Women In West Africa Research Articles

The Role of Formal Schooling, Literacy, and Health Knowledge in Addressing Domestic Violence Against Women in West Africa

When “education” is cited as a solution for domestic violence, different aspects of knowledge acquisition are often omitted. This study uses 2019 Demographic and Health Surveys from four West African countries (The Gambia, Liberia, Senegal, Sierra Leone) with a combined sample size of 12,480 women and generalized ordered logit regression to examine the effects of types of knowledge (years of schooling, literacy, and health knowledge) on domestic violence (physical abuse, emotional abuse, and control issues). The results suggest that literacy has the most reliable beneficial impact on domestic violence and was consistently associated with decreased odds of abuse. However, greater findings suggest that schooling, literacy, and health knowledge function as separate types of education and that their relationships are complex and context-specific. By neglecting to see these types of knowledge as separate entities that can operate together, it is possible that mitigation strategies for domestic violence are going undiscovered.

Gender role in food rights and sovereignty in West Africa: A rapid review

Recognizing the critical role gender plays in food systems within West Africa, this review paper explores the contributions women make throughout the food value chain and the challenges they face in achieving food and nutrition security. A search across the databases; Hinari, Ovid MEDLINE, Scopus and Web of Science targeted peer-reviewed articles reporting on studies published between 2000 and 2023 in English or French and focused on women in West Africa. Data were extracted using a predefined form in Covidence and a narrative synthesis was used to summarize women’s roles and challenges within food systems. Thematic analysis of 69 peer-reviewed articles out of a total of 9,789 screened revealed West African women as central figures in regional food systems. Beyond their well-documented roles in land preparation, planting, and harvesting, women actively engage in processing, distribution, marketing and household consumption of diverse food crops (fruits, vegetables, grains and tubers) across rural and urban agri-food systems. This multifaceted engagement extends far beyond production, demonstrably impacting key socio-economic and nutrition metrics including food security, food sovereignty, and sustainable livelihoods of countless communities across the region. Nonetheless, women are disproportionately affected by challenges such as unequal access to resources, limited decision-making power, and restrictive cultural norms and education. These factors hinder their participation in different activities within the food system. To address these gendered disparities and promote equitable food systems, targeted interventions are crucial. These interventions must prioritize education and training to equip women with knowledge, skills, and modern technology. Additionally, policy changes are necessary to promote equitable access to resources, financing and land ownership. Furthermore, dismantling discriminatory cultural norms and promoting gender equality are essential steps along with implementing infrastructure and technologies that address women's specific needs. By prioritizing women's empowerment through a combination of education, policy changes, technological upgrades, and collaborative efforts with stakeholders, West Africa can strive towards a more sustainable and equitable food system for all. Key words: food sovereignty, food rights, food systems, gender dynamics, West Africa

Contraceptive Utilization and Its Associated Factors Among Married Women in West African Countries: A Population-Based Survey Using Multinomial Logistic Regression.

The international development agenda emphasizes universal access to family planning, as seen in Sustainable Development Goal 3.7. However, the use of modern contraceptive methods remains low in developing countries, specifically in West Africa. This study aimed to assess the current status of contraceptive use in the region, focusing on different methods. We analyzed Demographic and Health Survey data from 13 West African nations (2012-2022) involving 117,165 married women. Using binary and multiple multinomial logistic regression, we identified key factors associated with contraceptive use. Adjusted odds ratios with 95% confidence intervals were utilized, and significance was determined at p ≤ 0.2 for binary regression and p < 0.05 for multiple multinomial regression. About 80.86% of women did not use any method, while 16.56% of women used modern methods. Maternal age of 35-49 years (RRR=0.77, 95% CI, 0.72,0.82), had given first birth after 20 years (RRR=0.80,95% CI, 0.77,0.83), cohabitation after 20 years old (RRR=1.24,95% CI, 1.18,1.29), being employed (RRR=1.38,95% CI, 1.33,1.43), women who have from 3-5, and more than five living children (RRR=2.06,95% CI,1.97,2.16, and (RRR=2.57, 95% CI, 2.42,2.74), primary(RRR=1.59, 95% CI, 1.52,1.66), secondary/higher education (RRR=2.08, 95% CI, 1.99,2.18), antenatal visit (RRR= 1.38, 95% CI 1.28,1.49), institutional delivery(AOR=1.42, 95% CI, 1.35,1.49), husband working status (RRR=1.39, 95% CI, 1.28,1.51), media exposure(RRR=1.23, 95% CI, 1.19,1.28), visited health facility more than once (RRR=1.09, 95% CI, 1.05,1.13), rural women (RRR=0.89,95% CI,0.85,0.93), female households (RRR=0.79, 95% CI,0.76,0.83), richer (RRR=1.42, 95% CI,1.33,1.51), and richest wealth indexes (RRR=1.69,95% CI,1.58,1.82) were associated. This study revealed a low level of contraceptive use among women in West Africa. Strengthening maternal reproductive health services, such as antenatal care, institutional delivery, and health visits, while also targeting mass media and disadvantaged women, has the potential to significantly increase the adoption of modern contraception techniques.

High risk fertility behaviour and health facility delivery in West Africa

BackgroundEvidence suggests that women who give birth in a health facility have lower odds of experiencing pregnancy complications and significantly reduced risk of death from pregnancy-related causes compared to women who deliver at home. Establishing the association between high-risk fertility behaviour (HRFB) and health facility delivery is imperative to inform intervention to help reduce maternal mortality. This study examined the association between HRFB and health facility delivery in West Africa.MethodsData for the study were extracted from the most recent Demographic and Health Surveys of twelve countries in West Africa conducted from 2010 to 2020. A total of 69,479 women of reproductive age (15–49 years) were included in the study. Place of delivery was the outcome variable in this study. Three parameters were used as indicators of HRFB based on previous studies. These were age at first birth, short birth interval, and high parity. Multivariable binary logistic regression analysis was performed to examine the association between HRFB and place of delivery and the results were presented using crude odds ratio (cOR) and adjusted odds ratio (aOR), with their respective 95% confidence interval (CI).ResultsMore than half (67.64%) of the women delivered in a health facility. Women who had their first birth after 34 years (aOR = 0.52; 95% CI = 0.46–0.59), those with short birth interval (aOR = 0.91; 95% CI = 0.87–0.96), and those with high parity (aOR = 0.58; 95% CI = 0.55–0.60) were less likely to deliver in a health compared to those whose age at first delivery was 18-34 years, those without short birth interval, and those with no history of high parity, respectively. The odds of health facility delivery was higher among women whose first birth occurred at an age less than 18 years compared to those whose age at first birth was 18-34 years (aOR = 1.17; 95% CI = 1.07–1.28).ConclusionHRFB significantly predicts women's likelihood of delivering in a health facility in West Africa. Older age at first birth, shorter birth interval, and high parity lowered women’s likelihood of delivering in a health facility. To promote health facility delivery among women in West Africa, it is imperative for policies and interventions on health facility delivery to target at risk sub-populations (i.e., multiparous women, those with shorter birth intervals and women whose first birth occurs at older maternal age). Contraceptive use and awareness creation on the importance of birth spacing should be encouraged among women of reproductive age in West Africa.

Men Who Have Sex with Both Men and Women in West Africa: Factors Associated with a High Behavioral Risk of Acquiring HIV from Male Partners and Transmission to Women (CohMSM ANRS 12324—Expertise France)

HIV is highly prevalent in men who have sex with men (MSM) in West Africa. Many MSM in the region also have sex with women (MSMW). Accordingly, they are a potential bridge subpopulation for HIV transmission to women. We aimed to evaluate the proportions and characteristics of West African MSMW at high behavioral risk of acquiring HIV from male partners and transmitting it to female partners (HBRMF). The cohort ANRS-12324 CohMSM Study included 630 HIV-negative MSM in Burkina Faso, Cote d’Ivoire, Mali, and Togo. Among MSMW (i.e., with ≥ 1 female partner) in the cohort, HBRMF was identified using trajectory models based on seven at-risk sexual practices with male and female partners, including inconsistent condom use, multiple partnerships, and receptive same-sex anal intercourse. To assess the relevance of using trajectory models, we compared the proportions of participants who seroconverted during the cohort follow-up among those at HBRMF and those not at HBRMF. Factors associated with HBRMF were identified using a generalized estimation equation logistic regression model accounting for longitudinal data. Approximately half (47%) of the 304 MSMW (22% of all CohMSM study participants) were at HBRMF. This group accounted for 75% of the 28 HIV seroconversions observed during follow-up (p = 0.001). HBRMF was positively associated with being aged < 25 years (aOR 95% CI 1.67 [1.23–2.27]), being sexually attracted only to men (1.97 [1.38–2.78]), feelings of loneliness (1.92 [1.38–2.65]), and homonegative violence score (1.22 [1.05–1.41]). HBRMF was negatively associated with having had both stable and casual female partners in the previous 6 months (0.34 [0.20–0.60] vs. only a stable female partner). HBRMF tended to be negatively associated with having ≥ 4 sexual intercourses with female partners in the previous four weeks (0.54 [0.27–1.06] vs. no intercourse). Establishing official relationships with women might be a strategy for young and/or stigmatized MSMW to comply with social pressure to display a heterosexual lifestyle. However, this seems to increase the risk of HIV transmission to female partners. In the present study, almost half of MSMW were at HBRMF. This result stresses the need to adapt HIV research and prevention to MSMW and their female partners.

A story-telling cloth approach to motivating cervical cancer screening in Mali.

Ninety percent of deaths from Cervical cancer (CC) caused by Human Papilloma Virus (HPV) occur in low- and middle-income countries. CC is the 2nd most common cause of cancer in women in West Africa, where 12,000 women develop cervical cancer and more than 6,000 die from the disease, annually. While HPV vaccination and CC screening have dramatically reduced the incidence of CC and mortality from CC in developed countries, prevention of CC in West Africa is often limited to visual inspection of the cervix and surgical intervention. In previous studies of CC in Mali, we demonstrated that knowledge about the link between HPV and CC is limited, and that screening for CC is often delayed until women are symptomatic. For this intervention, a story-telling cloth (West African-style printed pagne) was designed for use as a starting point for educational sessions run by community health workers. Community outreach using the cloth during 6 months of 2015 resulted in a 5-fold higher uptake of cervical cancer screening and increased awareness of the potential to vaccinate adolescents against CC. 3,271 women were motivated to visit one of five participating clinics for CC screening, where a mere 600 women had been screened during the previous year. This study shows that a comprehensive, visual, community-centered education campaign coupled with coordinated support for local clinics improves uptake of CC screening.

Heat stress and its severity during pregnancy: The worsening realities of heat stress for pregnant women in West Africa

Heat stress and its severity during pregnancy: The worsening realities of heat stress for pregnant women in West Africa

Breast Cancer Risk in Women from Ghana Carrying Rare Germline Pathogenic Mutations.

Risk estimates for women carrying germline mutations in breast cancer susceptibility genes are mainly based on studies of European ancestry women. We investigated associations between pathogenic variants (PV) in 34 genes with breast cancer risk in 871 cases [307 estrogen receptor (ER)-positive, 321 ER-negative, and 243 ER-unknown] and 1,563 controls in the Ghana Breast Health Study (GBHS), and estimated lifetime risk for carriers. We compared results with those for European, Asian, and African American ancestry women. The frequency of PV in GBHS for nine breast cancer genes was 8.38% in cases and 1.22% in controls. Relative risk estimates for overall breast cancer were: (OR, 13.70; 95% confidence interval (CI), 4.03-46.51) for BRCA1, (OR, 7.02; 95% CI, 3.17-15.54) for BRCA2, (OR, 17.25; 95% CI, 2.15-138.13) for PALB2, 5 cases and no controls carried TP53 PVs, and 2.10, (0.72-6.14) for moderate-risk genes combined (ATM, BARD1, CHEK2, RAD51C, RAD52D). These estimates were similar to those previously reported in other populations and were modified by ER status. No other genes evaluated had mutations associated at P &lt; 0.05 with overall risk. The estimated lifetime risks for mutation carriers in BRCA1, BRCA2, and PALB2 and moderate-risk genes were 18.4%, 9.8%, 22.4%, and 3.1%, respectively, markedly lower than in Western populations with higher baseline risks. We confirmed associations between PV and breast cancer risk in Ghanaian women and provide absolute risk estimates that could inform counseling in Ghana and other West African countries. These findings have direct relevance for breast cancer genetic counseling for women in West Africa.

Women Deprivation Index and Family Planning Utilisation in Urban Geography of West African Countries.

Inequalities in health care utilisation and outcomes vary significantly across geographies. Though available evidence suggests disparity in contraceptive uptake in favour of urban compared with rural geographies, there are unassessed nuances among women in urban communities. This study examines some of these disparities within the context of socioeconomic deprivations and family planning utilisation among urban women in West Africa. A secondary analysis of the most recent Demographic and Health Survey dataset of five selected West African countries was conducted, using pooled data of 21,641 women aged 15–49 years. Associations between family planning utilisation and women's deprivation status were investigated using a binary logistic regression model. The findings show that more than one-quarter of the women were severely deprived across the countries except Senegal (17.4%), and the severely deprived consistently have relatively low contraceptive prevalence rates (CPR) (16.0–24.3%) compared with women with no/low deprivation across the countries except Senegal (39.8%). The results for long-acting reversible contraceptives (LARC) were not consistent across the five countries: whereas, LARC utilisation was lower among severely deprived women in Nigeria (9.1%), Guinea (9.6%), and Mali (19.3%), utilisation was similar across the deprivation groups in Benin and Senegal. In the multivariable analyses, the log-odds of modern contraceptive utilisation decreases by 0.27 among the moderately deprived (ß = −0.27, SE = 0.05, p < 0.01) and by 0.75 among the severely deprived women (ß = −0.75, SE = 0.05, p < 0.01) compared with those with no/low deprivation, with variations across the countries. Similarly, the log-odds of LARC utilisation decreases by 0.44–0.72 among the severely deprived women compared with those with no/low deprivation across the countries except Senegal. This study concluded that family planning intervention programmes and policies need to underscore the deprivation context of urban geographies, particularly among women living in informal settlements.

Homonegativity, sexual violence and condom use with women in men who have sex with men and women in West Africa.

The study aimed to explore longitudinal interactions between homonegativity and sexual behaviors with female partners among HIV-negative West African men who have sex with men and women (MSMW). The community-based cohort CohMSM ANRS 12324 - Expertise France enrolled MSM in Togo, Burkina Faso, Côte d'Ivoire and Mali. Sociobehavioral data were collected every 6 months. Using 30-month follow-up data, a multiprobit analysis was performed to investigate the relationship between psychosocial and behavioral variables ex-ante (t - 1) and ex-post (t). MSMW (n = 326) accounted for half of all participants in CohMSM. They reported inconsistent condom use with women in 39% of visits. Perceived and internalized homonegativity at t - 1 tended to lead to sexual violence toward women at t (P < 0.1), which was associated with inconsistent condom use with them at t (P < 0.05). Given the high HIV prevalence in West African MSM, widespread condom-less sex with women in MSMW, and the aggravating effect of social and internalized homonegativity, more research in the MSMW subpopulation is needed to assess the risk of HIV bridging to women and to design support activities.

Village savings and loans association participation and impact on off-farm income among rural women

PurposeThis paper aims to examine the factors that influence rural women’s participation in Village Savings and Loans Association (VSLA) and the savings contribution in the Kassena-Nankana West District of Ghana. The study also analysed the impact of VSLA participation on off-farm income and on poverty.Design/methodology/approachIn total, 120 rural women were selected for this study. The probit and heteroskedasticity linear regression models were used to examine the factors that influence VSLA participation and the savings made by members, respectively. The propensity score matching technique, coupled with Rosenbaum Sensitivity analysis, were used to analyse the impact of VSLA on off-farm income and poverty.FindingsDemographic and livelihood factors such as human, natural, financial, physical and social capitals have different influences on the participation and the savings contribution in the VSLA. Moreover, VSLA has a significant impact on off-farm income; however, it did not affect poverty.Originality/valueDespite the numerous studies on VSLA, there is little evidence of literature of its impact on off-farm income of rural women in West Africa, specifically, Ghana. Thus, this paper expands the frontiers of the existing literature on VSLA impact assessment and the factors that influence the savings made by women in the association.

Vitamin D Status Increases During Pregnancy and in Response to Vitamin D Supplementation in Rural Gambian Women

Background:Vitamin D is important to maternal, fetal, and infant health, but quality data on vitamin D status in lowand middle-income countries and response to cholecalciferol supplementation in pregnancy are sparse. Objectives:We characterized vitamin D status and vitamin D metabolite change across pregnancy and in response to cholecalciferol supplementation in rural Gambia. Methods:This study was a secondary analysis of samples collected in a 4-arm trial of maternal nutritional supplementation [iron folic acid (FeFol); multiple micronutrients (MMN); protein energy (PE) as lipid-based supplement; PE + MMN]; MMN included 10 µg/d cholecalciferol. Plasma 25-hydroxycholecalciferol [25(OH)D3], 24,25-dihydroxycholecalciferol [24,25(OH)2D3], and C3-epimer-25-hydroxycholecalciferol [3-epi-25(OH)D3] were measured by LC-MS/MS in 863 women [aged 30 ± 7 y (mean ± SD)] in early pregnancy (presupplementation) and late pregnancy, (gestational age 14 ± 3 and 30 ± 1 wk). Changes in 25(OH)D3and vitamin D metabolite concentrations and associations with pregnancy stage and maternal age and anthropometry were tested. Results:Early pregnancy 25(OH)D3concentration was 70 ± 15 nmol/L and increased according to pregnancy stage (82 ± 18 and 87 ± 17 nmol/L in the FeFol and PE-arms) and to cholecalciferol supplementation (95 ± 19 and 90 ± 20 nmol/L in the MMN and PE + MMN-arms) P < 0.0001). There was no difference between supplemented groups. Early pregnancy 25(OH)D3was positively associated with maternal age and gestational age. Change in 25(OH)D3was negatively associated with late pregnancy, but not early pregnancy, triceps skinfold thickness. The pattern of change of 24,25(OH)2D3mirrored that of 25(OH)D3and appeared to flatten as pregnancy progressed, whereas 3-epi-25(OH)D3concentration increased across pregnancy. Conclusions:This study provides important data on the vitamin D status of a large cohort of healthy pregnant women in rural Africa. Without supplementation, vitamin D status increased during pregnancy, demonstrating that pregnancy stage should be considered when assessing vitamin D status. Nutritionally relevant cholecalciferol supplementation further increased vitamin D status. These data are relevant to the development of fortification and supplementation policies in pregnant women in West Africa.

Abstract PL02-03: The DARC side of breast cancer disparities: Links to African ancestry and immunologic tumor responses

Abstract The disparities in breast cancer mortality among ethnic and race groups in the United States, with highest morality in African Americans (AAs), has persisted for five decades. However, even with the typical delays in diagnosis, more advanced stage distribution at diagnosis, and inadequate multidisciplinary breast cancer treatment, these combined factors do not completely explain breast cancer survival outcomes, which persist after controlling for stage at diagnosis. Paradoxically, population breast cancer mortality rates were similar for both groups until the early-1980’s, at which point the mortality curves separated because of declining mortality rates in WAs contrasted against relatively stable mortality rates in AAs. The mortality gap that emerged very likely reflected the unmasking of differences in the biology of breast cancer between AA and WA women related to prevalence of biomarker expression and the development of targeted therapy for breast cancer cases that were treatable with these therapies, as indicated by target gene expression (i.e. Estrogen Receptor). Unfortunately, the advancement of targeted therapies has failed to address cancers that are more prevalent in non-white patient groups. In fact, the approximately two-fold increased risk of Triple Negative Breast Cancer (TNBC) in AA women has been confirmed by population-based incidence rates regionally as well as nationally, and across all age intervals. Compared to non-TNBC, triple negative disease has been confirmed to be an adverse prognostic feature in AA patients, driving some of the mortality disparities. From a global perspective, epidemiological studies of breast cancer incidence and prevalence across the African diaspora resonate a similar theme, that women of African descent have a worse clinical outcome worldwide. Our team has investigated African tumor phenotypes, identifying distribution patterns that are similar among West African women from Nigeria and Ghana. Like the US, these global poor outcomes are also coupled with higher incidence of TNBC among women with western, sub-Saharan African ancestry, across each continent. Interestingly, even within Africa, there are distinctive differences in TNBC frequency between women of West African descent compared to those of East African descent, where East Africans have lower incidence of TNBC. As, historical and genetic evidence indicate that most AA share ancestry with women in West Africa rather than East Africa. These observations suggest a geographic ancestry connection with tumor biology and imply biological differences in tumors may permeate throughout the world population, associated with ancestral lineage. Genomic expression analyses have been utilized in cancer disparities for more than two decades. In this presentation, Dr. Davis will highlight the historical progression of cancer genomics in cancer disparities and expound on recent findings from her research group, the International Center for the Study of Breast Cancer Subtypes. Overall, there are similar themes emerging across race-group analyses that implicate immunological pathways in disparities of tumor phenotypes and clinical outcomes. Specifically, recent reports from ICSBCS show that African-Specific alleles can play a significant role in cancer disease progression, particularly with regard to immune response in tumorigenesis. Citation Format: Melissa B. Davis. The DARC side of breast cancer disparities: Links to African ancestry and immunologic tumor responses [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr PL02-03.

Abstract 622: Reproductive factors and breast cancer risk to women in Ghana, West Africa

Abstract Background: Women of African ancestry have a higher proportion of early onset and estrogen receptor (ER) negative cancers compared to women of European descent. Differences in risk associations by age at onset and ER status for reproductive factors, particularly parity and breastfeeding, have been proposed as possible contributors to this racial disparity. We therefore investigated these relations in the Ghana Breast Health Study. Methods: The study population included 1,126 women diagnosed with invasive breast cancer and 2,106 population controls aged 18-74 years at recruitment (2013-2015) in three hospitals in Accra and Kumasi, Ghana. Factors evaluated included age at menarche, number of livebirths, age at first livebirth, and median months breastfeeding per pregnancy. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression models overall and stratified by age. Associations by ER status were estimated using polytomous logistic regression models. Results: We observed associations with parity and extended breastfeeding duration per pregnancy that were modified by age at onset (&amp;lt;50 vs. &amp;gt;50 years, P-het &amp;lt;0.02 and 0.01, respectively). For women &amp;lt;50 years, the OR was 0.70 (95% CI 0.42-1.18) for those with &amp;gt;5 v. 0 livebirths, but there was no association with breastfeeding months per pregnancy (&amp;gt;18 vs &amp;lt;12 months: OR (95%CI) = 1.04 (0.75-1.44). For women &amp;gt;50 years, both higher number of livebirths and longer durations of breastfeeding months per pregnancy were associated with lower breast cancer risk: OR (95%CI) = 0.40 (0.20-0.83) for &amp;gt;5 vs 0 livebirths and 0.71 (0.51-0.98) for &amp;gt;18 vs &amp;lt;12 breastfeeding months per pregnancy. Data were consistent with a higher risk of early onset (&amp;lt;50 years) ER-negative breast cancer for parous compared to nulliparous women (1.63 (0.82-3.25), that was attenuated by extended breastfeeding (0.72 (0.45-1.14) for &amp;gt;18 vs &amp;lt;12 breastfeeding months per pregnancy). Conclusion: In this population of women in West Africa, increased number of live births and breastfeeding months per pregnancy were strong protective factors for later onset breast cancer. Among younger women, these trends were modified by ER status, with opposite associations for parity in ER+ vs. ER- tumors and an inverse association with breastfeeding in the ER- tumors that was not seen in the ER+ tumors. Our data support previous reports in African-American women of differential associations of parity and breastfeeding by ER status and age at onset. Further attention should focus on how reproductive factors contribute to observed racial heterogeneity in breast cancer. Citation Format: Jonine D. Figueroa, Brittny Davis Lynn, Lawrence Edusei, Nicolas Titiloye, Ernest Adjei, Joe Nat Clegg-Lamptey, Beatrice Wiafe-Addai, Baffour Awuah, Montserrat Garcia-Closas, Louise A. Brinton. Reproductive factors and breast cancer risk to women in Ghana, West Africa [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 622.

Differential Impact of Risk Factors on Stroke Occurrence Among Men Versus Women in West Africa.

Background and Purpose- The interplay between sex and the dominant risk factors for stroke occurrence in sub-Saharan Africa has not been clearly delineated. We compared the effect sizes of risk factors of stroke by sex among West Africans. Methods- SIREN study (Stroke Investigative Research and Educational Networks) is a case-control study conducted at 15 sites in Ghana and Nigeria. Cases were adults aged >18 years with computerized tomography/magnetic resonance imaging confirmed stroke, and controls were age- and sex-matched stroke-free adults. Comprehensive evaluation for vascular, lifestyle, and psychosocial factors was performed using validated tools. We used conditional logistic regression to estimate odds ratios and reported risk factor specific and composite population attributable risks with 95% CIs. Results- Of the 2118 stroke cases, 1193 (56.3%) were males. The mean±SD age of males was 58.1±13.2 versus 60.15±14.53 years among females. Shared modifiable risk factors for stroke with adjusted odds ratios (95% CI) among females versus males, respectively, were hypertension [29.95 (12.49-71.77) versus 16.1 0(9.19-28.19)], dyslipidemia [2.08 (1.42-3.06) versus 1.83 (1.29-2.59)], diabetes mellitus [3.18 (2.11-4.78) versus 2.19 (1.53-3.15)], stress [2.34 (1.48-3.67) versus 1.61 (1.07-2.43)], and low consumption of green leafy vegetables [2.92 (1.89-4.50) versus 2.00 (1.33-3.00)]. However, salt intake and income were significantly different between males and females. Six modifiable factors had a combined population attributable risk of 99.1% (98.3%-99.6%) among females with 9 factors accounting for 97.2% (94.9%-98.7%) among males. Hemorrhagic stroke was more common among males (36.0%) than among females (27.6%), but stroke was less severe among males than females. Conclusions- Overall, risk factors for stroke occurrence are commonly shared by both sexes in West Africa favoring concerted interventions for stroke prevention in the region.

Social Pressure for Pregnancy Scale: Its Development, Psychometric Properties, and Potential Contributions to Infertility and Depression Research.

Women with infertility in different cultures, especially those in West African countries, are viewed as inferior. They tend to experience discrimination and have suboptimal mental health outcomes. However, recent evidence shows that social pressure for pregnancy, not infertility, is a significant predictor of depression. Yet, instruments that measure social pressure for pregnancy are scarce. Existing instruments to measure social pressure for pregnancy show no evidence of psychometric properties. To assess the psychometric properties of a new tool, the Social Pressure for Pregnancy Scale (SPPS), among Malian women in West Africa. Exploratory factor analysis, and analyses of convergent validity, discriminant validity (known-groups technique), and reliability. The SPPS has good psychometric properties and can be used in future infertility studies especially in relation to depression.

Rahama Wright and Shea Yeleen

Rahama Wright and Shea Yeleen is the story of a young female social entrepreneur, Rahama Wright, who started a nonprofit venture, Shea Yeleen, to train women in West Africa with a more lucrative livelihood by manufacturing shea butter to earn higher wages. The case describes the shea butter industry in Africa, the role of women in the industry, and Wright's background in nonprofit and government as her rationale for starting a nonprofit venture. The case outlines the different organizational forms that nascent entrepreneurs could start when creating a venture and ends with a decision point if Wright should continue running a nonprofit or if she should convert to a for-profit social venture. The case offers students an opportunity to understand the differences between nonprofits and for-profit ventures from organizational, strategic, and personal perspectives. Given Wright's goals and the dynamics of the shea butter industry, students learn that running a nonprofit is not sustainable and find that she did convert to a for-profit social venture in order to accomplish her mission of empowering women in the Sahel region of Africa.

Clearance of Type-Specific, Low-Risk, and High-Risk Cervical Human Papillomavirus Infections in HIV-Negative and HIV-Positive Women.

PurposeThere is a dearth of data on clearance of cervical human papillomavirus (HPV) infection among women in West Africa. We examined the clearance of low-risk (lr) and high-risk (hr) cervical HPV infections, and the factors associated with these measures in HIV-negative and HIV-positive women.MethodsWe studied 630 Nigerian women involved in a study of HPV infection using short polymerase chain reaction fragment-10 assay and line probe assay-25. Research nurses used a cervical brush to collect samples of exfoliated cervical cells from all the study participants. Cox proportional hazards models were used to estimate associations between HIV and HPV infections.ResultsThe mean age of the study participants was 38 (standard deviation, ± 8) years; 51% were HIV positive. The rate of clearing any HPV infection was 2.0% per month among all women in the study population, 2.5% per month among HIV-negative women, and 1.6% per month, among HIV-positive women. The clearance rate per 1,000 person-months of observation for any lrHPV infection and any hrHPV infection were 9.21 and 8.83, respectively, for HIV-negative women, and 9.38 and 9.37, respectively, for HIV-positive women. In multivariate models, the hazard ratios for HIV-positive compared with HIV-negative women were 0.85 (95% CI, 0.51 to 1.43; P = .55) and 0.95 (95% CI, 0.54 to 1.65; P = .85) for cleared infections with any lrHPV and any hrHPV, respectively. The hazard ratio for HIV-positive compared with HIV-negative women was 0.39 (95% CI, 0.17 to 0.88; P = .02) for cleared infections with any multiple HPV and 0.13 (95% CI, 0.03 to 0.58; P = .007) for cleared infections with multiple hrHPV.ConclusionIn this study population, we observed that HIV-positive women were less likely to clear infections with multiple hrHPV types.

서부아프리카 무슬림 여성들에게 복음을 전하기 위한 효과적인 접촉방법

서부아프리카 무슬림 여성들에게 복음을 전하기 위한 효과적인 접촉방법

When Women Are Central to African Religious History: On Power, Prophecy, and Memory

Abstract This article examines the centrality of women's voices in Robert Baum's West Africa's Women of God, where African women emerge as prophetic figures and leaders in their regions, shaping both the political and religious scenes under colonial France. By recovering these women's stories, Baum is able to show how the colonial authority systemically attempted to discount the leadership and prophetic powers of these women, constraining them to private space and to rigid gender roles.