Public Health Emergency Management (PHEM) Directorate, Amhara Public Health Institute (APHI), Bahir Dar, Ethiopia.
School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
BMC Public Health. 2021 Jan 21;21(1):186. doi: 10.1186/s12889-021-10235-8.
Female genital mutilation/cutting (FGM/C) is a harmful traditional practice that violates the human rights of girls and women. It is widely practiced mainly in Africa including Ethiopia. There are a number of studies on the prevalence of FGM/C in Ethiopia. However, little has been devoted to its spatial epidemiology and associated factors. Hence, this study aimed to explore the spatial pattern and factors affecting FGM/C among girls in Ethiopia.
A further analysis of the 2016 Ethiopia Demographic and Health Survey data was conducted, and a total of 6985 girls nested in 603 enumeration areas were included in this analysis. Global Moran's I statistic was employed to test the spatial autocorrelation, and Getis-Ord Gi* as well as Kulldorff's spatial scan statistics were used to detect spatial clusters of FGM/C. Multilevel logistic regression models were fitted to identify individual and community level factors affecting FGM/C.
Spatial clustering of FGM/C was observed (Moran's I = 0.31, p-value < 0.01), and eight significant clusters of FGM/C (hotspots) were detected. The most likely primary SaTScan cluster was detected in the neighborhood areas of Amhara, Afar, Tigray and Oromia regions (LLR = 279.0, p < 0.01), the secondary cluster in Tigray region (LLR = 67.3, p < 0.01), and the third cluster in Somali region (LLR = 55.5, P < 0.01). In the final best fit model, about 83% variation in the odds of FGM/C was attributed to both individual and community level factors. At individual level, older maternal age, higher number of living children, maternal circumcision, perceived beliefs as FGM/C are required by religion, and supporting the continuation of FGM/C practice were factors to increase the odds of FGM/C, whereas, secondary or higher maternal education, better household wealth, and regular media exposure were factors decreasing the odds of FGM/C. Place of residency, Region and Ethnicity were also among the community level factors associated with FGM/C.
In this study, spatial clustering of FGM/C among girls was observed in Ethiopia, and FGM/C hotspots were detected in Afar, Amhara, Tigray, Benishangul Gumuz, Oromia, SNNPR and Somali regions including Dire Dawa Town. Both individual and community level factors play a significant role in the practice of FGM/C. Hence, FGM/C hotspots require priority interventions, and it is also better if the targeted interventions consider both individual and community level factors.
女性生殖器切割是一种有害的传统习俗，侵犯了女孩和妇女的人权。它主要在非洲国家包括埃塞俄比亚广泛实施。已经有许多关于埃塞俄比亚女性生殖器切割流行情况的研究。然而，很少有研究致力于其空间流行病学及其相关因素。因此，本研究旨在探讨埃塞俄比亚女孩中女性生殖器切割的空间模式和影响因素。
对 2016 年埃塞俄比亚人口与健康调查数据进行进一步分析，共纳入 6985 名嵌套在 603 个普查区的女孩。采用全局 Moran's I 统计量检验空间自相关，采用 Getis-Ord Gi*和 Kulldorff 空间扫描统计量检测女性生殖器切割的空间聚类。采用多水平逻辑回归模型确定影响女性生殖器切割的个体和社区水平因素。
观察到女性生殖器切割的空间聚类（Moran's I=0.31，p 值<0.01），并检测到 8 个显著的女性生殖器切割热点集群。最有可能的原发性 SaTScan 集群位于阿姆哈拉、阿法尔、提格雷和奥罗米亚地区的邻近地区（LLR=279.0，p<0.01），二级集群位于提格雷地区（LLR=67.3，p<0.01），三级集群位于索马里地区（LLR=55.5，P<0.01）。在最终最佳拟合模型中，女性生殖器切割的可能性约有 83%归因于个体和社区水平因素。在个体水平上，母亲年龄较大、生育子女数量较多、母亲割礼、认为女性生殖器切割是宗教所要求的、支持继续实施女性生殖器切割的信念，以及增加女性生殖器切割可能性的因素，而母亲接受中等或高等教育、家庭财富状况较好、定期接触媒体则是降低女性生殖器切割可能性的因素。居住地、地区和民族也是与女性生殖器切割相关的社区水平因素。
本研究观察到埃塞俄比亚女孩中女性生殖器切割的空间聚类，在阿法尔、阿姆哈拉、提格雷、本尚古勒-古姆兹、奥罗莫、南方各族州和索马里地区包括德雷达瓦市发现了女性生殖器切割热点。个体和社区水平因素都在女性生殖器切割的实践中发挥着重要作用。因此，女性生殖器切割热点需要优先干预，如果有针对性的干预措施同时考虑到个体和社区水平因素，则效果更好。
