28.5%). The overall rate of multidrug-resistant (MDR) bacteria was 65.71% (n = 69). History of abortion (p = 0.01; AOR = 4.0, 95% CI = 2.1, 7.7) and the habit of using vaginal pH-altering contraceptives (p = 0.01; AOR = 4.7, 95% CI = 2.5, 8.8) have the greatest odds of RTI. The high prevalence of RTIs in our study warrants an urgent intervention to minimize the associated morbidities and complications. The overall rate of MDR bacterial isolates necessitates the implementation of an effective surveillance program in the study setting.

Changing the mindsets? Education and the intergenerational spread of tolerance for physical violence against women in Zimbabwe

We investigate the relationship between childhood exposure to interparental violence and adult tolerance for violent beliefs against women. For individuals who have witnessed parental violence in childhood, our analysis suggests a 14.3–15.2 percentage point (pp) increase in tolerance, highlighting the transmission of violent beliefs across generations. Leveraging Zimbabwe’s 1980 education reform as a natural experiment through a regression discontinuity design, we explore the potential of increased education to disrupt this intergenerational transmission. The reform led to an approximately two-year increase in female education, with a more pronounced impact in rural areas. This educational boost is associated with an estimated 4.1–7.9 pp reduction in tolerance for violence, especially among those who witnessed parental violence in childhood. We identify four primary mechanisms contributing to this reduction in tolerance: enhanced access to information, increased help-seeking behaviours, improved labour market outcomes, and higher educational levels among partners. Our findings underscore the effectiveness of educational policies in reducing tolerance for violence against women within low-income contexts such as Zimbabwe, thereby disrupting its intergenerational transmission. Moreover, these results emphasise the potential of education-based interventions in addressing the broader issue of violence against women in low-income countries.

Factors Influencing Choice of Place for Child Delivery among Child Bearing-Aged Women in Balambala Sub-County, Garissa County, Kenya

Background: There has been little progress made in Sub-Saharan Africa in achieving Sustainable Development Goal of reducing maternal deaths. Maternal mortality can be reduced significantly by skilled delivery. Women in low-income countries choose home deliveries despite the risks. In Kenya, maternity services are offered free-of-charge in all public health facilities. Mothers receive non-cash incentives after delivery. Investigated independent variables were health care related factors, gynecological factors and socio-cultural factors. The dependent variable was the proportions of hospital and, home deliveries. Maternal mortality rate in Balambala was found to be 587/100,000 while the national and county averages were 223 and 530/100,000 respectively. The study investigated factors influencing choice of place of child delivery. 
 Methods: Cross-sectional study was used and participants recruited through randomization. A sample size of 384 mothers, who had 1-year-old child, registered for ante-natal care services in latest pregnancy in Balambala were interviewed at the households. Quantitative data collected using structured questionnaires and analyzed using Statistical Package for Social Sciences version 25. P-value of .05 was set as statistical significance. Descriptive and inferential statistics were calculated, nature and magnitude of association between dependent and independent variables investigated.
 Results: The independent variables recorded the following; p-value of 0.042 for socio-cultural factors, p-value of 0.039 for obstetric factors and p-value of 0.035 for health care related factors.
 Conclusion: Proportions of home and hospital deliveries were 52% and 48% respectively. The independent variables were statistically significant, p-value<.05. The researcher recommends inclusion of literacy lessons into the present ANC profile. Husbands to accompany their pregnant wives to health facilities at least 2 of the 4 scheduled ANC visits.

The femtech revolution-A new approach to pregnancy management: Digital transformation of maternity care-The hybrid e-health perinatal clinic addressing the unmet needs of low- and middle-income countries.

Prenatal care and infant mortality rates are crucial indicators of healthcare quality. However, millions of women in low-income countries lack access to adequate care. Factors such as high-risk pregnancies and unmanaged diet increase the risk of developing complications during pregnancy, highlighting the need for continuous monitoring of maternal health. The increasing burden of non-communicable diseases represents a significant threat to fragile health systems. The lack of access to appropriate prenatal care and poor maternal and newborn health outcomes are major concerns in low- and middle-income countries (LMICs). It emphasizes the need for innovative, integrative approaches to healthcare delivery, especially in pregnant women. The health services need to be reorganized holistically and effectively, focusing on factors that directly impact maternal, neonatal, and infant mortality, resulting in improved access to maternity services and survival of "at-risk" mothers and their offspring in many LMICs. Based on the FIGO (the International Federation of Gynecology & Obstetrics) recommendations of extending preconception care to the postpartum stage, the authors of this review have developed a new model of care-PregCare-based on the triple-intervention-based holistic and multidisciplinary maternal and fetal medicine model for low-risk pregnancies. This model will help transform the traditional model's high visitation frequency into a safe and reduced office visit, while increasing virtual connections, point of care and self-care with doctors, nurses, and community-based providers of self-care. This shall be based on a sophisticated central PregCare call center powered by innovative technologies combined with experienced personnel in perinatal management (doctors and nurses/midwives).

Harnessing the Power of Behavioral Science: An Implementation Pilot to Improve the Quality of Maternity Care in Rural Madagascar.

Postpartum hemorrhage (PPH) is the leading direct cause of maternal deaths worldwide, and women in low-income countries are at particularly high risk of dying from PPH-related consequences. Most deaths can be avoided through consistent provider adherence to prevention protocols and timely, appropriate management, yet providers do not consistently adhere to these best practices. USING BEHAVIORAL DESIGN TO DEVELOP SOLUTIONS TO IMPROVE PROVIDER CARE: We applied the behavioral design methodology to identify behavioral drivers, develop solutions, and build a program theory of change. Implementation research was conducted to understand the adoption, desirability, feasibility, and appropriateness of the solutions and explore suggestive findings related to impact. Data were collected through observation and in-depth interviews. Solutions developed included: (1) a timer to remind providers of the 1-minute window to administer oxytocin; (2) a glow-in-the-dark poster illustrating a simplified algorithm for PPH management; (3) badges to assign family members tasks to support providers during labor and delivery; and (4) a risk visualization exercise. Clinical mentors introduced the solutions during facility visits, and providers received orientation using videos. Solutions were piloted in 10 rural facilities in southeastern Madagascar during November-December 2020. Providers reported high adoption of the timers and task badges during routine deliveries. They remarked on the desirability and appropriateness of the timer, task badges, and algorithm poster, as well as the value of the cocreation process. Adoption of the timer solution shows promise in having a potential positive impact on increasing the awareness of and adherence to timely oxytocin administration. This work highlights the promise of applying behavioral science to identify underlying drivers of gaps in clinical practice and to develop innovative and desirable solutions to address them.

A mixed-method study examined the reasons why pregnant women late initiate antenatal care in Northeast Ethiopia.

Timely initiation of antenatal care visits is crucial for ensuring optimal care and health outcomes for women and children. However, late antenatal care initiation among pregnant women in low-income countries including Ethiopia is acknowledged in the literature. Therefore, this study examined why pregnant women initiate antenatal care late in Northeast Ethiopia. This study was done using a mixed design approach that included phenomenology and retrospective cross-sectional designs. A retrospective cross-sectional study was deployed among randomly selected 632 medical charts of women who had antenatal care visit in Legambo District primary hospital and health centers. Kaplan Meier curve was used to estimate survival time. Bi-variable and multivariable Cox-proportional hazard regression models were fitted using R-studio-1.2.5033 to identify independent predictors of antenatal care initiation time. Six vignette-based focused group discussions were held with pregnant women who had been purposefully selected. Then, a qualitative content analysis that was informed by the phenomenological theory was done. This study indicated that only 195 (30.9%) of women timely initiated their antenatal care follow-up. In a survival analysis, all 632 women contributed 12,474 person-weeks giving a timely antenatal care initiation rate of 15.6 per 1000 person-weeks. According to the multivariable Cox regression models, late antenatal are initiation was found among pregnant women with an unknown last normal menstruation period, no living children, no bad obstetric history, not accompanied by their partner during antenatal care visit, and who lived in a >5-kilometer radius of health facility. In a qualitative analysis, being uncertain whether the pregnancy had occurred, believing that they have a very low probability of experiencing any complications, negative experience with healthcare providers, negative influence from their immediate contacts such as the mother and mother-in-law, and socio-cultural beliefs like "Qare" were found as major reasons why they started antenatal care follow-up late. Most pregnant women in Legambo district, northeastern Ethiopia, initiate their antenatal care visits late. Based on the findings of this study, strengthening the pregnant women identification program and performing regular pregnant women's conference will help to achieve early initiation of antenatal care visits. To lessen the negative influence of their immediate contacts, it will also good to include these old moms and husbands in the conference of pregnant women.

Maternal mental health screening and management by health workers in southwestern Uganda: a qualitative analysis of knowledge, practices, and challenges

BackgroundMaternal mental health (MMH) problems, such as perinatal depression, maternal anxiety, suicide ideation and puerperal psychosis among others, have a significant impact on maternal morbidity and mortality, as well as the health and development of children. One in every four pregnant women and one in every five postpartum women in low-income countries, suffer from maternal mental health (MMH) problems. Despite this, MMH screening, diagnosis, and reporting remain scanty in Uganda. Consequently, this study aimed to investigate the knowledge, practices, and impediments that maternity care workers face when screening and managing women with maternal mental health disorders in health facilities in south-western Uganda.MethodsIn-depth interviews were conducted with 22 health-care professionals who work in maternity care departments in primary and tertiary healthcare facilities in southwestern Uganda to investigate their medical knowledge, clinical practices, and challenges related to the screening and management of maternal mental health problems. Using qualitative content analysis, distinct categories and subcategories were found.ResultsMedical staff especially midwives lacked specialized training in screening and managing women with maternal mental health problems They screened and managed MMH problems solely based on history and physical examination, and they referred nearly every mother displaying signs of mental illness because they felt ill-prepared to handle them. On the other hand, medical staff with some level of specialized training in mental health particularly staff working in mental health units, were more likely to use a mental health screening tool in addition to history and physical examination; and to treat any women exhibiting signs and symptoms of maternal mental problems without referring them. Lack of in-service training on maternal mental health, poorly coordinated referral systems, reluctance of mentally ill to visit medical facilities, scarcity of mental health specialists, and shortage of relevant medications were identified as the major challenges. Age, experience level, or gender had no effect on screening or management practices.ConclusionsThe results suggest that specialized training in mental health, and particularly maternal mental health, is essential for the effective screening and management of maternal mental health conditions in South Western Uganda.

Different impact of COVID-19 on symptomatic pregnant and postpartum women in low-income countries and low- and middle-income countries.

SynopsisThe adverse outcomes of COVID‐19 among pregnant women have been pronounced in the low‐income countries compared with low‐ and middle‐income countries.

THE IMPACT OF HEALTH EDUCATION ON THE UTILIZATION OF HEALTHCARE FACILITIES AMONG PREGNANT WOMEN DURING DELIVERY IN CROSS RIVER STATE, NIGERIA

Every day, women in low-income countries lose their lives to pregnancy and childbirth that involve potential complications; most fatalities were avoidable. In Nigeria, the unfortunate odds of a woman passing away during pregnancy, childbirth, or postpartum are 1 in 22, which is significantly higher than the odds in most developed countries, where it's only 1 in 4900. During delivery, pregnant women need to use health facilities where skilled birth attendants can handle any potential obstetric and newborn complications that may arise. This study aimed to evaluate the impact of health education on the utilization of healthcare facilities by pregnant women during delivery in Cross River State, Nigeria. The study followed a quasi-experimental design and included pregnant women aged between 15 and 45 years from all senatorial districts. A sample of 60 pregnant women in their third trimester was examined; 30 each for health education and control group and a validated semi-structured questionnaire, with a Cronbach’s Alpha internal consistency range of 0.76 to 0.81, was administered at baseline, immediate post-intervention after 4 weeks, and during the 8th-week follow-up period. Descriptive and inferential statistics were used to analyze the data with a significance level of 5%. The study showed that the average age of the participants was 21.53±6.07 years. The practice of the utilisation of health facilities during delivery among pregnant women’s mean score increased significantly between the baseline and follow-up from 1.13±1.62; p = 0.000. In conclusion, the health education intervention effectively improved the utilization of Health facilities during delivery among pregnant women. The study recommended that health education strategies should be utilized to promote positive change in the practice of health facilities utilisation among pregnant women

Associations between forced non-consensual first-sex and HIV among sexually active women in the Kingdom of Eswatini

ABSTRACT Studies continue to underscore the profound impact of sexual violence on women’s health. Yet, little is known about the impact, via a complex matrix of behavioural and social factors, of first intercourse, namely forced non-consensual on HIV status, particularly among sexually active women (SAW) in low-income countries where HIV prevalence remains high. Using a national sample from Eswatini, we employed multivariate logistic regression modelling to estimate the associations between forced first-sex (FFS), subsequent sexual behaviour and HIV status among 3555 SAW aged from 15 years to 49 years. The results found that women who experienced FFS had a greater number of sexual partners compared to those who had never experienced FFS (aOR = 2.79, p < .01), although there were no significant differences in condom use, early sexual debut and casual sex involvement between these two groups. FFS remained significantly associated with a higher risk of having HIV (aOR = 1.70, p < .05) even after controlling for risky sexual behaviours and various other factors. These findings further reinforce the relationship between FFS and HIV, and suggest that addressing sexual violence is a critical component of HIV prevention among women in low-income countries.

Implementation of a novel ultrasound training programme for midwives in Malawi: A mixed methods evaluation using the RE-AIM framework.

Despite recommendation that all women receive an ultrasound in pregnancy prior to 24 weeks', this remains unavailable to many women in low-income countries where trained practitioners are scarce. Although many programmes have demonstrated efficacy, few have achieved longterm sustainability, with a lack of information about how best to implement such programmes. This mixed-methods study aimed to evaluate the implementation of a novel education package to teach ultrasound-naive midwives in Malawi basic obstetric ultrasound, assessing its impact in the context of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. The study ran across six sites in Malawi between October 2020 and June 2021, encompassing three phases; pre-implementation, implementation and post-implementation. Twenty nine midwives underwent a bespoke education package with matched pre and post course surveys assessed their knowledge, attitudes and confidence and "hands on" assessments evaluating practical skills. Training evaluation forms and in-depth interviews explored their satisfaction with the package, with repeat assessment and remote image review evaluating maintenance of skills. 28/29 midwives completed the training, with significant increases in knowledge, confidence and practical skills. Adherence to the education package varied, however many changes to the proposed methodology were adaptive and appeared to facilitate the efficacy of the programme. Unfortunately, despite reporting approval regarding the training itself, satisfaction regarding supervision and follow up was mixed, reflecting the difficulties encountered with providing ongoing in-person and remote support. This programme was successful in improving trainees' knowledge, confidence and skill in performing basic obstetric ultrasound, largely on account of an adaptive approach to implementation. The maintenance of ongoing support was challenging, reflected by trainee dissatisfaction. By evaluating the success of this education package based on its implementation and not just its efficacy, we have generated new insights into the barriers to sustainable upscale, specifically those surrounding maintenance.

Gender-aware inclusive value chain: A theoretical perspective

Achieving SDG5 requires an analytical and practical framework enabling a win–win participation of women with poor resources in gender-blind societies. Women with poor resources are mostly excluded from formal economic systems and face gender inequalities. In agricultural and food value chains, women are not equally included as men in highly attractive value chains, so they end up engaging in informal (less lucrative) agri-food activities alongside the value chains. However, the existing literature fails to design an adequate framework that efficiently addresses gender inequality and the poverty conditions of women in low-income countries, mostly gender-blind. This study contributes to filling this knowledge gap by proposing a gender-aware inclusive value chain from a theoretical perspective. For this purpose, we conducted a deep and extensive state-of-the-art study on value chain development and strategies over the past three decades. Two main types of value chains are drawn from this literature review: (1) conventional value chains, mainly exclusive or adverse, including the bottom of the pyramid populations and gender-blind; and (2) gender-aware value chains mostly focus on value chains that are controlled by women. Hence, the paper proposes a third type of value chains inspired by the Foucauldian perspective of human being: gender-aware inclusive value chain (GAIVC). This perspective considers a value chain similar to the human body in its functioning because the human body is composed of different organs that are autonomous but complementary to each other. GAIVC is also composed of different elements (actors/stakeholders, farms, storage, infrastructure, and so on) that should be complementary and non-competitive. From this perspective, it provides more opportunities for poor resource women to evolve into a non-discriminatory environment based on gender. It also breaks down the power relations between the chain actors, as they have to cooperate and avoid the chain from collapsing from within and outside threats. In this way, the sustainability of value chains is guaranteed, and all actors involved receive fair rewards from chain participation.

Midwife‐Led Ultrasound Scanning to Date Pregnancy in Malawi: Development of a Novel Training Program

The use of ultrasound to determine gestational age is fundamental to the optimum management of pregnancy and is recommended for all women by the World Health Organization. However, this modality remains unavailable to many women in low-income countries where trained practitioners are scarce. Although previous initiatives have demonstrated efficacy in training midwives and technicians to perform antenatal ultrasound, these programs have often been too long and too complex to be realistic within the specific constraints of this context, highlighting the need for a novel and pragmatic approach. We describe the development and piloting of a bespoke course to teach midwives 3 fundamental components of early antenatal ultrasound scanning: (1) to identify the number of fetuses, (2) to confirm fetal viability, and (3) to determine gestational age. Having established that 5 days is insufficient, we propose that the minimum duration required to train ultrasound-naive midwives to competency is 10 days. Our completed program therefore consists of one and one-half days of didactic teaching, followed by 8 and one-half days of supervised hands-on practical training in which trainees are assessed on their skills. This package has subsequently been successfully implemented across 6 sites in Malawi, where 28 midwives have achieved competency. By describing the processes involved in our cross-continental collaboration, we explain how unexpected challenges helped shape and improve our program, demonstrating the value of preimplementation piloting and a pragmatic and adaptive approach.

Determinants of Pelvic Floor Disorders among Women Visiting the Gynecology Outpatient Department in Wolkite University Specialized Center, Wolkite, Ethiopia.

Background Pelvic floor disorders encompass a broad range of interrelated clinical conditions. Pelvic floor disorders are a common public health concern that affects the lives of millions of adult females. This disorder is expected to be more widespread and probably more severe among women in low-income countries. However, there is limited knowledge about pelvic floor disorders and their determinants among women in Ethiopia. Objective The purpose of the study was to assess the determinants of pelvic floor disorders among women who visited the gynecology outpatient service at the Wolkite University Specialized Hospital, Wolkite, Ethiopia, in 2021. Methods A cross-sectional hospital study was conducted on 275 randomly chosen women from June 1 to July 1, 2021. A systematic sampling technique was used when selecting the study subjects. The data were gathered using interviewer administered structured questionnaires. The data collected was entered in version 3.1 of EpiData, and version 23 of Statistical Package for Social Sciences was used for the analysis. The variables with a P-value <0.25 in the bivariate analysis were considered for a subsequently built multivariable model, and factors with P < 0.05 in the final model were statistically significant. The results were presented in an adjusted odds ratio with a 95% confidence interval. Result The prevalence of pelvic floor disorder was reported to be 17.8% with 9.3% of the women experiencing urinary incontinence, 8.9% experiencing pelvic organ prolapse, and 5.9% experiencing anal incontinence. Two hundred thirty-two (85.9%) were currently married, while 110 (40.7%) were housewives. Statistically, a significant association was found between age at first pregnancy (AOR = 5.193; 95% CI = 1.905–14.157), many vaginal deliveries (AOR = 15.858; 95% CI = 5.305–47.400), history of episiotomy (AOR = 7.508 95% CI = 1.556–36.224), and menopause (AOR = 7.665; 95% CI = 2.440–24.078) when analyzed with a multivariate logistic regression model. Conclusion In this study, age at first pregnancy, number of vaginal births, history of episiotomy, and menopause were independently associated with pelvic floor disorder. Therefore, educating women about the year of their first pregnancy, promoting family planning, and advice on the prevention of routine episiotomy by a health professional is recommended.