The Journals of Gerontology: Series B, Feb 21, 2023
Objectives: To examine the circumstances and needs of older adults who were "kinless," defined as... more Objectives: To examine the circumstances and needs of older adults who were "kinless," defined as having no living spouse or children, when they developed dementia. Methods: We conducted a secondary analysis of information from the Adult Changes in Thought study. Among 848 participants diagnosed with dementia between 1994 and 2016, we identified 64 who had no living spouse or child at dementia onset. We then conducted a qualitative analysis of administrative documents pertaining to these participants: handwritten comments recorded after each study visit, and medical history documents containing clinical chart notes from participants' medical records. Results: In this community-dwelling cohort of older adults diagnosed with dementia, 8.4% were kinless at dementia onset. Participants in this sample had an average age of 87 years old, half lived alone, and one third lived with unrelated persons. Through inductive content analysis, we identified 4 themes that describe their circumstances and needs: (1) life trajectories, (2) caregiving resources, (3) care needs and gaps, and (4) turning points in caregiving arrangements. Discussion: Our qualitative analysis reveals that the life trajectories that led members of the analytic cohort to be kinless at dementia onset were quite varied. This research highlights the importance of nonfamily caregivers and participants' own roles as caregivers. Our findings suggest that clinicians and health systems may need to work with other parties to directly provide dementia caregiving support rather than rely on family, and address factors such as neighborhood affordability that particularly affect older adults who have limited family support.
Excess male mortality across the lifespan is partly attributed to masculine norms. Largely unexpl... more Excess male mortality across the lifespan is partly attributed to masculine norms. Largely unexplored are ways masculine norms are positively aligned with healthy practices like diet, exercise, and doctor’s visits. Hence, we explored how men described their masculine norms in the context of their physical health practices. Data from 4 focus groups and 16 interviews was analyzed for how masculine norms shape healthy intentions and behaviors. Contrary to models of masculinity as just a barrier, considerable health motivation is related to masculine roles of providers, workers, and protectors of family. In particular, work and family were central motivators of healthy behaviors. Better recognition of the role of family and work could help inform policy aiming to support healthier men.
Purpose of Review Female genital cutting/mutilation (FGM/C) performed by health care professional... more Purpose of Review Female genital cutting/mutilation (FGM/C) performed by health care professionals (medicalization) and reduced severity of cutting have been advanced as strategies for minimizing health risks, sparking acrimonious ongoing debates. This study summarizes key debates and critically assesses supporting evidence. Recent Findings While medicalization is concentrated in Africa, health professionals worldwide have faced requests to perform FGM/C. Whether medicalization is hindering the decline of FGM/C is unclear. Factors motivating medicalization include, but are not limited to, safety concerns. Involvement of health professionals in advocacy to end FGM/C can address both the supply and demand side of medicalization, but raises ethical concerns regarding dual loyalty. Ongoing debates need to address competing rights claims. Summary Polarizing debates have brought little resolution. We call for a focus on common goals of protecting the health and welfare of girls living in communities where FGM/C is upheld and encourage more informed and open dialog.
Literature on dynamics of change in female genital mutilation/cutting (FGM/C) portray two common ... more Literature on dynamics of change in female genital mutilation/cutting (FGM/C) portray two common but conflicting views. On one side, FGM/C is seen as static and deeply entrenched, with parents lacking agency to interpret culture, evaluate options and adopt changes. An alternative perspective focuses on the fluidity of social norms, influencing whether and how FGM/C is practised. This study asks: in counties where FGM/C persists at high rates, Kisii and Narok, are there changes in the way that FGM/C is performed? and what drives these changes? In-depth interviews and focus group discussions were conducted to illuminate these questions. Data showed five ways that FGM/C practices have changed: (1) reduction in severity of cutting, (2) medicalised cutting, (3) performing FGM/C at younger ages, (4) cutting in secret, and (5) occasionally, abandonment of FGM/C. Messaging on health risks of FGM/C and fear of criminal punishment have motivated less severe cutting and medicalisation. Legislation has also driven the practice underground. Programmes aimed at ending FGM/C should create a critical dialogue on changes in norms with the intent of reducing stigmatisation of uncut girls and their families, and the ways cutting practices are shifting, thereby building on change that is already underway.
Female genital mutilation derails efforts to achieve gender equality and the empowerment of girls... more Female genital mutilation derails efforts to achieve gender equality and the empowerment of girls and women. In Kenya, national estimates show a steady decline in prevalence, although there is considerable variation at the sub-national level. There is a need to better understand female genital mutilation-related norms and meanings and whether there have been changes in these given long-term and diverse efforts to promote abandonment. Focusing on Narok and Kisii counties, we conducted a cross-sectional qualitative study to identify social norms surrounding the practice of female genital mutilation, as well as consensus or contestation with respect to these norms. Ten focus group discussions were held with men and women aged 18 years and older from the Maasai and Abagusii communities that have traditionally practised female genital mutilation. Study findings showed that norms associated with female genital mutilation such as sexuality and marriageability were actively contested by community members. This change may provide a useful starting point for programmes that seek to create dialogue and critical reflection on female genital mutilation to accelerate its abandonment.
Objectives: To investigate the hygiene (or "old friends") hypothesis in a highinfectious disease ... more Objectives: To investigate the hygiene (or "old friends") hypothesis in a highinfectious disease (ID) environment, rural Kilimanjaro, Tanzania. Methods: Among a cross-sectional sample of 2-to 7-year-old children, we collected physician-diagnosed hay fever, asthma, and eczema, history of hospitalization, family size, and household environment information via questionnaire; performed active and passive surveillance for ID; and, evaluated total immunoglobulin E (IgE) and biomarkers of inflammation in dried blood spot specimens. We used regression models to describe patterns in allergic diseases. Results: Complete information was available for 280 children: 12.5% had been diagnosed with hay fever; 18.9% with eczema; 2.1% with asthma. There was a positive association between hay fever and eczema diagnoses (p 2 : 4.07; P 5 0.044); total IgE was positively associated with eczema (b: 0.24; P 5 0.100) and allergic diseases together (b: 0.26; P 5 0.042). ID were common: the incidence of any ID diagnosis was 28 per 100 children per month. Hay fever was inversely associated with household animals (OR: 0.27; P 5 0.006), and positively associated with earth housing materials (OR: 1.93; P 5 0.079) and hospitalization in infancy with an ID (3.16; P 5 0.066); patterns were similar when allergic disease outcomes were considered together. Few associations between these predictors and eczema or asthma alone were apparent. Conclusions: Allergic diseases were common among children in Kilimanjaro. The inverse association between household animals and allergy is consistent with the hygiene/old friends hypothesis; however, positive associations between allergic diseases and earth housing materials and early hospitalization with ID bear further explanation.
ObjectiveThe objective of the present study was to evaluate the effect of settlement on the nutri... more ObjectiveThe objective of the present study was to evaluate the effect of settlement on the nutrition and health status of pastoral women of reproductive age.DesignA cross-sectional survey that included a 24 h dietary recall was administered to 224 randomly selected Gabra women. Height and weight were used to compute BMI. Whole capillary blood was used to measure Hb. Additional capillary blood was collected on filter paper and dried blood spots were analysed for transferritin receptor, C-reactive protein and α1-acid glycoprotein. Descriptive statistics were used to analyse population characteristics. The t test and the χ2 test were used to determine population differences. Multiple criteria models were used to determine the prevalence of Fe deficiency, anaemia and inflammation.SettingSettled and semi-settled women in Kalacha Location in Marsabit County, Kenya.SubjectNon-pregnant women aged 15–49 years.ResultsFe repletion was observed in 43 % of settled and 40 % of semi-settled women...
PATH is an international, nonprofit organization that creates sustainable, culturally relevant so... more PATH is an international, nonprofit organization that creates sustainable, culturally relevant solutions, enabling communities worldwide to break longstanding cycles of poor health. By collaborating with diverse public-and private-sector partners, PATH helps provide appropriate health technologies and vital strategies that change the way people think and act. PATH's work improves global health and well-being. Headquartered in Seattle, Washington, PATH has 18 offices in 13 countries. PATH currently works in more than 100 countries in the areas of reproductive health; vaccines and immunization; HIV, AIDS, and tuberculosis; and children's health and nutrition.
Background Female Genital Mutilation (FGM) is recognized internationally as an issue of global he... more Background Female Genital Mutilation (FGM) is recognized internationally as an issue of global health concern and a violation of human rights. Changing climactic conditions are argued to put a strain on Maasai livelihoods making women and girls more susceptible to harmful practices. Therefore, this study sought to elucidate the effect of climate change on changing social, gender norms and FGM practice among the Maasai of Kajiado County.
Background To our knowledge, no studies exist on the influence of nomadic pastoralist women’s net... more Background To our knowledge, no studies exist on the influence of nomadic pastoralist women’s networks on their reproductive and sexual health (RSH), including uptake of modern family planning (FP). Methods Using name generator questions, we carried out qualitative egocentric social network analysis (SNA) to explore the networks of four women. Networks were analyzed in R, visuals created in Visone and a framework approach used for the qualitative data. Results Women named 10–12 individuals. Husbands were key in RSH decisions and never supported modern FP use. Women were unsure who supported their use of modern FP and we found evidence for a norm against it within their networks. Conclusions Egocentric SNA proves valuable to exploring RSH reference groups, particularly where there exists little prior research. Pastoralist women’s networks likely change as a result of migration and conflict; however, husbands make RSH decisions and mothers and female neighbors provide key support in b...
There exist two dominant but conflicting views on the role of men in the perpetuation female geni... more There exist two dominant but conflicting views on the role of men in the perpetuation female genital mutilation/cutting (FGM/C). One paints men as culprits, with FGM/C viewed as a manifestation of patriarchal oppression of women. An alternative portrays men as relatively uninvolved in a practice described as 'women's business'. These two perspectives lead to divergent predictions: if FGM/C underpins patriarchal structures, men should be expected to be ardent supporters of FGM/C as it bolsters their power and status; if FGM/C is a women's affair, men should have little involvement. We test these predictions using data from a mixed-method study of norms and social networks in two regions of Senegal. Data show that men comprise 50% of core network members, although they exert influence in different ways in each study site. In South Senegal excision is upheld by men, as well as older women, through a constellation of norms that define FGM/C as prerequisite to marriage and social inclusion. In Central Senegal these gender norms have eroded, opening possibilities for abandonment of FGM/C, and men, particularly fathers, at times successfully advocate this change. This suggests that men can play an important role in ending FGM/C, and should be involved in intervention efforts.
The Journals of Gerontology: Series B, Feb 21, 2023
Objectives: To examine the circumstances and needs of older adults who were "kinless," defined as... more Objectives: To examine the circumstances and needs of older adults who were "kinless," defined as having no living spouse or children, when they developed dementia. Methods: We conducted a secondary analysis of information from the Adult Changes in Thought study. Among 848 participants diagnosed with dementia between 1994 and 2016, we identified 64 who had no living spouse or child at dementia onset. We then conducted a qualitative analysis of administrative documents pertaining to these participants: handwritten comments recorded after each study visit, and medical history documents containing clinical chart notes from participants' medical records. Results: In this community-dwelling cohort of older adults diagnosed with dementia, 8.4% were kinless at dementia onset. Participants in this sample had an average age of 87 years old, half lived alone, and one third lived with unrelated persons. Through inductive content analysis, we identified 4 themes that describe their circumstances and needs: (1) life trajectories, (2) caregiving resources, (3) care needs and gaps, and (4) turning points in caregiving arrangements. Discussion: Our qualitative analysis reveals that the life trajectories that led members of the analytic cohort to be kinless at dementia onset were quite varied. This research highlights the importance of nonfamily caregivers and participants' own roles as caregivers. Our findings suggest that clinicians and health systems may need to work with other parties to directly provide dementia caregiving support rather than rely on family, and address factors such as neighborhood affordability that particularly affect older adults who have limited family support.
Excess male mortality across the lifespan is partly attributed to masculine norms. Largely unexpl... more Excess male mortality across the lifespan is partly attributed to masculine norms. Largely unexplored are ways masculine norms are positively aligned with healthy practices like diet, exercise, and doctor’s visits. Hence, we explored how men described their masculine norms in the context of their physical health practices. Data from 4 focus groups and 16 interviews was analyzed for how masculine norms shape healthy intentions and behaviors. Contrary to models of masculinity as just a barrier, considerable health motivation is related to masculine roles of providers, workers, and protectors of family. In particular, work and family were central motivators of healthy behaviors. Better recognition of the role of family and work could help inform policy aiming to support healthier men.
Purpose of Review Female genital cutting/mutilation (FGM/C) performed by health care professional... more Purpose of Review Female genital cutting/mutilation (FGM/C) performed by health care professionals (medicalization) and reduced severity of cutting have been advanced as strategies for minimizing health risks, sparking acrimonious ongoing debates. This study summarizes key debates and critically assesses supporting evidence. Recent Findings While medicalization is concentrated in Africa, health professionals worldwide have faced requests to perform FGM/C. Whether medicalization is hindering the decline of FGM/C is unclear. Factors motivating medicalization include, but are not limited to, safety concerns. Involvement of health professionals in advocacy to end FGM/C can address both the supply and demand side of medicalization, but raises ethical concerns regarding dual loyalty. Ongoing debates need to address competing rights claims. Summary Polarizing debates have brought little resolution. We call for a focus on common goals of protecting the health and welfare of girls living in communities where FGM/C is upheld and encourage more informed and open dialog.
Literature on dynamics of change in female genital mutilation/cutting (FGM/C) portray two common ... more Literature on dynamics of change in female genital mutilation/cutting (FGM/C) portray two common but conflicting views. On one side, FGM/C is seen as static and deeply entrenched, with parents lacking agency to interpret culture, evaluate options and adopt changes. An alternative perspective focuses on the fluidity of social norms, influencing whether and how FGM/C is practised. This study asks: in counties where FGM/C persists at high rates, Kisii and Narok, are there changes in the way that FGM/C is performed? and what drives these changes? In-depth interviews and focus group discussions were conducted to illuminate these questions. Data showed five ways that FGM/C practices have changed: (1) reduction in severity of cutting, (2) medicalised cutting, (3) performing FGM/C at younger ages, (4) cutting in secret, and (5) occasionally, abandonment of FGM/C. Messaging on health risks of FGM/C and fear of criminal punishment have motivated less severe cutting and medicalisation. Legislation has also driven the practice underground. Programmes aimed at ending FGM/C should create a critical dialogue on changes in norms with the intent of reducing stigmatisation of uncut girls and their families, and the ways cutting practices are shifting, thereby building on change that is already underway.
Female genital mutilation derails efforts to achieve gender equality and the empowerment of girls... more Female genital mutilation derails efforts to achieve gender equality and the empowerment of girls and women. In Kenya, national estimates show a steady decline in prevalence, although there is considerable variation at the sub-national level. There is a need to better understand female genital mutilation-related norms and meanings and whether there have been changes in these given long-term and diverse efforts to promote abandonment. Focusing on Narok and Kisii counties, we conducted a cross-sectional qualitative study to identify social norms surrounding the practice of female genital mutilation, as well as consensus or contestation with respect to these norms. Ten focus group discussions were held with men and women aged 18 years and older from the Maasai and Abagusii communities that have traditionally practised female genital mutilation. Study findings showed that norms associated with female genital mutilation such as sexuality and marriageability were actively contested by community members. This change may provide a useful starting point for programmes that seek to create dialogue and critical reflection on female genital mutilation to accelerate its abandonment.
Objectives: To investigate the hygiene (or "old friends") hypothesis in a highinfectious disease ... more Objectives: To investigate the hygiene (or "old friends") hypothesis in a highinfectious disease (ID) environment, rural Kilimanjaro, Tanzania. Methods: Among a cross-sectional sample of 2-to 7-year-old children, we collected physician-diagnosed hay fever, asthma, and eczema, history of hospitalization, family size, and household environment information via questionnaire; performed active and passive surveillance for ID; and, evaluated total immunoglobulin E (IgE) and biomarkers of inflammation in dried blood spot specimens. We used regression models to describe patterns in allergic diseases. Results: Complete information was available for 280 children: 12.5% had been diagnosed with hay fever; 18.9% with eczema; 2.1% with asthma. There was a positive association between hay fever and eczema diagnoses (p 2 : 4.07; P 5 0.044); total IgE was positively associated with eczema (b: 0.24; P 5 0.100) and allergic diseases together (b: 0.26; P 5 0.042). ID were common: the incidence of any ID diagnosis was 28 per 100 children per month. Hay fever was inversely associated with household animals (OR: 0.27; P 5 0.006), and positively associated with earth housing materials (OR: 1.93; P 5 0.079) and hospitalization in infancy with an ID (3.16; P 5 0.066); patterns were similar when allergic disease outcomes were considered together. Few associations between these predictors and eczema or asthma alone were apparent. Conclusions: Allergic diseases were common among children in Kilimanjaro. The inverse association between household animals and allergy is consistent with the hygiene/old friends hypothesis; however, positive associations between allergic diseases and earth housing materials and early hospitalization with ID bear further explanation.
ObjectiveThe objective of the present study was to evaluate the effect of settlement on the nutri... more ObjectiveThe objective of the present study was to evaluate the effect of settlement on the nutrition and health status of pastoral women of reproductive age.DesignA cross-sectional survey that included a 24 h dietary recall was administered to 224 randomly selected Gabra women. Height and weight were used to compute BMI. Whole capillary blood was used to measure Hb. Additional capillary blood was collected on filter paper and dried blood spots were analysed for transferritin receptor, C-reactive protein and α1-acid glycoprotein. Descriptive statistics were used to analyse population characteristics. The t test and the χ2 test were used to determine population differences. Multiple criteria models were used to determine the prevalence of Fe deficiency, anaemia and inflammation.SettingSettled and semi-settled women in Kalacha Location in Marsabit County, Kenya.SubjectNon-pregnant women aged 15–49 years.ResultsFe repletion was observed in 43 % of settled and 40 % of semi-settled women...
PATH is an international, nonprofit organization that creates sustainable, culturally relevant so... more PATH is an international, nonprofit organization that creates sustainable, culturally relevant solutions, enabling communities worldwide to break longstanding cycles of poor health. By collaborating with diverse public-and private-sector partners, PATH helps provide appropriate health technologies and vital strategies that change the way people think and act. PATH's work improves global health and well-being. Headquartered in Seattle, Washington, PATH has 18 offices in 13 countries. PATH currently works in more than 100 countries in the areas of reproductive health; vaccines and immunization; HIV, AIDS, and tuberculosis; and children's health and nutrition.
Background Female Genital Mutilation (FGM) is recognized internationally as an issue of global he... more Background Female Genital Mutilation (FGM) is recognized internationally as an issue of global health concern and a violation of human rights. Changing climactic conditions are argued to put a strain on Maasai livelihoods making women and girls more susceptible to harmful practices. Therefore, this study sought to elucidate the effect of climate change on changing social, gender norms and FGM practice among the Maasai of Kajiado County.
Background To our knowledge, no studies exist on the influence of nomadic pastoralist women’s net... more Background To our knowledge, no studies exist on the influence of nomadic pastoralist women’s networks on their reproductive and sexual health (RSH), including uptake of modern family planning (FP). Methods Using name generator questions, we carried out qualitative egocentric social network analysis (SNA) to explore the networks of four women. Networks were analyzed in R, visuals created in Visone and a framework approach used for the qualitative data. Results Women named 10–12 individuals. Husbands were key in RSH decisions and never supported modern FP use. Women were unsure who supported their use of modern FP and we found evidence for a norm against it within their networks. Conclusions Egocentric SNA proves valuable to exploring RSH reference groups, particularly where there exists little prior research. Pastoralist women’s networks likely change as a result of migration and conflict; however, husbands make RSH decisions and mothers and female neighbors provide key support in b...
There exist two dominant but conflicting views on the role of men in the perpetuation female geni... more There exist two dominant but conflicting views on the role of men in the perpetuation female genital mutilation/cutting (FGM/C). One paints men as culprits, with FGM/C viewed as a manifestation of patriarchal oppression of women. An alternative portrays men as relatively uninvolved in a practice described as 'women's business'. These two perspectives lead to divergent predictions: if FGM/C underpins patriarchal structures, men should be expected to be ardent supporters of FGM/C as it bolsters their power and status; if FGM/C is a women's affair, men should have little involvement. We test these predictions using data from a mixed-method study of norms and social networks in two regions of Senegal. Data show that men comprise 50% of core network members, although they exert influence in different ways in each study site. In South Senegal excision is upheld by men, as well as older women, through a constellation of norms that define FGM/C as prerequisite to marriage and social inclusion. In Central Senegal these gender norms have eroded, opening possibilities for abandonment of FGM/C, and men, particularly fathers, at times successfully advocate this change. This suggests that men can play an important role in ending FGM/C, and should be involved in intervention efforts.
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