Northumbria University, Newcastle, United Kingdom.
Nnamdi Azikiwe University, Awka, Nigeria.
PLoS One. 2021 Feb 12;16(2):e0246661. doi: 10.1371/journal.pone.0246661. eCollection 2021.
Female genital mutilation/cutting (FGM/C) is considered a public health and human rights concern, mainly concentrated in Africa, and has been targeted for elimination under the sustainable development goals. Interventions aimed at ending the practice often rely on data from household surveys which employ complex designs leading to outcomes that are not totally independent, thus requiring advanced statistical techniques. Combining data from multiple surveys within robust statistical framework holds promise to provide more precise estimates due to increased sample size, and accurately identify 'hotspots' and allow for assessment of changes over time. In this study, rich datasets from six (6) successive waves of the Nigeria Demographic and Health Surveys and Multiple Indicator Cluster Surveys undertaken between 2003 and 2016/17, were combined and analyzed in order to better assess changes in the likelihood and prevalence of FGM/C among 0-14-year old girls in Nigeria. We used Bayesian hierarchical regression models which explicitly accounted for the inherent spatial and temporal autocorrelations within the data while simultaneously adjusting for variations due to different survey methods and the effects of linear and non-linear covariates. Parameters were estimated using Markov chain Mote Carlo techniques and model fit assessments were based on Deviance Information Criterion. Results show that prevalence of FGM/C among 0-14 years old girls in Nigeria varied over time and across geographical locations and peaked in 2008 with a shift from South to North. A girl was more likely to be cut if her mother was cut, supported FGM/C continuation, or had no higher education. The effects of mother's age, wealth and type of residence (urban-rural) were no longer significant in 2016. These results reflect the gains of interventions over the years, but also echo the belief that FGM/C is a social norm thus requiring tailored all-inclusive interventions for the total abandonment of FGM/C in Nigeria.
女性生殖器官切割是一个公共卫生和人权问题，主要集中在非洲，并已被确定为可持续发展目标下需要消除的问题。旨在结束这种做法的干预措施通常依赖于家庭调查数据，这些数据采用复杂的设计，导致结果并非完全独立，因此需要先进的统计技术。在稳健的统计框架内合并来自多个调查的数据有望提供更精确的估计，因为样本量增加，并且可以准确识别“热点”并允许评估随时间的变化。在这项研究中，我们合并和分析了来自尼日利亚人口与健康调查和多指标类集调查的六个连续波次的丰富数据集，以更好地评估尼日利亚 0-14 岁女孩中女性生殖器官切割的可能性和流行率的变化。我们使用贝叶斯层次回归模型，该模型明确考虑了数据中的固有空间和时间自相关，同时调整了由于不同的调查方法以及线性和非线性协变量的影响而导致的变化。参数使用马尔可夫链蒙特卡罗技术进行估计，模型拟合评估基于偏差信息准则。结果表明，尼日利亚 0-14 岁女孩中女性生殖器官切割的流行率随时间和地理位置而变化，并在 2008 年达到峰值，从南部转移到北部。如果母亲被切割、支持女性生殖器官切割的继续或没有更高的教育，则女孩更有可能被切割。母亲的年龄、财富和居住类型（城乡）的影响在 2016 年不再显著。这些结果反映了多年来干预措施的成效，但也反映了女性生殖器官切割是一种社会规范的信念，因此需要有针对性的、包容各方的干预措施，才能在尼日利亚完全放弃女性生殖器官切割。
