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Prevalence and determinants of unintended pregnancy among female sex workers (FSW) in Jashore, Bangladesh

by Md. Masud Reza, Hasibul Hasan Shanto, Samira Dishti Irfan, A. K. M. Masud Rana, Mohammad Niaz Morshed Khan, Golam Sarwar, Mohammad Sha Al Imran, Mahbubur Rahman, Md. Safiullah Sarker, Muntasir Alam, Md. Abu Hena Chowdhury, Mustafizur Rahman, Sharful Islam Khan

Background

Unintended pregnancy among female sex workers (FSW) is a pressing reproductive health concern attributable to risky sexual behaviors, healthcare inequities and poor negotiation powers with male sex partners. However, evidence is scarce on the prevalence and determinants of unintended pregnancies among FSW, which is crucial for enhancing reproductive healthcare. This analysis aims to measure the prevalence of lifetime unintended pregnancies and their associated factors.

Methods

A cross-sectional study was conducted on 327 FSW in Jashore (a border belt district of Bangladesh) from September 2022 to March 2023. Participants were recruited through take-all sampling. Data were collected on the lifetime history of unintended pregnancies and other relevant variables through face-to-face interviews. Chi-square statistic was used to compare the characteristics of FSW reporting unintended pregnancies. To assess the net association of factors associated with unintended pregnancy, multiple logistic regression was applied.

Result

The lifetime prevalence of unintended pregnancies was reported at 75.8% (95%CI: 71.0–80.1). Among those who reported unintended pregnancies, 37.1% (95%CI: 30.8–43.8) had no education, 39.9% (95%CI: 32.8–47.5) were 25–34 years old, 49.6% (95%CI: 39.3–59.9) were currently married and 62.9% (95%CI: 49.7–74.4) earned ≤10,000 BDT per month compared to those who did not report lifetime unintended pregnancies. The likelihood of unintended pregnancies was significantly higher among those who reported having sex with non-transactional male sex partners (AOR: 2.4, 95%CI: 1.1–5.3, p = 0.036) than those who never had sex with any non-transactional male sex partner. The likelihood was also higher among those who reported rape in their lifetime (AOR: 2.0, 95%CI: 1.0–3.8, p = 0.037) and who self-reported mental health problems (AOR: 2.1, 95%CI: 1.0–4.2, p = 0.045) within the past year, compared to their counterparts.

Conclusion

This study highlights the considerable prevalence and associated determinants of unintended pregnancies among FSW in Jashore. These determinants need to be considered to strengthen reproductive healthcare interventions and policies for FSW. Reproductive health of FSW cannot be improved unless these factors are addressed in the ongoing interventions.

Effectiveness of focal muscle vibrations in improving sensorimotor performance, mobility and strength in spinal cord injury population: a systematic review

Por: Ashfaque · M. · Pujari · A. N. · Niazi · I. K. · Amjad · I. · Haavik · H. · Farmer · S. F.
Objective

Spinal cord injury (SCI) results in debilitating sensory, functional deficits and paralysis requiring neurorehabilitation solutions. In this regard, focal muscle vibration (FMV) is an emerging neuro-rehabilitation tool that uses mechanical vibration on muscles/tendons to stimulate underlying nerves and consequently modulate neural pathways. We conducted a systematic review to understand the exact effectiveness of FMVs on the sensorimotor function and mobility/strength in the SCI population.

Design

Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach.

Data sources

PEDro, Springer, PubMed, Science Direct, Cochrane Library and Google Scholar were searched through 15 February 2025.

Eligibility criteria for selecting studies

We included studies adhering to the following population–intervention–comparison–outcomes (PICO) elements. Population: SCI, intervention: FMV, comparison: unexposed controls, outcome: either of sensorimotor function or mobility and strength.

Data extraction and synthesis

Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) scale. Findings were summarised and a narrative synthesis is provided.

Results

25 studies were included. 9 studies used FMV in the upper limb and 14 in the lower limb. The analysis includes 427 patients with SCI, with a focus on male, chronic SCI cases and a prevalence of North American studies.

Conclusion

Our systematic review of 25 studies, with 21 (84%) reporting positive outcomes, suggests that FMV may improve sensory perception, motor function, mobility and strength in individuals with SCIs, with benefits observed in both limbs. However, substantial heterogeneity in FMV parameters, study designs, participant characteristics and the high prevalence of serious/critical risk of bias (13/25 studies, 52%) limit definitive conclusions. Further research with optimised protocols, larger sample sizes and longitudinal designs is needed to confirm efficacy and establish clinical guidelines.

Community-based mental health screening & referral for flood-affected women in rural Pakistan: an intervention feasibility study protocol

Por: Das · J. K. · Gaffey · M. F. · Ansari · Z. N. · Mirani · M. · Tabassum · F. · Niaz · M. · Siddiqui · A. · Rabbani · F. · Rizvi · A. · Ahmed · I. · Khan · M. · Bhutta · Z. A.
Introduction

South Asia carries the burden of a rapidly changing climate with floods and extreme heat. These disasters further translate into mental health distress, financial stress and detrimental effects on well-being, with women being the most vulnerable. This study aims to demonstrate that mental health screening, referral and resilience-building group sessions can be successfully administered by community health workers and primary health facility staff in a flood-affected rural population of women in Pakistan and provide evidence on the effectiveness of this approach for improving their mental health status.

Methods and analysis

A quasi-experimental design with a comparison group will be used for the study, preceded by a formative phase. The formative phase evaluated the feasibility of mental health screening by Lady Health Workers (LHWs) in flood-affected areas using a qualitative approach such as focus group discussions and in-depth interviews. Manuals developed by the study team of mPareshan will be used to train LHWs, Lady Health Supervisors (LHS) and health facility staff. Following this, LHWs will briefly screen women aged 18 to 49 years, administer awareness-raising and resilience-building sessions and refer women who screen positive for depression or anxiety to a primary health facility. Physicians at the health facility will confirm the diagnosis and provide counselling to mild-moderate cases, while severe cases would be referred to specialists. Statistical evaluation of quantitative data and thematic content analysis of qualitative data will be conducted to assess the feasibility and impact of the intervention. This trial is registered at clinicaltrials.gov with number NCT06756165.

Ethics and dissemination

The study acquired ethical approval from the Ethical Review Committee at Aga Khan University (2024-10475-30776) and the National Bioethics Committee (4-87/NBC-1158/23/481) in Islamabad. Approval was obtained from relevant provincial authorities. The trial will adhere to the ethical principles of autonomy, anonymity, confidentiality, equity and respect. All eligible participants will be provided with informed consent, details regarding the purpose and procedure of the study, and the right to withdraw at any time. Data and information will be anonymised and stored securely. Dissemination of the results of the trial will occur after its completion to stakeholders, participants and the public.

Trial registration number

NCT06756165.

Towards a holistic framework: a scoping review protocol to map early childhood development services

Por: Amir-Behghadami · M. · Tabrizi · J.-S. · Heidarabady · S. · Barzegar · M. · Nikniaz · A. · Azami-Aghdash · S.
Introduction

Programmes based on early childhood development (ECD) services play a vital role in improving child health and developmental outcomes. Across many countries, these programmes target children under 5 years of age—including those who are healthy, at risk or with developmental disorders—and are implemented in governmental and non-governmental organisations in both the health and non-health sectors globally. This protocol outlines a scoping review designed to systematically map and synthesise existing evidence on the components, implementation strategies and delivery mechanisms of ECD services worldwide. The review aims to inform the development of optimised and comprehensive interventions that support holistic child development.

Methods and analysis

This review will be conducted by Arksey and O’Malley’s framework and its recent advances. Several databases, including PubMed/MEDLINE, Scopus, Science Direct and Web of Science, Scientific Information Database, Magiran, IranMedex and Barakat knowledge network system, will be initially searched for studies up to December 2024. All searches will be done for published or unpublished articles/reports without time and language restrictions. Two researchers will independently carry out screening of the included studies and extraction of data. Any discrepancies will be resolved by consensus. In case no initial consensus is reached, a third researcher will be consulted to make a decision. The findings will be synthesised through the content-analysis method.

Ethics and dissemination

The findings of this review may offer a novel perspective for developing a comprehensive package of ECD services within the Iranian health system. Furthermore, it provides a detailed roadmap for researchers and stakeholders aiming to enhance child health and prevent developmental disorders. This study received ethical approval from Tabriz University of Medical Sciences (ID: IR.TBZMED.REC.1404.139), with no ethical concerns as it involves no patient participation or interventions.

Coproducing a new scale with young people aged 10-24 years: a protocol for the development and validation of the Youth Loneliness Scale (YLS)

Por: Fuhrmann · D. · Riddleston · L. · Verity · L. · Alam · I. · Chavez · L. · Conway · J. · Niaz · A. · Pollmann · A. · Qualter · P. · Spowage · P. · Turner · L. · Walibhai · W. · Lau · J. Y. F.
Introduction

The high prevalence of loneliness in young people, aged 10–24 years, is increasingly recognised as an urgent global health concern. The experience of loneliness is linked to a wide range of adverse physical and mental health outcomes. A lack of loneliness scales that can accurately capture the authentic experiences of young people has hampered progress in our understanding of the aetiology and sequelae of youth loneliness, as well as the development of preventative policies and interventions. Here, we provide a protocol for developing and validating an age-sensitive loneliness scale for young people aged 10–24 years: the Youth Loneliness Scale (YLS). The scale is designed to measure loneliness in the general population of young people in the UK.

Methods and analysis

The scale is coproduced with young people from design to dissemination. The scale development process follows a three-phased, multistep approach that includes item development, scale construction and scale evaluation. Item development is achieved via deductive (literature review) and inductive methods (arts workshops and focus groups), as well as a Delphi survey of experts (by profession and experience) for initial refinement. The scale is then constructed via pretesting items in cognitive interviews with young people, and exploratory testing for preliminary evaluation and refinement. Finally, the scale is administered in confirmatory testing, where a full psychometric evaluation is provided.

Ethics and dissemination

The project was approved by the Queen Mary University of London Research Ethics Committee (Reference: 2024-0231-341) as the lead site and subsequently endorsed by the University of Manchester Research Ethics Committee. The YLS scale and results of its psychometric evaluation will be published open-access. The protocol provided here will allow researchers to evaluate the final scale generated against the plans set out. We also encourage the use and adaptation of the protocol to develop age-sensitive loneliness scales for other populations.

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