Kandala Ngianga-Bakwin, Ezejimofor Martinsixtus C, Uthman Olalekan A, Komba Paul
Department of Mathematics, Physics and Electrical Engineering, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK.
Division of Epidemiology and Biostatistics, University of the Witwatersrand, School of Public Health, Johannesburg, South Africa.
BMJ Glob Health. 2018 Nov 6;3(5):e000549. doi: 10.1136/bmjgh-2017-000549. eCollection 2018.
Current evidence on the decline in the prevalence of female genital mutilation or cutting (FGM/C) has been lacking worldwide. This study analyses the prevalence estimates and secular trends in FGM/C over sustained periods (ie, 1990-2017). Its aim is to provide analytical evidence on the changing prevalence of FGM/C over time among girls aged 0-14 years and examine geographical variations in low-income and middle-income countries.
Analysis on the shift in prevalence of FGM/C was undertaken using the Demographic Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) data sets from Africa and Middle East. A random-effects model was used to derive overall prevalence estimates. Using Poisson regression models, we conducted time trends analyses on the FGM/C prevalence estimates between 1990 and 2017.
We included 90 DHS and MICS data sets for 208 195 children (0-14 years) from 29 countries spread across Africa and two countries in Western Asia. The prevalence of FGM/C among children varied greatly between countries and regions and also within countries over the survey periods. The percentage decline in the prevalence of FGM/C among children aged 0-14 years old was highest in East Africa, followed by North and West Africa. The prevalence decreased from 71.4% in 1995 to 8.0% in 2016 in East Africa. In North Africa, the prevalence decreased from 57.7% in 1990 to 14.1% in 2015. In West Africa, the prevalence decreased from 73.6% in 1996 to 25.4% in 2017. The results of the trend analysis showed a significant shift downwards in the prevalence of FGM/C among children aged 0-14 years in such regions and subregions of East Africa, North Africa and West Africa. East Africa has experienced a much faster decrease in the prevalence of the practice (trend=-7.3%, 95% CI -7.5% to -7.1%) per year from 1995 to 2014. By contrast, the decline in prevalence has been much slower in North Africa (trend=-4.4%, 95% CI -4.5% to -4.3%) and West Africa (trend=-3.0%, 95% CI -3.1% to -2.9%).
The prevalence of FGM/C among children aged 0-14 years varied greatly between countries and regions and also within countries over the survey periods. There is evidence of huge and significant decline in the prevalence of FGM/C among children across countries and regions. There is a need to sustain comprehensive intervention efforts and further targeted efforts in countries and regions still showing high prevalence of FGM/C among children, where the practice is still pervasive.
全球范围内一直缺乏关于女性生殖器切割（FGM/C）流行率下降的现有证据。本研究分析了FGM/C在较长时期（即1990 - 2017年）的流行率估计及长期趋势。其目的是提供关于0至14岁女孩中FGM/C流行率随时间变化的分析证据，并研究低收入和中等收入国家的地理差异。
利用来自非洲和中东的人口与健康调查（DHS）以及多指标类集调查（MICS）数据集，对FGM/C流行率的变化进行分析。采用随机效应模型得出总体流行率估计值。利用泊松回归模型，我们对1990年至2017年期间FGM/C流行率估计值进行了时间趋势分析。
我们纳入了来自非洲29个国家和西亚两个国家的90个DHS和MICS数据集，涉及208195名儿童（0 - 14岁）。在调查期间，各国和各地区以及国家内部儿童中FGM/C的流行率差异很大。0至14岁儿童中FGM/C流行率下降百分比在东非最高，其次是北非和西非。东非的流行率从1995年的71.4%降至2016年的8.0%。在北非，流行率从1990年的57.7%降至2015年的14.1%。在西非，流行率从1996年的73.6%降至2017年的25.4%。趋势分析结果显示，在东非、北非和西非等地区和次区域，0至14岁儿童中FGM/C的流行率出现了显著下降。从1995年到2014年，东非该做法的流行率下降速度要快得多（趋势 = -7.3%，95%置信区间 -7.5%至 -7.1%）。相比之下，北非（趋势 = -4.4%，95%置信区间 -4.5%至 -4.3%）和西非（趋势 = -3.0%，95%置信区间 -3.1%至 -2.9%）的流行率下降速度要慢得多。
在调查期间，各国和各地区以及国家内部0至14岁儿童中FGM/C的流行率差异很大。有证据表明，各国和各地区儿童中FGM/C的流行率大幅显著下降。对于儿童中FGM/C流行率仍然较高且该做法仍然普遍存在的国家和地区，有必要持续开展全面干预措施并进一步进行有针对性的努力。
Zotero 插件