Abstract ObjectivesThis study compared the prevalence of concentrated urine (urine specific gravity ≥1.021), an indicator of hypohydration, across Tsimane' hunter‐forager‐horticulturalists living in hot‐humid lowland Bolivia and Daasanach agropastoralists living in hot‐arid Northern Kenya. It tested the hypotheses that household water and food insecurity would be associated with higher odds of hypohydration. MethodsThis study collected spot urine samples and corresponding weather data along with data on household water and food insecurity, demographics, and health characteristics among 266 Tsimane' households (N = 224 men, 235 women, 219 children) and 136 Daasanach households (N = 107 men, 120 women, 102 children). ResultsThe prevalence of hypohydration among Tsimane' men (50.0%) and women (54.0%) was substantially higher (P < .001) than for Daasanach men (15.9%) and women (17.5%); the prevalence of hypohydration among Tsimane' (37.0%) and Daasanach (31.4%) children was not significantly different (P= .33). Multiple logistic regression models suggested positive but not statistically significant trends between household water insecurity and odds of hypohydration within populations, yet some significant joint effects of water and food insecurity were observed. Heat index (2°C) was associated with a 23% (95% confidence interval [CI]: 1.09‐1.40,P= .001), 34% (95% CI: 1.18‐1.53,P < .0005), and 23% (95% CI: 1.04‐1.44,P= .01) higher odds of hypohydration among Tsimane' men, women, and children, respectively, and a 48% (95% CI: 1.02‐2.15,P= .04) increase in the odds among Daasanach women. Lactation status was also associated with hypohydration among Tsimane' women (odds ratio = 3.35, 95% CI: 1.62‐6.95,P= .001). ConclusionThese results suggest that heat stress and reproductive status may have a greater impact on hydration status than water insecurity across diverse ecological contexts.
more »
« less
Bayesian spatial modelling of intimate partner violence and associated factors among adult women and men: evidence from 2019/2020 Rwanda Demographic and Health Survey
Abstract BackgroundIntimate partner violence (IPV) remains a global public health concern for both men and women. Spatial mapping and clustering analysis can reveal subtle patterns in IPV occurrences but are yet to be explored in Rwanda, especially at a lower small-area scale. This study seeks to examine the spatial distribution, patterns, and associated factors of IPV among men and women in Rwanda. MethodsThis was a secondary data analysis of the 2019/2020 Rwanda Demographic and Health Survey (RDHS) individual-level data set for 1947 women aged 15–49 years and 1371 men aged 15–59 years. A spatially structured additive logistic regression model was used to assess risk factors for IPV while adjusting for spatial effects. The district-level spatial model was adjusted for fixed covariate effects and was implemented using a fully Bayesian inference within the generalized additive mixed effects framework. ResultsIPV prevalence amongst women was 45.9% (95% Confidence interval (CI): 43.4–48.5%) while that for men was 18.4% (95% CI: 16.2–20.9%). Using a bivariate choropleth, IPV perpetrated against women was higher in the North-Western districts of Rwanda whereas for men it was shown to be more prevalent in the Southern districts. A few districts presented high IPV for both men and women. The spatial structured additive logistic model revealed higher odds for IPV against women mainly in the North-western districts and the spatial effects were dominated by spatially structured effects contributing 64%. Higher odds of IPV were observed for men in the Southern districts of Rwanda and spatial effects were dominated by district heterogeneity accounting for 62%. There were no statistically significant district clusters for IPV in both men or women. Women with partners who consume alcohol, and with controlling partners were at significantly higher odds of IPV while those in rich households and making financial decisions together with partners were at lower odds of experiencing IPV. ConclusionCampaigns against IPV should be strengthened, especially in the North-Western and Southern parts of Rwanda. In addition, the promotion of girl-child education and empowerment of women can potentially reduce IPV against women and girls. Furthermore, couples should be trained on making financial decisions together. In conclusion, the implementation of policies and interventions that discourage alcohol consumption and control behaviour, especially among men, should be rolled out.
more »
« less
- Award ID(s):
- 2015425
- PAR ID:
- 10516812
- Publisher / Repository:
- Springer Nature
- Date Published:
- Journal Name:
- BMC Public Health
- Volume:
- 23
- Issue:
- 1
- ISSN:
- 1471-2458
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
More Like this
-
-
Abstract BackgroundIn Rwanda, nearly a third of contraceptive users discontinue within the first year of use. Family planning programs often focus more on recruitment of new users as opposed to maintaining use among current users. A focus on sustaining users and minimizing discontinuation is imperative for long-term family planning program success. This study explores the efforts providers and contraceptive users in Rwanda employ to prevent one of the greatest challenges to family planning programs: contraceptive discontinuation. MethodsThis was a qualitative study conducted in Rwanda between February and July 2018. It included eight focus group discussions with 88 family planning providers and 32 in-depth interviews with experienced modern contraceptive users. Data were collected in two districts with the highest (Musanze) and lowest (Nyamasheke) rates of contraceptive use. Data were analyzed using thematic content approach. ResultsFamily planning providers in this study used the following strategies to prevent discontinuation: counseling new users on the potential for side effects and switching, reminding clients about appointments for resupply, as well as supporting dissatisfied users by providing counseling, medicine for side effects, and discussing options for switching methods. Users, on the other hand, employed the following strategies to prevent discontinuation: having an understanding that experiences of side effects vary by individuals, supporting peers to sustain use, persisting with use despite experiences of side effects, and switching methods. ConclusionsThe strategies used by family planning providers and users in Rwanda to prevent discontinuation suggest the possibility of long-term sustained use of contraception in the country. Harnessing and supporting such strategies could contribute to sustaining or improving further contraceptive use in the country.more » « less
-
“We'll make it work”: Navigating surveilled living arrangements after romantic partner incarcerationAbstract ObjectiveWe use the case of housing insecurity to examine how romantic partner incarceration results in increased and prolonged surveillance of women at home. BackgroundRomantic partner incarceration prompts surveillance from the criminal legal system while simultaneously eroding women's finances, health, and family relationships. Less is known about how these symbiotic harms of romantic partner incarceration enable surveillance beyond the criminal legal system. MethodWe use longitudinal interviews with 35 (previously coresident) romantic partners of incarcerated men, showing how incarceration prompts unwanted moves for partners, how women manage housing insecurity following partner incarceration, and how they become embedded into living arrangements where they are monitored, evaluated, and controlled. ResultsWe identify three primary findings. First, women experiencing housing insecurity after romantic partner incarceration relied heavily on their social ties (and, to a lesser extent, institutional housing providers) while enduring stressful and prolonged housing searches. Second, the homes that women move into expose them to increased surveillance. Women encounter domestic, caregiving, romantic, and financial surveillance. Romantic partner incarceration prompts large changes in surveillance among women who left independent homes, moderate changes in surveillance among women who left comparatively desirable doubled‐up homes, and prolonged surveillance among nonmovers. Finally, women respond to surveillance by monitoring burdens on hosts and reframing stays in shared homes as temporary. ConclusionTaken together, these findings extend prior research on the symbiotic harms of romantic partner incarceration, how women attached to incarcerated men experience surveillance, and how doubled‐up families sustain shared homes.more » « less
-
Research suggests that Indigenous girls, women, and LGBTQ+ Two-Spirit people experience disproportionately high rates of intimate partner violence (IPV), but there is a dearth of research on IPV among Indigenous college students. Therefore, the current study sought to explore rates of IPV victimization and perpetration among Indigenous college students, as well as correlates including depressive and anxious symptoms, emotion dysregulation, on-campus social support, and hazardous drinking. Participants were 230 undergraduate students who identified as American Indian/Alaska Native attending 20 medium- and large-sized universities across the contiguous U.S. Results indicated that 28.9% of Indigenous students reported any type of IPV victimization in the past 6 months (psychological: 24.5%; physical: 9.1%; sexual: 9.8%; coercive control: 12.4%). Further, 18.3% of Indigenous students reported any type of IPV perpetration in the past 6 months (psychological: 16.9%; physical: 4.5%; sexual: 2.6%; coercive control: 7.1%). Anxious and depressive symptoms were related to many forms of IPV victimization; emotion dysregulation was related to all forms of IPV victimization and sexual IPV perpetration; and hazardous drinking was related to most forms of IPV victimization and perpetration. These findings underscore the alarmingly high rates of IPV among Indigenous college students as well as the potential deleterious effects of IPV victimization on psychological functioning, as well as the need to concurrently address hazardous alcohol use in IPV prevention and response efforts.more » « less
-
Abstract BackgroundHIV/AIDS remains a major public health problem globally. The majority of people living with HIV are from Sub-Saharan Africa, particularly adolescent girls and young women (AGYW) aged 15-24 years. HIV testing is crucial as it is the gateway to HIV prevention, treatment, and care; therefore this study determined the prevalence and factors associated with self-reported HIV testing among AGYW in Rwanda. MethodsWe conducted secondary data analysis on the AGYW using data extracted from the nationally representative population-based 2019/2020 cross-sectional Rwanda Demographic and Health Survey (DHS). We described the characteristics of study participants and determined the prevalence of HIV testing and associated factors using the multivariable logistic regression model. We adjusted all our analyses for unequal sampling probabilities using survey weights. ResultsThere were a total of 5,732 AGYW, with the majority (57%) aged 15-19 years, 83% were not living with a man, 80% were from rural areas, 29% were from the East region, and 20% had a history of pregnancy. Self-reported HIV testing prevalence was 55.4% (95%CI: 53.7 to 57.0%). The odds of ever having an HIV test were significantly higher for those aged 20-24 years (aOR 2.87, 95%CI: 2.44 to 3.37); with higher education (aOR 2.41, 95%CI:1.48 to 3.93); who were rich (aOR 2.06, 95%CI:1.57 to 2.70); with access to at least one media (aOR 1.64, 95%CI: 1.14 to 2.37); who had ever been pregnant (aOR 16.12, 95%CI: 9.60 to 27.07); who ever had sex (aOR 2.40, 95%CI: 1.96 to 2.95); and those who had comprehensive HIV knowledge (aOR 1.34, 95%CI: 1.17 to 1.54). ConclusionsWe report an unmet need for HIV testing among AGYW in Rwanda. We recommend a combination of strategies to optimize access to HIV testing services, especially among the 15-19 years adolescent girls, including facility-based testing, school and community outreach, awareness campaigns on HIV testing, and home-based testing through HIV self-testing.more » « less
An official website of the United States government

