Epidomiology Quetion Domestic violence and its association with preterm or low birthweight delivery in Vietnam Discussio

[answerhappygod]

Epidomiology Quetion
Domestic violence and its association with preterm or low
birthweight delivery in Vietnam
Discussion This study was one of the few
community-based studies on domestic violence conducted with a
random sample of women at reproductive age in Vietnam. The study
provided important evidence regarding the prevalence of DV against
women in the community as well as its impact on birth outcomes. DV
may occur before, during, or after pregnancy. Due to changes in
women’s emotional, physical, social, and economic needs during
pregnancy, this period may be the time when women are the most
vulnerable to DV. DV prevalence in our study was high (23.4%),
meaning that in every five interviewed women, there was one who had
suffered from DV during pregnancy. The prevalence of emotional
violence, physical violence, and sexual violence during pregnancy
was 16.8%, 7.3%, and 12.4%, respectively. Our findings were
consistent with those of other studies in this field in Vietnam.12
Compared to studies in other countries, the prevalence of DV during
pregnancy among the sample of Vietnamese women in our study was
higher. For example, a study in 19 countries by WHO showed that the
prevalence of DV against women ranged between 2.0–13.5% in Africa,
2.0–5.0% in America, 1.8– 6.6% in Europe, and was 2.0% in
Australia.13 Moreover, according to WHO, the proportion in the
Philippines was 2.0%, Cambodia 2.8%, Azerbaijan 4.0%, and Jordan
5.0%.10 Therefore, it could be said that Vietnam is among the
countries with the highest proportion of DV during pregnancy in
Asia. The finding of the National Study on DV against women in
Vietnam showed that the prevalence of physical violence in
pregnancy was 5%14 lower than ours. The survey by Nguyen Hoang
Thanh et al9 in Dong Anh district – Hanoi reported a 1.5-times
higher prevalence of DV during pregnancy than our study (35.4% vs
23.4%). Also in Thanh’s study emotional violence accounted for
32.5%, physical violence 3.5%, and sexual violence 10%. Dong Anh
district is a district 15 km away from central Hanoi, the capital
city of Vietnam, and it has relatively good economic development.
Although evidence of the association between rural/urban residence
and risk of DV during pregnancy has not been clearly discussed in
the literature yet, it has been reported that females who were born
and grow up in rural areas would easily become DV victims, since
they have limited educational levels, with limited access to
healthcare facilities and social services as well.15 A relatively
widemay result from differences in distribution of various factors,
in study methodology, and DV screening tools as well. Therefore, it
is very difficult to have an appropriate comparison.12,16 DV during
pregnancy can cause negative consequences to birth outcomes through
direct or indirect mechanisms. Physical violence directly affects
the abdominal area or sexual violence causes complications to the
fetus such as abruption of the placenta, irritation of uterine
contraction, premature rupture of membranes, or genital tract
infection.5 DV may also result in risk behaviors of pregnant women,
causing negative influences on the fetus, eg tobacco smoking, drug
or alcohol abuse, incomplete antenatal care.19 Moreover, numerous
studies have also reported that DV often made pregnant women live
in highly stressful conditions, with no support from husband/sex
partner, and have an inferiority complex.20 These effects in turn
may lead to pre-term and/or low birthweight deliveries. In our
study, DV was associated with increased risk of pre-term and/or low
birthweight. Women with any type of DV in pregnancy were 1.44-times
more likely to have preterm/low birthweight delivery (OR=1.44, 95%
CI=1.04–1.99) compared to those without DV exposure. Our study
supports findings from numerous previous studies conducted with
women from other populations. For example, in a meta-analysis of 50
studies, Donovan et al17 found 30 studies reporting the association
between DV and pre-term delivery in which there was a nearly double
increase in the risk of pre-term delivery among those exposed to DV
during pregnancy compared to non-exposed women (OR=1.89, 95%
CI=1.43–2.48). In addition, a cohort study conducted with 1,112
women seeking antenatal services at Moshi hospital (Tanzania)
reported that DV increased pre-term delivery risk by 2.9- times and
low birthweight delivery risk by 3.2-times.18 This relationship was
once again strongly confirmed in the study by Nguyen Hoang Thanh et
al,9 in which physical violence was associated with a 5-times
increased risk of pre-term delivery (AOR=5.5; 95% CI=2.1–14.1) and
a nearly 6-times increased risk of low birthweight delivery
(AOR=5.7; 95% CI=2.2– 14.9) among study women. Both of the
above-mentioned cohort studies involved interviews with
hospital-based samples at three pregnancy points of 24 weeks, 34
weeks, and 48 hours after birth. In our study, regarding the effect
of specific types of DV, only sexual violence was found to be
significantly associated with pre-term and/or low birthweight
delivery (OR=1.5, 95% CI=1.23–2.67), while there was no significant
association detected between physical or emotional violence with
the adverse birth outcomes. Besides DV, we noted that there was a
strong association between economic status with the pregnancy
outcome. Specifically, the group with economic hardship had a 1.82-
fold increased risk of pre-term or low birthweight delivery (95%
CI=1.15–2.88) compared to that of the group who reported their
economic status as enough-for-living. This finding is consistent
with that reported by Joseph et al.21 Low socio-economic conditions
may cause fatigue and stress to women; poverty often comes along
with unstable employment, poor knowledge and limited access to full
antenatal care, and malnutrition, thereby resulting in pre range of
prevalence of DV in pregnancy from various studies in Vietnam
(5.9–32.6%) term and low birthweight newborns.15 In addition,
our study also found that husband’s alcohol abuse was significantly
associated with a 1.87-fold increased risk of preterm/low
birthweight delivery (OR=1.87, 95% CI=1.04– 3.38). Husband’s
frequent alcohol use may lead to loss of behavior control, which
creates a tense atmosphere in the family, and may become a threat
to the pregnant wife’s both mental and physical health. This study
has several strengths. The study applied a random sampling
technique to have a representative sample of women of reproductive
age in HCMC. The study used a questionnaire with DV questions
adapted from the WHO’s questionnaire, which is a reliable tool to
measure DV against women. Interviews at commune health centers
assured safety and confidentiality for the participants as by that
way, the interview was not disturbed or interrupted by family
members, especially the husband. The face-to-face interviews were
conducted by experienced and well-trained research staff to assure
collection of accurate and sufficient data. High response rate
(95%) is also one of our study strengths. DV is always a sensitive
topic, and interviewees often hesitate to disclose it, which may
lower the real prevalence of DV. Taking this into careful
consideration, the research set the following criteria for
recruitment of interviewers: being female, having had experience in
community surveys, and having knowledge about reproductive health.
Therefore, female researchers having experience working with the
community in health surveys were recruited. Interviewers also did
not have any pre-established relationship with the participants to
avoid the situation where pre-established relationships may prevent
the participants from disclosing sensitive information. The study
has some limitations. We focused on women with pre-term/low
birthweight living children. No women with dead pre-term/low
birthweight children were included. Consequently, our results could
be generalized for Vietnamese women with living children only. The
study with a cross-sectional design and using a questionnaire for
interview to collect information about events that occurred in the
past may be subject to recall bias. To minimize recall bias, we
used a standard structured questionnaire with close questions
adapted from the WHO’s DV questionnaire, and interviewers were
carefully trained in interview technique so that the same interview
procedure was applied to all participants. In addition, collected
data were dependent on subjective assessment for such variables as
types and extents of violence in pregnancy, maternal status during
pregnancy and childbirth, newborn status of whether pre-term or low
birthweight at birth delivery. However, those pieces of information
were recorded in the child’s health book for all children under 2
years of age. Therefore, the collected values of variables still
remain valid.
(g) “What could be a source of measurement error
(random or systematic) in this study and did the authors tried to
address this problem. Explain with evidence from the relevant text
in discussion.” [4 marks]
(h) “Do you think the risk of selection bias is high or
low? Corroborate your answer from the paper facts – this should not
take more than 60 words?” [4 marks]