Abstract This qualitative study explores the contraceptive use behaviours among women with disabilities in low-resource settings in Ghana, a group whose reproductive health needs are often overlooked in mainstream family planning programmes. Sixteen women with visual, physical, and hearing impairments in Apam, Central Region, were purposively selected to participate in semi-structured in-depth interviews conducted in their preferred languages, including Ghanaian Sign Language. Reflexive thematic analysis was used to identify key patterns in the data, revealing four main themes: (1) pathways for acquiring contraceptive knowledge, which included institutional outreach, maternal health visits, and informal peer networks; (2) determinants of non-utilisation, such as fear of side effects, religious stigma, and the desire to have children for future caregiving support; (3) drivers of modern contraceptive uptake, including the pursuit of educational and vocational goals, partner support, and the desire to prevent obstetric trauma; and (4) structural and systemic health inequalities, characterised by communication barriers, inaccessible physical infrastructure, and inconsistent provider attitudes. The findings advance scientific knowledge by moving beyond a simple narrative of unmet need to illustrate how women with disabilities exercise reproductive agency within a complex landscape of intersecting personal, social, and structural constraints. The novel findings highlight the dual role of informal networks in disseminating both accurate information and persistent myths, as well as the nuanced ways in which fertility is viewed as a long-term survival strategy in the absence of robust social support. These insights inform policy by underscoring the urgent need for disability-inclusive family planning services. This requires a multi-pronged approach that includes accessible communication through sign language interpretation, disability-sensitivity training for healthcare workers, retrofitting health facilities to improve physical access, and linking contraceptive services with broader social protection programmes to address the root causes of non-use.
Single childhood is a growing social phenomenon in Iran that occurs under the influence of various factors that need to be identified. Therefore, the current research was conducted to explain the reasons behind only single children in Western Iran. This qualitative research was conducted using a conventional qualitative content analysis approach in Lorestan province, western Iran. The study participants were parents with one child who no longer wanted to have more children. Key informants were also involved in the study. To identify participants, purposive and snowball sampling were used. Data were collected through semi-structured interviews with 29 couples with one child and seven key informants until saturation was reached. Data analysis was conducted using the Graneheim and Lundman qualitative content analysis approach with the assistance of MAXQDA software (version 2020). Analysis of the interviews obtained four categories, 16 subcategories, and 205 initial codes. The main categories were (1) past negative experiences (concerns about the mother and child's health, negative experiences with the first child), (2) weak support systems (lack of a supportive environment, dissatisfaction with married life), (3) changing social discourses on childbearing and parenting (spread of individualism, normalization of single-childing in society, considering having a child as more of a limitation, formation of new gender attitudes among women, changes in parental expectations of children, fading of religious beliefs encouraging childbearing, idealism in child-rearing, increased knowledge and access to contraceptives), and (4) inability to overcome challenges (financial challenges, lack of a suitable living environment, social hopelessness, missing opportunities for re-parenthood). Single-child families represent a complex phenomenon driven by a multitude of factors, necessitating interventions at the individual, family, and societal levels to address it. Enhancing financial support, expanding social welfare programmes, emphasizing religious norms that encourage childbearing, strengthening family bonds, and providing appropriate parenting models can potentially increase fertility intentions and behaviours.
The notion of 'urban exposome' brings promise to the public health and epidemiology fields of inquiry, particularly within research projects conducted within birth cohorts. However, it is also challenging. The present paper addresses how combining qualitative methods with numerical data on exposures and health outcomes may help to fulfil that promise while posing important challenges to researchers. Quantitative methods based on Geographic Information System and other geo-technologies establish the linkage between participants' residential locations and geospatial datasets, generating many quantitative measurements of environmental exposures throughout participants' life course since birth. Yet, abstracted quantitative measurements alone do not capture lived experiences and do not allow for a rich inquiry about the complex and situated webs of social, physical, and biological phenomena that shape their bodies. Qualitative approaches may enhance quantitative data collected from sensors, blood samples, and physical examinations. These methods help to uncover, with depth and nuance, how individuals build meaning, navigate their surroundings, and how their complex contexts shape their lives and health, strengthening epidemiological evidence. In other words, they may help produce more data points and provide context, thus improving the interpretation of quantitative measurements. Besides, some of these methods promote reflection, collective discussion, and community empowerment. By integrating quantitative and qualitative approaches, researchers can obtain a more holistic and contextualised understanding of the external urban exposome. Multi-methods and mixed-methods approaches may strengthen the validity of findings, improve the interpretability of results, generate new hypotheses, and support the development of place-based interventions. Nevertheless, integrating quantitative and qualitative approaches may raise several challenges related to epistemological and ontological tensions, different scientific practices, ethical compliance, and the training of research teams. Concluding, the combined use of quantitative and qualitative methods in measuring the external urban exposome within cohort studies offers a powerful approach to understanding the complex interplay between urban environments and health outcomes.
Food insecurity (FI), defined as unreliable access to sufficient, safe, and nutritious food, affects nearly 10 million people in the UK. However, official statistics often exclude individuals relying on informal or non-referral-based food support, rendering their experiences largely invisible. This study explores how users and volunteers experience and interpret FI in charity-run, community-based food aid settings across England, an area under-represented in UK studies which are dominated by formal, referral-based food bank models. This qualitative study employed a hermeneutic phenomenological approach to understand the lived experiences of FI. Nineteen semi-structured interviews were conducted with a purposive sample of food bank users (n = 10) and volunteers (n = 9). Interviews were transcribed verbatim and analysed using reflexive thematic analysis (TA). The socio-ecological model (SEM) was used to structure analysis across five levels: individual, interpersonal, institutional, community, and policy levels. Five interconnected themes emerged across the socio-ecological model: (1) Individual: Mental Health, Stigma and Shame; (2) Interpersonal: Caregiving Responsibilities and Sacrifice; (3) Institutional: Chronic Food Aid Reliance and Nutritional Constraints; (4) Community: Informal Networks and Support; and (5) Public Policy: Welfare Inadequacy and Political Neglect. Volunteers also played a mediating role between systems and individuals, navigating logistical burdens and emotional labour. The findings highlight the multidimensional and structured nature of FI in the UK and offer new insights into how dignity, autonomy, and nutritional adequacy are negotiated within informal food support systems. The study calls for more sustainable, community-responsive food aid models and structural policy reforms addressing poverty, inequality, and the legal right to food.
This study examines how China's former one-child policy has shaped fertility attitudes among the Chinese diaspora in the United States. Through semi-structured qualitative interviews with thirty reproductive-age women of Chinese descent, either born in China or first-generation immigrants to the United States, this study explored opinions towards the policy, self-reported impact on reproductive decision-making, and attitudes towards family size. Participants were recruited from an internet-based survey distributed through cultural groups on social media, paper flyers, and email listservs. Interviews were analysed using the principle of thematic analysis by three authors, who met after coding to resolve disagreements. The mean age of participants was 33. Six participants (20%) used an interpreter. Eighteen participants (60%) were born in China. The range of pregnancies was 0-5, and the range of births was 0-2. Authors found that while participants were no longer directly constrained by the one-child policy, many continued to demonstrate preferences for fewer children. Financial strains, resource allocation, societal shame, and internalised social norms emerged as key themes. These themes echo messages promoted during the one-child policy era through propaganda and enforcement measures, such as audits of family registrations, rewards for compliant families, fines, mandatory IUDs, or sterilisations for noncompliant ones, and even forced abortions for 'unauthorized' pregnancies. These messages reinforced that small families were more appropriate. These findings suggest a lasting cultural shift towards fewer children as a result of the policy, even after emigration. They also carry theoretical implications towards understanding the long-term social and psychological consequences of reproductive mandates and the generational transmission of policy-shaped fertility norms. This study offers a perspective for nations currently implementing pronatalist fertility regulations. These findings highlight the role of historical policies in shaping contemporary reproductive perspectives, family dynamics, and potentially, engagement with medicine beyond geographic, political, and temporal boundaries.
What can be learned about pandemic preparedness from greater attention to perspectives of people who live in regions labelled as 'hotspots' for disease outbreaks? And how might such attention require us to reconfigure science, policy, and practice - as part of a broader shifting of power in pandemics? These are the questions that motivate and are explored through the papers in this special issue on pandemic preparedness, for which this paper serves as Introduction. All the contributions to this special issue present perspectives, experiences, and reflections from African settings, drawing on research co-designed and conducted in close engagement with local communities or in dialogue with African scientists and public health actors. They approach biosocial questions from the concerns of the disciplinary fields of social, medical, and political anthropology, of engaged interdisciplinary social science, and, crucially, of embedded, 'grassroots' fieldwork by researchers who have grown up with the communities they are studying. The team bringing these complementary areas of expertise came together for a collaborative programme on 'Pandemic preparedness: local and global concepts and practices in tackling disease threats in Africa' supported by a collaborative award from the Wellcome Trust during 2018-2023. This special issue thus forms part of wider advocacy for rethinking pandemic preparedness and for the value of anthropology in informing its meanings and practices, now more than ever.
Induced abortions (IAs) constitute a fundamental right contributing to women's reproductive sexual health allowing them to decide whether they wish to avoid, postpone, space, or conclude their motherhood. In this study, fertility control through IA is analysed according to the age combined with the individual and contextual characteristics of the women. Data from the Voluntary Termination of Pregnancy Statistics (Ministry of Health) and the Vital Statistics (Movimiento Natural de la Población, National Statistics Institute) were combined to capture all pregnancy outcomes, including IAs, live births, stillbirths, and late foetal deaths. Binary logistic regression models were applied to each age group (15-19, 20-29, 30-39, and 40-44 years) to calculate the likelihood of opting for an abortion based on whether individuals have a partner, the number of children, and adjusted for other sociodemographic variables. In the early reproductive stages, the probability of opting for an IA was higher in women without a partner than in those with one. In contrast, in the later years of the reproductive cycle, women with two or more children were more likely to opt for an IA, indicating their desire to stop childbearing. The likelihood of opting for an IA varies according to the woman's age. Furthermore, sociodemographic characteristics within each group of age undergo significant changes. A more detailed analysis of the reasons leading to the choice of abortion is necessary. Additionally, this study serves as valuable input for family planning public policies.
Persons with mental illnesses may experience stigma from their immediate family members in addition to other forms of stigma. The researchers used semi-structured interviews to investigate the experiences of familial mental illness stigma among 15 people diagnosed with mental illnesses in a mid-sized city in Canada. Five themes that spoke to participants' experiences of familial mental illness stigma and ways to reduce it were identified by the investigators. The themes included: diagnosis as a 'double-edged sword,' potential familial isolation, familial stigma as societal stigma localized, stories of acceptance and support, and confronting potential familial mental illness stigma. Participants' narratives indicate that familial mental illness stigma is rooted in the broader social or public stigma, which sees its way into familial relations as well. This stigma takes various forms, including relationship bias or unfair treatment, breakdown in romantic relationships, loss of status, verbal and emotional abuse, exclusion from decision-making, and alienation within their immediate and extended families. Familial mental illness stigma experiences negatively impact participant's psychological well-being and personal empowerment. However, participants also shared ways that family members create supportive environments or actively confront or prevent stigma. Overall, this study has contributed to knowledge on mental illness stigma, particularly familial mental illness stigma from the perspective of participants living with a mental illness in a high-income country. Suggestions for future research include a focus on strategies to prevent ongoing familial mental illness stigma, and large-scale studies to explore familial mental illness stigma to understand why families might themselves at times perpetrate stigma.
Self-rated health (SRH) is a validated epidemiological measure that captures an individual's overall health perception and predicts morbidity and mortality. Despite extensive research on SRH among older adults in India, evidence on its transition across the life course remains limited. Using data from 70,595 individuals aged 45 years and above from the Longitudinal Aging Study in India (LASI) 2017-2018, this study examined transitions in SRH from childhood to older adulthood. An adverse SRH trajectory was defined as a shift from good childhood health to poor or fair health in later life. Descriptive, bivariate, and multivariable logistic regression analyses were conducted. Overall, 51% of older adults experienced an adverse SRH trajectory. Higher odds were observed among women (AOR: 1.30), individuals with substance consumption (AOR:1.24), chronic multimorbidity (AOR: 3.37), functional limitations (AOR: 2.03), and depression (AOR: 1.51). Early-life disadvantages - child labour, child marriage, and persistent household poverty - were also significant risk factors. In contrast, higher education and participation in social and physical activities were protective. These findings indicate that an adverse subjective health trajectory is shaped by cumulative life-course exposures rather than ageing alone. Strengthening early-life social investments and community-based wellness initiatives is vital to promote healthy and equitable ageing in India.
This cross-sectional study examines differentials in age at marriage, collecting data from 665 ever-married women in Howrah district, West Bengal, using a mixed-methods approach across three generational cohorts. Quantitative analyses included ANOVA and multinomial logistic regression, complemented by qualitative interviews to contextualize marriage timing. Results revealed a non-linear trajectory of marriage age across generations. Mean age at marriage was 21.4 years, 23.2 years, and 19.5 years in Generation I, Generation II, and Generation III, respectively, with significant differences. MLR results showed respondents in Generation II had higher odds of marrying at ages 19-24 (RRR = 1.5, CI = 0.6-2.7) and ≥25 years (RRR = 1.4, CI = 0.9-4.0), whereas Generation III women had lower odds at ages 19-24 (RRR = 0.3, CI = 0.2-0.9) and ≥25 years (RRR = 0.6, CI = 0.1-0.9), compared to Generation I. Urban women showed delayed marriage at ages 19-24 (RRR = 3.1, CI = 2.6-11.5) and ≥25 years (RRR = 4.5, CI = 2.2-15.5). Higher educated women increased the likelihood of delaying marriage at ages 19-24 (RRR = 1.6, CI = 0.4-1.9) and ≥25 years (RRR = 1.2, CI = 0.8-1.6). Fathers' secondary education was associated with marriage at ages 19-24 (RRR = 1.5, CI = 1.0-2.3) and ≥25 years (RRR = 4.6, CI = 1.3-15.8), and fathers' higher education was associated with marriage at ≥25 years (RRR = 2.6, CI = 1.3-12.8); mothers' secondary education was associated with marriage at ages 19-24 (RRR = 1.7, CI = 1.0-2.9) and ≥25 years (RRR = 3.1, CI = 1.9-12.3), and mothers' higher education was associated with marriage at ≥25 years (RRR = 3.2, CI = 1.6-10.4). Respondents in white-collar jobs were more likely to delay marriage at 19-24 (RRR = 1.5, CI = 0.3-2.0) and ≥25 years (RRR = 1.6, CI = 0.8-3.4). White-collar employment of fathers increased the odds of marriage at ages 19-24 (RRR = 1.7, CI = 0.7-2.1) and ≥25 years (RRR = 1.6, CI = 0.4-2.6) and of mothers at ages 19-24 (RRR = 1.2, CI = 0.4-1.6) and ≥25 years (RRR = 1.1, CI = 0.3-1.9). Women from the upper wealth quintile were more likely to marry at ≥25 years (RRR = 1.2, CI = 0.5-2.8). Muslim women showed significantly less likelihood to marry at ≥25 years (RRR = 0.2, CI = 0.1-0.6). Ethnographic narratives revealed tensions between aspirations for daughters' education and parental anxieties related to employment insecurity, dowry, and premarital relationships, shaping marriage decisions.
This paper examines how past experience and legacies of epidemics shaped Sierra Leone's response to COVID-19 and how these influences evolved over time. COVID-19 unfolded in the wake of the West African Ebola epidemic (2013-2016), a crisis which was unprecedented in scale. Despite differing markedly in both transmission patterns and clinical outcomes, the Sierra Leonean government repeatedly invoked Ebola when responding to COVID-19, framing the new outbreak through the lens of the old. Drawing on ethnographic fieldwork and interviews with policymakers, response personnel, health workers, and members of the public, the paper analyses how Ebola's imprint surfaced across four domains of the COVID-19 response: public and governmental framings, the design and implementation of key control measures, disputes over incentives and hazard pay, and practices of data and testing. It shows that when confronting a new outbreak, the past manifests in diverse ways. The analysis reveals how these 'epidemic pasts' - contained in lessons, memories, legacies, and assumptions - actively constitute 'epidemic presents'; and should be understood as politically mobilised and socially contested, shaping responses in both enabling and constraining ways. As such, it is suggested that past experience has been under-explored in preparedness and response, and that formal 'lessons learned' exercises offer a limited view of how the past is relevant.
Globally, child marriage is a persistent issue, adversely affecting the rights and well-being of girls. With a special focus on religious affiliation, this study explores the contributing factors leading to child marriage, such as cultural norms, religious beliefs, and socioeconomic conditions. From the Census of India 2011 data, percentage distributions of child marriage were used to assess the trends and magnitude of child marriage over the years. From NFHS-5 data, bivariate and multivariate analyses were conducted to assess factors like education and wealth index. Spatial analysis techniques, including Moran's I statistics, helped identify the geographic distribution of child marriage. Findings reveal a history of relatively high child marriage rates among Muslims and their faster decline over the last decades. In 2011, under-14 marriages among Hindus exceeded 1.03% more than that of Muslims, with a 0.33% higher incidence of under-18 marriages among Muslims. The sample-based NFHS-5 study highlights significant disparities in child marriage based on the sample populations' religious affiliations, regions, social categories, education, and wealth. In conclusion, the issue transcends religious boundaries, is rooted in broader social and economic contexts, and advocates for multidimensional interventions.
Despite biomedical explanations for diseases being increasingly accepted in sub-Saharan Africa, traditional African explanatory models of illness remain widespread. This study sought to understand local explanatory models for illness and patient experiences with different traditional health practitioners (THPs) among a population of rural women in Limpopo, South Africa. This was a cross-sectional qualitative study in which eighty-two in-depth interviews were conducted, and the data were thematically analysed. Study findings indicate that 68% of participants believed illnesses can be caused by bewitchment, and these diseases were often considered too taboo to even be discussed. High percentages of participants also believe that THPs can cure illnesses that medical doctors cannot treat. Additionally, several illnesses were identified related to traditional practices and cultural beliefs, which can only be cured traditionally, via THPs. While the hospital/clinic is often first approached, its failure to resolve illness can often be seen as a sign of the spiritual origin of the ailment. This study is a pre-context for more research around biomedical/traditional medicine collaborations.
Sexual-identity disparities in substance use among U.S. veterans, and whether mental-health treatment mitigates risk for those with depression, remain under-examined. Using data on veterans from the 2021-2023 National Survey on Drug Use and Health (NSDUH; N = 7,212), disparities were estimated in past-30-day nicotine, marijuana, binge drinking, and polysubstance use, as well as severe psychological distress (K6≥13) and past-year suicidal ideation. Guided by a biosocial/minority-stress framework, multiple imputation was applied (m = 20) and survey-weighted logistic regression adjusting for age, year, race/ethnicity, sex, education, metro status, insurance, marital status, employment, and income; among veterans with a past-year major depressive episode (MDE), interactions were tested between sexual identity and (a) depression-related clinical contact (DRC) and (b) prescription medication for depressive feelings. Bisexual veterans showed the highest prevalence of marijuana (33.5%) and polysubstance use (30.6%), exceeding that of heterosexual (11.8%, 14.9%) and gay/lesbian veterans (24.0%, 18.8%). Models restricted to veterans with MDE, past-year DRC (DRC defined as any visit or conversation with a health professional about depressive feelings) moderated risk for gay/lesbian veterans, with DRC associated with lower odds of binge drinking and polysubstance use; prescription medication showed a similar moderating pattern for nicotine and polysubstance outcomes. Findings for severe psychological distress and suicidal ideation were mixed and consistent with confounding by indication. Results should be interpreted cautiously given the cross-sectional data, self-report, small sexual-minority subgroups, and non-aligned recall windows (past-year mental health/treatment vs past-30-day substance use). Overall, sexual-identity disparities in substance use are evident, with bisexual veterans bearing the greatest burden, and engagement in DRC and medication among veterans with MDE, particularly gay/lesbian veterans, showing associations consistent with a buffering effect of affirming care. Longitudinal and qualitative studies are needed to test causal pathways and to illuminate lived experiences, and policy/clinical efforts should expand culturally competent, integrated services and routine SOGI data collection to monitor and reduce inequities.
Loneliness and social isolation represent persisent global public health concerns, particurarly for people in later life, with extensive mental, social, and biological consequences. Both have been associated with increased risk of depression, anxiety, dementia, cardiovascular disease, premature mortality, and greater demand for health and social care services. A growing body of evidence indicates that nature-based interventions are effective in reducing loneliness, enhancing mood, and promoting overall well being, yet they still remain underutilised within health and social care strategies; particularly for older adults and those with limited mobility. One such initiative, Cycling Without Age, a grassroots programme, demonstrates the potential of nature-based interventions. Evidence across multiple contexts indicates improvements in mood, life satisfaction, and social connectedness, alongside benefits for families and care staff. Cycling Without Age illustrates a type of scalable, person-centred intervention that could be integrated into healthy ageing strategies. However, rigourous large-scale research remains scarce, which highlights the need for further evaluation to guide policy adoption and sustainable implementation. Effective responses to loneliness and social isolation require integrated support programmes that foster social connectedness and healthy ageing, delivered through coordinated efforts spanning public health, urban design, and community services.
Mortality trends among Indigenous peoples in Brazil remain poorly characterised. An ecological time-series study (2010-2022) was conducted, comparing Indigenous and non-Indigenous populations using nationwide open-access demographic and mortality data. Mortality was stratified by sex, age, and ICD-10 groups, populations were compared using Pearson's chi-square test (p < 0.05), and trends were evaluated with joinpoint regression (JR) to estimate Average Annual Percentage Changes (AAPCs). Between 2010 and 2022, mortality among Indigenous peoples increased by 82.5% (from 2,927 to 5,343), compared with a 42.3% increase in the non-Indigenous population. Over 40% of deaths among Indigenous peoples occurred outside health facilities in both years, versus fewer than 30% among non-Indigenous populations. Crude mortality rates remained lower in Indigenous peoples (2010: 35.8 versus 55.9; 2022: 43.5 versus 74.8 per 10,000 population). However, age-specific differences were marked: mortality among Indigenous children and adolescents (0-19 years) was 3.3 times higher in 2010 and 3.8 times higher in 2022, while mortality among adults aged ≥40 years was approximately 2.5 times lower in both years compared with non-Indigenous populations (all p < 0.05). Mortality rates among Indigenous peoples were consistently higher for maternal, perinatal, and congenital conditions in both 2010 and 2022. JR revealed heterogeneous proportional mortality trends: significant increases in perinatal, congenital, and external causes (AAPC approximately 5.0-6.4%), as well as neoplasms, circulatory, haematological, digestive, respiratory, and endocrine/metabolic diseases (AAPC approximately 1.6-4.4%); a significant decline in infectious and parasitic diseases (AAPC -6.6%); and stability in other groups. Indigenous peoples in Brazil continued to face unfavourable mortality, particularly among children, adolescents, and maternal conditions. Many leading causes of death are preventable. Strengthening primary healthcare, expanding prenatal and perinatal services, improving vaccination and mental-health support, and adopting culturally safe, community-driven strategies to address chronic diseases are critical to reducing inequities and preventable deaths.
Given the surging economic and health costs associated with childhood stunting, identifying its associated factors is crucial. This study therefore explores a key determinant of long-term nutritional status, women's participation in household decision-making in the context of Pakistan. To empirically estimate this association, three-level modelling was employed by pooling the data from two recent nationally representative survey rounds PDHS 2012-13 and PDHS 2017-18. Multilevel analysis was better suited compared to traditional methods for robust estimates because of the hierarchical nature of the data. Women's decision-making power was measured by formulating an index through factor analysis from the direct questions about women's participation in household decisions. This study found a positive association between women's decision-making power and children's nutritional growth at the national level, with no significant changes across the survey years. However, this relationship was moderated by regional variations, which was more pronounced in Sindh and relatively modest in other regions. The sensitivity analysis showed that among the different decision-making domains, only women's participation in large household purchases was significantly and positively associated with child linear growth. The insights of this research suggest that nutrition-oriented policies should also consider non-nutritional factors, like women's decision-making power when designing projects for target population. Meanwhile, it is also crucial to recognize that decision-making power is a contextual factor and its effect on child nutritional growth may vary across regions.
Hypertension (HTN) is the primary cause of preventable cardiovascular-related deaths globally, representing the most important modifiable risk factor for preventing such deaths. Nearly 700 million of the 1.3 billion adults with HTN worldwide remain untreated, most of whom live in low-and middle-income countries, including East Africa. Barriers to the diagnosis of HTN also impact treatment adherence after diagnosis and the initiation of treatment. This scoping review used a qualitative synthesis method to describe studies examining the cultural and contextual factors influencing HTN treatment adherence in East Africa and the lived experiences of patients with HTN to gain a better understanding of these factors in the region. A total of 34 studies, 25 qualitative and 9 mixed-methods designs from five East African nations were included in the final review. Reported influencing factors are classified into individual, structural, and social factors. Lack of HTN literacy and limited risk perception were often cited as individual barriers to adherence, along with mental health challenges, including fear of stigma, while trust and HTN literacy enhanced adherence. Inconsistent healthcare delivery, lack of access, and financial constraints were the most reported structural factors. Social norms surrounding health behaviours and attitudes towards HTN treatment were identified as key determinants of adherence at the social level. The findings underscore the complex interplay of individual, structural, and social factors associated with HTN treatment adherence in East Africa, offering practical ways to enhance adherence in the region at all three levels.
This study presents a revised estimation of the prevalence of female genital mutilation/cutting (FGM/C) among migrant women and second-generation girls in Italy as of 1 January 2023. The study is based on an enhanced indirect estimation of the prevalence among migrants and data on first- and second-generation women legally residing in Italy as of 1 January 2023. The study estimates that approximately 88,600 women aged 15 and over have undergone FGM/C in Italy, representing 46% of migrant women from practising countries. Notably, around one-third of these women are over 50 years old, indicating that FGM/C remains a significant health concern beyond childbearing age. Among foreign-born women, 46.5% are estimated to be affected, compared to 22.5% of Italian-born women. The research also identifies approximately 16,000 girls under 15 at potential risk, with the highest numbers among those of Egyptian, Nigerian, and Senegalese descent. Methodologically, the study underscores the importance of refining indirect estimation techniques to account for the socio-demographic selectivity of migration. While the overall prevalence of FGM/C is decreasing, the persistence of the practice among specific communities calls for targeted interventions. The findings emphasise the need for culturally sensitive awareness campaigns, strengthened legal frameworks, and accessible healthcare services. Furthermore, this research contributes to the European discourse on FGM/C by providing a replicable estimation model adaptable to other non-practising countries receiving migrants from FGM/C-prevalent regions. Periodic replication of such estimates can provide valuable insights into evolving FGM/C trends, aiding policymakers in resource allocation and intervention strategies to eradicate the practice.
