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调查前五年内分娩的坦桑尼亚女性中女性生殖器切割的患病率及相关因素:一项基于人群的研究。

Prevalence and factors associated with female genital mutilation/cutting among Tanzanian women who gave birth in the five years prior to the survey: A population-based study.

作者信息

Moshi Fabiola Vincent

机构信息

Department of Clinical Nursing, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania.

出版信息

PLoS One. 2024 Dec 30;19(12):e0310337. doi: 10.1371/journal.pone.0310337. eCollection 2024.

Abstract

BACKGROUND

Female Genital Mutilation/Cutting (FGM/C) poses a significant public health challenge in developing countries, leading to increased risks of adverse obstetric outcomes such as caesarean section, postpartum hemorrhage, episiotomy, difficult labor, obstetric tears/lacerations, instrumental delivery, prolonged labor, and extended maternal hospital stays. The study aimed to determine the prevalence and factors associated with FGM/C among Tanzanian women who had given birth within five years preceding the Survey.

METHOD

This study utilized an analytical cross-sectional design based on data from the 2015-2016 Tanzania Demographic and Health Survey and Malaria Indicators Survey (TDHS-MIS). A total of 5,777 women who had given birth within the five years preceding the survey and who provided responses to questions regarding female circumcision were included in the analysis. Descriptive analysis was employed to examine the prevalence of FGM/C among women in Tanzania. Additionally, multiple logistic regression was used to identify factors associated with FGM/C within this population.

RESULTS

The prevalence of FGM/C was 12.1% at 95%CI of 11.3% to 13%. Factors associated with FGM/C were marital status [married (AOR = 3.141 at 95%CI = 1.757-5.616,p<0.001), living with male partners (AOR = 2.001 at 95%CI = 1.082-3.699, p = 0.027), widowed (AOR = 2.922 at 95%CI = 1.201-7.111, p = 0.03)] never in union a reference population; wealth index [poorest (AOR = 2.329 at 95% CI = 1.442-3.763, p = 0.001), middle (AOR = 1.722 at 95% CI = 1.075-2.758, p = 0.024), richer (AOR = 1.831 at 95%CI = 1.205-2.781, p = 0.005)] in reference to richest women; zones [Northern zone, (AOR = 91.787 at 95%CI = 28.41-296.546, p<0.001), central zone, (AOR = 215.07 at 95%CI = 67.093-689.423,p<0.001), southern highlands, (AOR = 12.005 at 95% CI = 3.49-41.298, p<0.001), lake zone (AOR = 13.927 at 95%CI = 4.338-44.714,p<0.001), eastern zone, (AOR = 24.167 at 95% CI = 7.299-80.017, p<0.001)]; place of childbirth [outside health facility (AOR = 1.616 at 95%CI = 1.287-2.03, p<0.001)] in reference to health facility childbirth; parity [para 5+ (AOR = 2.204 at 95% CI = 1.477-3.288,p<0.001)] para one a reference population; and opinion on whether FGM/C stopped or continued [continued (AOR = 8.884 at 95% CI = 5.636-14.003, p<0.001).

CONCLUSION

This study underscores the persistent issue of FGM/C in Tanzania, particularly among married women, those from lower-income households, and those living in regions with high prevalence. Women giving birth outside health facilities and those with multiple children are at higher risk. The study emphasizes the need for targeted interventions addressing socio-cultural factors, alongside providing legal, healthcare, and psychological support to those affected. Educational campaigns and community engagement, especially with traditional and religious leaders, are crucial for challenging cultural beliefs and reducing FGM/C's prevalence.

摘要

背景

女性生殖器切割在发展中国家构成了重大的公共卫生挑战,导致剖宫产、产后出血、会阴切开术、难产、产科撕裂伤、器械助产、产程延长和产妇住院时间延长等不良产科结局的风险增加。该研究旨在确定在调查前五年内分娩的坦桑尼亚女性中女性生殖器切割的患病率及其相关因素。

方法

本研究采用基于2015 - 2016年坦桑尼亚人口与健康调查及疟疾指标调查(TDHS - MIS)数据的分析性横断面设计。共有5777名在调查前五年内分娩且对女性割礼问题作出回应的女性纳入分析。采用描述性分析来研究坦桑尼亚女性中女性生殖器切割的患病率。此外,使用多元逻辑回归来确定该人群中与女性生殖器切割相关的因素。

结果

女性生殖器切割的患病率为12.1%,95%置信区间为11.3%至13%。与女性生殖器切割相关的因素包括婚姻状况[已婚(95%置信区间为1.757 - 5.616时比值比 = 3.141,p < 0.001),与男性伴侣同住(95%置信区间为1.082 - 3.699时比值比 = 2.001,p = 0.027),丧偶(95%置信区间为1.201 - 7.111时比值比 = 2.922,p = 0.03)],从未结婚为参照人群;财富指数[最贫困(95%置信区间为1.442 - 3.763时比值比 = 2.329,p = 0.001),中等(95%置信区间为1.075 - 2.758时比值比 = 1.722,p = 0.024),较富裕(95%置信区间为1.205 - 2.781时比值比 = 1.831,p = 0.005)],以最富裕女性为参照;地区[北部地区(95%置信区间为28.41 - 296.546时比值比 = 91.787,p < 0.001),中部地区(95%置信区间为67.093 - 689.423时比值比 = 215.07,p < 0.001),南部高地(95%置信区间为3.49 - 41.298时比值比 = 12.005,p < 0.001),湖区(95%置信区间为4.338 - 44.714时比值比 = 13.927,p < 0.001),东部地区(95%置信区间为7.299 - 80.017时比值比 = 24.167,p < 0.001)];分娩地点[在医疗机构外分娩(95%置信区间为1.287 - 2.03时比值比 = 1.616,p < 0.001)],以在医疗机构分娩为参照;产次[5次及以上(95%置信区间为1.477 - 3.288时比值比 = 2.204,p < 0.001)],产次为1次为参照人群;以及对女性生殖器切割是否停止或继续的看法[继续(95%置信区间为5.636 - 14.003时比值比 = 8.884,p < 0.001)]。

结论

本研究强调了坦桑尼亚女性生殖器切割这一持续存在的问题,特别是在已婚女性、低收入家庭女性以及高患病率地区的女性中。在医疗机构外分娩的女性和多子女女性风险更高。该研究强调需要针对社会文化因素进行有针对性的干预,同时为受影响者提供法律、医疗和心理支持。开展教育活动和社区参与,特别是与传统和宗教领袖合作,对于挑战文化观念和降低女性生殖器切割的患病率至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/115e/11684563/0a3b62b6bddd/pone.0310337.g001.jpg

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