Institute of Health Science, School of Public Health, Department of Epidemiology, Jigjiga University, P.O.Box: 1020, Jigjiga, Ethiopia.
School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
BMC Womens Health. 2024 Oct 29;24(1):581. doi: 10.1186/s12905-024-03427-y.
Female Genital Mutilation/Cutting (FGM/C) is a form of gender-based violence that has negative health consequences. The decision to perform FGM/C is often made collectively and a variety of actors influence the decision. There is inconsistent and inconclusive evidence that health education interventions lead behavioural changes related to FGM/C among key decision-makers. Therefore, the aim of this systematic review and meta-analysis was to examine the effectiveness of health education interventions on decision-makers intentions not to perform FGM/C in the future.
A systematic review and meta-analysis were performed according to the Preferred Item for Systematic Review and Meta-analysis (PRISRMA) guideline. Studies were obtained from databases such as PubMed, Google Scholar, EMBASE, CINAHL, Cochrane, African Journals Online and relevant lists of identified studies (interventional studies related to FGM/C among key decision-makers). Unpublished sources and organizational websites were also searched for relevant articles. The quality of studies was assessed using the Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project's. The meta-analysis was carried out using STATA.17 and Review Manager 5.3 software. Heterogeneity and publication bias were assessed using the I statistic and funnel plot, respectively. The pooled effect size with a 95% confidence interval was presented using a forest plot and random effect model.
This meta-analysis included nineteen studies with a total of 13,326 study participants. The overall pooled relative risk of intention not to perform FGM/C in the future was 1.55 (95% CI;1.24, 1.94). In the subgroup analysis, the effect of health education on intention not to perform in the future was higher in studies that used both health education and other interventions (RR = 3.75, 95% CI; 2.04, 6.88) compared to those using only health education (RR = 1.35, 95% CI; 0.95, 1.92). Studies with longer intervention duration (above 12 months) had a greater effect on intention not to perform (RR = 1.34, 95% CI; 0.86, 2.09) compared to studies with a short intervention period (6-12 months) (RR = 1.14, 95% CI; 0.61, 2.15).
This review examined the impact of health education on key decisions-makers' intention not to perform FGM/C in the future. Although the pooled effect size estimate may have been influenced by heterogeneity, the results suggest that education about FGM/C has a positive influence on the intentions of key decision-makers. It is recommended that health education interventions target local decision-makers such as religious and clan leaders and include them in initiatives aimed at preventing and eliminating FGM/C.
CRD42024542541.
女性外阴残割/切割（FGM/C）是一种基于性别的暴力形式，会对健康产生负面影响。进行 FGM/C 的决定通常是集体做出的，各种行为者都会影响这个决定。有不一致和不确定的证据表明，健康教育干预措施可以导致关键决策者在与 FGM/C 相关的行为上发生变化。因此，本系统评价和荟萃分析的目的是研究健康教育干预措施对未来不进行 FGM/C 的决策者意图的有效性。
根据系统评价和荟萃分析的首选项目（PRISRMA）指南进行系统评价和荟萃分析。研究从 PubMed、Google Scholar、EMBASE、CINAHL、Cochrane、African Journals Online 和已确定研究的相关列表（与关键决策者有关的 FGM/C 干预研究）等数据库中获取。还搜索了未发表的来源和组织网站，以获取相关文章。使用有效公共卫生实践项目的定量研究质量评估工具评估研究质量。使用 STATA.17 和 Review Manager 5.3 软件进行荟萃分析。使用 I 统计量和漏斗图分别评估异质性和发表偏倚。使用森林图和随机效应模型呈现具有 95%置信区间的汇总效应大小。
这项荟萃分析包括 19 项研究，共有 13326 名研究参与者。未来不进行 FGM/C 的总体综合相对风险为 1.55（95%置信区间：1.24，1.94）。在亚组分析中，与仅接受健康教育的研究（RR=1.35，95%CI：0.95，1.92）相比，同时接受健康教育和其他干预措施的研究对未来不进行的意图的影响更高（RR=3.75，95%CI：2.04，6.88）。与干预时间短（6-12 个月）的研究相比，干预时间较长（超过 12 个月）的研究对未来不进行的意图的影响更大（RR=1.34，95%CI：0.86，2.09）。
本综述考察了健康教育对未来不进行 FGM/C 的关键决策者意图的影响。尽管汇总效应大小估计可能受到异质性的影响，但结果表明，关于 FGM/C 的教育对关键决策者的意图有积极影响。建议健康教育干预措施以当地决策者（如宗教和族裔领袖）为目标，并将他们纳入旨在预防和消除 FGM/C 的举措中。
PROSPERO 注册号：CRD42024542541。
