Nevin Manimala

Reprod Health. 2025 Apr 26;22(1):60. doi: 10.1186/s12978-025-02011-3.

ABSTRACT

BACKGROUND: Approximately 164 million women report an unmet need for family planning globally. This has far-reaching consequences for the health of women and their children. Women’s exposure to intimate partner violence (IPV) is strongly linked to increased unmet need as IPV likely affects both women’s desire for contraception and their ability to access it. Around 245 million women were subject to physical and/or sexual IPV by an intimate partner in the past twelve months alone, making it the most common form of violence against women. Yet, laws that prohibit domestic violence (DV) are not universal and countries actively debate whether legal provisions are effective in deterring and reducing its harmful impacts. This study examines the impact of DV laws on women’s unmet need for family planning.

METHODS: We built new data on DV laws adoption in Africa and used the Demographic and Health Surveys (DHS) data collected between 2000 and 2021 across 23 African countries for outcomes data. Exploiting the staggered adoption of DV laws across the continent, we used a difference-in-differences study design to estimate the impact of DV laws in the treated countries compared to countries without such laws.

RESULTS: We find that DV laws reduced women’s unmet need for family planning by 6.2% points, 95% CI [- 9.2, – 3.2], a 20.5% reduction from the mean. Positive impacts were observed in 6 countries across multiple model specifications. While the impacts were largely broad-based across wealth, age, geography, and education categories, we found no significant impacts for women younger than 20 years of age and those without formal education. These findings were robust to alternative model specifications.

CONCLUSIONS: Our findings demonstrate that countries can significantly benefit from prohibiting DV as a fundamental step towards addressing women’s unmet need for family planning and promoting their reproductive health. While fully addressing IPV and women’s unmet need may require a range of complementary interventions, especially among marginalized populations, DV laws play a crucial role in improving women’s control over their reproductive health.

PMID:40287771 | DOI:10.1186/s12978-025-02011-3

World J Surg Oncol. 2025 Apr 26;23(1):163. doi: 10.1186/s12957-025-03822-1.

ABSTRACT

BACKGROUND: While growing evidence highlights the role of gut microbiota and inflammatory proteins in cancer, with cancer-related inflammation now considered the seventh hallmark of cancer, the direct causal relationships between specific microbiota, cancer, and the potential mediating effects of inflammatory proteins have not been fully established.

METHODS: We employed Mendelian randomization (MR) to assess the causal relationships between gut microbiota, inflammatory proteins, and eighteen distinct cancers using data from extensive genome-wide association studies (GWAS). The primary statistical method utilized was inverse variance weighting (IVW). We also investigated whether inflammatory proteins could mediate the effects of gut microbiota on cancer development.

RESULTS: Our findings revealed 42 positive and 49 inverse causal impacts of gut microbiota on cancer risk (P < 0.05). Additionally, we identified 32 positive and 28 inverse causal relationships between inflammatory proteins and cancer risk. Moreover, genus Collinsella decreased the risk of lung cancer by decreasing levels of T-cell surface glycoprotein CD5 (mediating effect = 16.667%), while genus Ruminococcaceae UCG005 increased the risk of mesothelioma by increasing levels of CCL4 (mediating effect = 5.134%).

CONCLUSIONS: Our study provides evidence for a causal association between gut microbiota, inflammatory proteins, and eighteen different cancer types. Notably, the T-cell surface glycoprotein CD5 and CCL4 were identified as mediators linking the genus Collinsella with lung cancer and the genus Ruminococcaceae UCG005 with mesothelioma, respectively.

PMID:40287752 | DOI:10.1186/s12957-025-03822-1

Infect Dis Poverty. 2025 Apr 27;14(1):31. doi: 10.1186/s40249-025-01305-9.

ABSTRACT

BACKGROUND: Oral emtricitabine-tenofovir disoproxil fumarate (F/TDF) for HIV pre-exposure prophylaxis (PrEP) demonstrates dual potential through antiviral activity against hepatitis B virus (HBV). While F/TDF lacks activity against hepatitis C virus (HCV), the use of F/TDF for HIV PrEP may elevate HCV risk through risk compensation. This study aims to investigate HBV/HCV incidence among men who have sex with men (MSM) using F/TDF-based HIV PrEP, addressing evidence gaps in low- and middle-income countries.

METHODS: We conducted a secondary analysis of the China Real-World Oral Intake of PrEP (CROPrEP) study, a multicenter prospective cohort of MSM (F/TDF users/non-users) from Beijing, Shenyang, Shenzhen, and Chongqing. Participants underwent HBV/HCV testing at baseline and at the 12-month follow-up. Only HBV-susceptible (hepatitis B surface antigen-negative, hepatitis B surface and core antibody-negative) MSM were included in the secondary analysis, to calculate HBV incidence. The primary outcomes were HBV/HCV incidence rates at the 12-month follow-up. Bayesian Poisson regression identified HBV/HCV infection risk factors.

RESULTS: The CROPrEP cohort prospectively recruited 1023 F/TDF users and 507 F/TDF non-users at baseline. This secondary analysis included 259 F/TDF users and 120 non-users identified as HBV-susceptible at baseline. At the 12-month of follow-up, no incident HBV infections occurred in the F/TDF users group, and only one incident HBV infection occurred in the F/TDF non-users group. The incidence of new HBV infections was 0.00/100 person-years (PY) [95% confidence interval (CI): 0.00-1.32] among HBV-susceptible F/TDF users and 0.77/100 PY (95% CI: 0.02-4.20) among HBV-susceptible F/TDF non-users. HBV incidence was reduced with F/TDF compared with no F/TDF [adjusted incidence rate ratio (aIRR): 0.00; 95% CI: 0.00-0.00]. HCV incidence among F/TDF users and non-users was 0.31/100 PY (95% CI: 0.06-0.90) and 0.00/100 PY (95% CI: 0.00-0.74) after 12 months, respectively. HCV incidence was lower in F/TDF non-users than in F/TDF users (aIRR: 0.00; 95% CI: 0.00-0.25).

CONCLUSIONS: This study suggests a potential benefit in reducing HBV incidence among MSM using F/TDF as HIV PrEP, highlighting the potential for integrated prevention strategies addressing both HIV and HBV risks in PrEP programmes.

TRIAL REGISTRATION: ChiCTR, ChiCTR-IIN-17013762. Registered 8 December 2017, https://www.chictr.org.cn/showproj.html?proj=22916 .

PMID:40287745 | DOI:10.1186/s40249-025-01305-9

Reprod Health. 2025 Apr 26;22(1):59. doi: 10.1186/s12978-025-02012-2.

ABSTRACT

BACKGROUND: Asylum-seeking women have an increased risk of sexually transmitted diseases, sexual and gender-based violence, unwanted pregnancies, maternal illness and death. This study examined sexual and reproductive health issues among asylum-seeking women in Finland in 2018. The acceptability of asking questions on sexual health was also evaluated.

METHODS: Data from the Asylum Seekers Health and Wellbeing Survey were used. Women aged 18-50 (n = 278) were included in the analysis and grouped to four categories based on their country of birth. Register information on sex, age group, country of birth, and place of residency was obtained from the Finnish Immigration Service and used in the calculations of analysis weights. Weighted percentages with 95% confidence intervals (Cl) were calculated for sexual activity, the use of contraceptives, female genital mutilation/cutting, pregnancies, previous births, miscarriages, induced abortions and menstrual health. The differences between the groups were compared using the chi-square test. The acceptability was examined based on nonresponse in each question about sexual health.

RESULTS: Among women from the other African countries (excl. North Africa), 21% (95% Cl 10.4-38.9%) had had six or more sexual partners within the past 12 months. Majority of women (62%, 95% CI 39.9-79.7%) from the ‘other countries’ and 51% (95% Cl 34.1-68.2%) from the other African countries had not used contraceptives during their latest intercourse. Female genital mutilation/cutting was reported by 30% (95% Cl 18.7-45.2%) of women from the other African countries. A total of 10% (95% Cl 6.6-13.9%) of all women and 25% (95% Cl 14.3-39.2%) of those from other African countries were pregnant at the time of study. Moreover, 35% (95% CI 25.5-46.0%) of the women from Russia and former Soviet Union had had at least one induced abortion. Nonresponse varied between 7 and 17%, being the highest in the questions about the gender of the sexual partner(s) and contraceptive use among women from Middle East and Africa.

CONCLUSION: It is both acceptable and important to cover sexual and reproductive health when assessing the health of asylum-seeking women. The sensitivity of this topic must be considered when planning data collection.

PMID:40287738 | DOI:10.1186/s12978-025-02012-2

BMC Public Health. 2025 Apr 26;25(1):1563. doi: 10.1186/s12889-025-22836-8.

ABSTRACT

BACKGROUND: Menstruation is a natural and inevitable process in females. However, adolescent girls continue to face challenges with several misconceptions and myths. Despite numerous efforts and campaigns, limited knowledge and unhygienic practices persist, leading to various adverse social and health outcomes. This study examined knowledge, practices and factors influencing menstrual hygiene management practices among female senior high school students in the New Juaben Municipality of Ghana.

METHODS: A descriptive cross-sectional study was conducted among 2 senior high schools. Students were selected using systematic random sampling. Data were collected using a structured questionnaire adapted from literature between August to September 2022. Data was entered into Microsoft Excel Software (2020) and then exported to STATA/MP version 17 (STATA Corp) for analysis. Descriptive statistics and multiple logistic regression were conducted with p-values ≤ 0.05 considered significant.

RESULTS: A total of 557 students were included in the study. 61.22% of students demonstrated good knowledge of menstruation, and 57.09% practiced good menstrual hygiene. Disposable sanitary pads were the most commonly used (97.44%) and preferred (93.25%) menstrual products. Most students changed their sanitary pads two or three times per day (47.49% and 47.30%, respectively). Nearly all participants (99%) bathed during menstruation, with water only (61.13%) being the most common method for genital cleaning. Logistic regression analysis revealed that students who lived with their mothers only (AOR = 1.88, 95% CI: 1.16-3.02, p = 0.01), had access to dedicated disposal bins (AOR = 2.20, 95% CI: 1.42-3.39, p < 0.001), and reported adequate facilities for menstrual hygiene needs (AOR = 0.60, 95% CI: 0.39-0.91, p = 0.017) were more likely to practice good menstrual hygiene.

CONCLUSION: Generally, female students had good MHM knowledge and practices with few misconceptions. The study underscores the importance of enhancing menstrual hygiene education, improving school infrastructure, and supporting family-based health education to promote safe and effective menstrual hygiene practices among adolescent girls. Targeted interventions involving schools, parents, and policymakers are needed to create a supportive environment that ensures menstrual health and educational continuity for all girls.

PMID:40287730 | DOI:10.1186/s12889-025-22836-8

J Orthop Surg Res. 2025 Apr 26;20(1):420. doi: 10.1186/s13018-025-05821-0.

ABSTRACT

OBJECTIVE: To conduct a comparative analysis of the clinical efficacy and quality of life in elderly patients with lumbar degenerative disease (LDD) treated with TLIF (transforaminal lumbar interbody fusion) combined with either unilateral pedicle screw fixation (UPSF) or bilateral pedicle screw fixation (BPSF).

METHODS: A total of 112 patients with single- or double-segment lumbar degenerative disease were divided into two groups. In the unilateral fixation cohort, 32 single-segment patients and 22 double-segment patients underwent TLIF combined with UPSF, whereas in the bilateral fixation cohort, 34 single-segment patients and 24 double-segment patients underwent TLIF combined with BPSF. Data on operative time, intraoperative blood loss, time to postoperative ambulation, length of hospital stay, and perioperative complications were collected and analysed. Pain and functional status were preoperatively evaluated, in addition to being postoperatively evaluated at 1, 6, and 12 months, using the visual analogue scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, and Short Form-36 (SF-36) health survey questionnaire. Imaging follow-up was conducted for 1 year; at the final follow-up, the fusion rate was determined using the Bridwell fusion grading system, and clinical outcomes were assessed by using the modified MacNab criteria.

RESULTS: All of the follow-up patients successfully completed the surgeries. There were no significant differences observed in average postoperative ambulation time or hospital stay between the UPSF and BPSF groups for either single- or double-segment patients. However, the UPSF group exhibited less average blood loss and a shorter surgery time (P < 0.05). At 12 months after surgery, there were no statistically significant differences observed in the VAS, ODI, or JOA scores between the UPSF and BPSF groups, although both scores were significantly improved compared with the preoperative scores. There were fewer perioperative complications observed in the UPSF group than in the BPSF group for both single-segment (P = 0.040) and double-segment (P = 0.009) patients. In terms of quality of life, the UPSF group exhibited better long-term physical and mental health outcomes compared with the BPSF group (single-segment PCS: preoperative, P = 0.694; 1 month, P = 0.310; 6 months, P = 0.022; 12 months, P = 0.020; MCS: preoperative, P = 0.849; 1 month, P = 0.655; 6 months, P = 0.022; 12 months, P < 0.001; double-segment PCS: preoperative, p = 0.890; 1 month, P = 0.374; 6 months, P = 0.022; 12 months, P = 0.023; MCS: preoperative, P = 0.447; 1 month, P = 0.419; 6 months, P = 0.023; 12 months, P < 0.001). At the final follow-up, there were no significant differences observed in fusion rates between the groups according to the Bridwell fusion grading system (P > 0.05), with both groups achieving satisfactory fusion rates. The modified MacNab criteria revealed that excellent and good results in each group were > 90%, with no significant differences being observed between the groups (P > 0.05).

CONCLUSIONS: For the treatment of LDD in elderly patients, both TLIF combined with UPSF and TLIF combined with BPSF can achieve favourable outcomes. However, UPSF demonstrates advantages compared with BPSF, including a shorter surgery time, reduced intraoperative blood loss, and greater postoperative quality of life.

PMID:40287721 | DOI:10.1186/s13018-025-05821-0

BMC Public Health. 2025 Apr 26;25(1):1555. doi: 10.1186/s12889-025-22700-9.

ABSTRACT

BACKGROUND: Achieving gender equality in education is crucial for promoting social equity, driving economic growth, and improving overall population health. In Nepal, deeply rooted socio-cultural norms, economic disparities, and patriarchal values greatly impact women’s access to educational opportunities, particularly in the field of medicine. Although there has been an increase in female enrollment in medical programs, pervasive biases, gendered expectations, and informal cultural scripts-often referred to as the “hidden curriculum”-continue to influence their aspirations, specialty choices, and professional journeys. Understanding these dynamics is vital for ensuring women’s full engagement in the medical workforce.

METHODS: This qualitative study employed semi-structured interviews with fifteen final-year female undergraduate medical students at a private medical college in Bharatpur, Nepal. Thematic analysis was employed to identify and interpret the key themes.

RESULTS: Five key themes emerged: (1) The Marriage Mandate: Negotiating Family, Tradition, and Professional Aspirations; (2) The Gendered Clinic: Unveiling Bias in Medical Education and Practice; (3) Investing in Daughters, Expecting Returns: The Gendered Economics of Medical Education; (4) Transnational Aspirations: Negotiating Mobility, Marriage, and Medical Careers and (5) Claiming Space: Agency, Resistance, and Redefining Success in the Medical Profession.

DISCUSSION: The pervasive “hidden curriculum” of gendered barriers persists despite policy efforts, constitutional safeguards, and increasing female representation in medical schools. These challenges, if unaddressed, risk perpetuating a cycle of underutilizing women’s talents, limiting the diversity of the healthcare workforce, and hindering progress toward achieving equitable health outcomes. The findings underscore the urgent need for gender-transformative approaches that acknowledge and actively dismantle these deeply rooted biases at institutional, community, and policy levels. These approaches should focus on creating supportive structures that empower women to fully contribute to the medical profession.

CONCLUSION: Female medical graduates encounter significant obstacles, including entrenched patriarchal norms, systemic inequalities, and a pervasive “hidden curriculum” of biases. However, they demonstrate remarkable resilience and determination in challenging stereotypes, redefining success, and reimaging their professional identities. Their experiences align with global efforts toward gender parity in education and employment. Equitable representation of women in the medical workforce is not only a moral imperative but also a strategic necessity for advancing public health, strengthening healthcare systems, and promoting social justice.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40287720 | DOI:10.1186/s12889-025-22700-9

World J Surg Oncol. 2025 Apr 26;23(1):168. doi: 10.1186/s12957-025-03817-y.

ABSTRACT

BACKGROUND: Globally, the most common malignancy in women today is breast cancer. Numerous factors affect the incidence of breast cancer; therefore, we examined the connections involving age, body mass index (BMI), serum lipid levels, and breast cancer risk in women.

METHODS: This was a cross-sectional analytical study. 382 female patients with a breast cancer diagnosis in this study, and 11842 healthy, age-matched females who were selected from physical examination centers in the same period. Univariate analysis was conducted first, after which factors with statistically significant differences were used to construct a multi-factor binary logistic regression equation. We explored associations across different ages, BMI, triglyceride (TG), and high-density lipoprotein-cholesterol (HDL-C) levels, and breast cancer risk.

RESULTS: Age, BMI, TG, and HDL-C were the risk factors that showed the most significant association with breast cancer. Age, BMI, low-density lipoprotein-cholesterol (LDL-C) and TG levels in the breast cancer group were higher than those in the control group, but HDL-C and total cholesterol (TC) levels were lower. As BMI and TG levels increased, the risk of developing breast cancer increased, and, as HDL-C levels decreased, the risk of developing breast cancer increased. Women aged ≥ 40 years old had an increased breast cancer risk. There were no significant variations in TC and LDL-C levels between groups.

CONCLUSIONS: In this study, a lower risk of breast cancer was linked to high HDL-C levels, while a higher risk of breast cancer was linked to high BMI and TG levels. Women aged ≥ 40 years old had an increased breast cancer risk.

PMID:40287713 | DOI:10.1186/s12957-025-03817-y

BMC Health Serv Res. 2025 Apr 26;25(1):610. doi: 10.1186/s12913-025-12639-3.

ABSTRACT

BACKGROUND: Addressing disparities in reproductive, maternal, newborn, and child health services is crucial in achieving the Sustainable Development Goal of universal health coverage. The persistence of social and geographic disparities in maternal health service coverage and utilization poses significant challenges. Ensuring equity in health service access and utilization as part of universal health coverage requires evidence whether these inequities exist. This study aimed to measure socio-economic and geographic equity in coverage and effective coverage of both antenatal care and skilled birth attendance.

METHODS: We conducted a secondary analysis of data collected from the Performance Monitoring for Action Ethiopia from 2019 to 2020, including 2714 postpartum women at around six weeks and service delivery point assessment data from 462 health facilities. We measured inequities in the utilization of four or more antenatal care visits and skilled birth attendance using equiplots and concentration index. Moran’s I, Getis-Ord Gi statistics and Kriging interpolations were employed to analyze geographic variations of maternal health service utilization.

RESULTS: In this study, 40% (95%CI: 36, 45) utilized four or more ANC visits, and 12% (95%CI: 11, 14) received quality antenatal care. Over half (54%, 95%CI: 48, 59) of women utilized skilled birth attendance, but only 7% (95%CI: 4, 8) received quality delivery care. The absolute equity gap between the least poor and the poorest women was 43 percentage points for ANC visits and 65 percentage points for skilled birth attendance. A higher proportion of women in Central and Northern parts of Ethiopia had four or more ANC visits and utilized skilled birth attendance, while most parts of the Eastern part of the country and most areas in the South had low levels of utilization.

CONCLUSION: The coverage of four or more antenatal care visits and skilled birth attendance was low and inequitable, with the poorest women receiving fewer services. The coverage varied across different parts of the country. Interventions that target groups of women and geographic areas with low coverage of services are crucial for reaching the goal of universal health coverage.

PMID:40287709 | DOI:10.1186/s12913-025-12639-3