The impact of COVID-19 on women and children in the UK who were victims of domestic abuse: a practitioner perspective

PurposeThis study aims to explore the impact of COVID-19 on women and children in the UK who were victims of domestic abuse.Design/methodology/approachThe authors draw from their experiences of working in the domestic abuse sector to reflect on the impact of lockdown restrictions on women and children, focussing on the impact of government restrictions that created an environment in which abusers could control the movement of victims.FindingsThe impact of the pandemic was significant as victims were locked into the abuse, unable to escape for fear of breaching lockdown rules. The lockdown affected victims of different forms of violence against women and girls in the UK including forced marriage and female genital mutilation, which highlighted the ramifications of intersectional inequalities for abuse victims.Originality/valueThis paper articulates the devastating impact of the pandemic on vulnerable women, and their fair and just access to the family courts. This paper concludes that women were failed by the government and that there was not nearly enough support from support agencies, which has left many at risk and suffering significant harm.

Female genital mutilation (FGM) trauma and mental health support during the UK lockdown: exploring women's experiences

PurposeThe purpose of this study is to report findings from interviews with seven African-heritage women attending a female genital mutilation (FGM) Clinic in the north of England, during the COVID-19 lockdown. The Clinic, established several years before the pandemic, provides specialist therapeutic support to women and girls from minority ethnic communities who are affected by harmful "traditional" practices, including FGM. The services provided by the Clinic include early interventions, peer support, community engagement and empowerment around FGM. Design/methodology/approachData was collected during an online focus group discussion with seven women who had received counselling for FGM, to gain insight into their lived experiences of therapeutic support during the pandemic. FindingsUsing Braun and Clarke (2006) six-step thematic analysis, four superordinate themes derived from the data: consistency and continuity;safety in shared experience and creativity;feeling heard, feeling stronger;and altruism and desire for change. Research limitations/implicationsIt is important to recognise some limitations within this study. It is based on one focus group discussion that involved seven participants, who had experienced FGM, were living in a targeted area and whose mental health had been further compromised by the COVID-19 pandemic. Practical implicationsThe findings of this study indicate that it is essential to consider participants' experiences of receiving therapeutic support during the COVID-19 pandemic. It was observed that emotional stressors linked with participants' experiences of FGM may be exacerbated by those related to COVID-19. Social implicationsThere is a need to conduct similar research, perhaps on an individual basis, that would reach a wider sample of women from ethnic minority populations who are survivors of FGM, including those from FGM practicing communities who have been hospitalised through their deteriorating mental health. This would add to the small but growing body of evidence, to provide a better understanding of the experiences of their mental health needs during the COVID-19 pandemic and perhaps better identify effective therapeutic interventions. Originality/valueThese themes provide an insight into these women's experiences of the trauma associated with FGM and receiving mental health support during the pandemic.

Caesarean childbirth and associated factors during Covid-19 pandemic at public hospitals in the Sidama region, Southern Ethiopia.

Background: The increasing number of caesarean births worldwide concerns pregnant women, obstetric service providers, and the country's economy. Unnecessary caesarean childbirth increases childbirth complications and the cost of health care in low-income countries, including Ethiopia. Objective: This study aims to assess caesarean birth and associated factors at the Sidama region public hospitals, Southern Ethiopia, 2020. Methods: An institution-based cross-sectional study was conducted among 484 women who gave birth at public hospitals in the Sidama region. A multi-stage sampling technique was employed. The data were collected from 1st to 30th of July 2020 by face-to-face interviews using a semi-structured questionnaire (see Table S1: see supplementary materials associated with this article on line), and the wealth index was analysed by principal component analysis. Backward logistic regression used an adjusted odds ratio and a 95% confidence interval to assess the strength and association between the caesarean section and its associated factors. A P-value of < 0.05 was used to declare statistical significance. Result: Caesarean childbirth in this study was 34.3%. In this study, partograph monitoring (AOR = 2.23, CI = 1.13, 4.38), previous caesarean birth (AOR = 3.21, CI = 1.28,8.17), having genital cutting/mutilation (AOR = 2.51, CI = 1.14,5.53), intermittent cardiotocography monitoring during childbirth (AOR = 2.3, CI = 1.14, 4.49), absence of companionship during delivery (AOR = 4.97, CI = 2.37, 10.43) and is not remembering the last normal menstrual period (AOR = 3.12, CI = 1.40,6.94) had increased the odds of caesarean birth. Conclusion: Studies show that the prevalence of caesarean has alarmingly increased in both developed and developing countries. However, the magnitude of caesarean section differs from country to country and in rural and urban areas; the magnitude of caesarean section in this study is much higher than the WHO recommends threshold. The local health bureau and obstetric care providers should pay attention to the caesarean section and need intervention in partograph plotting, companionship, cardiotocography, and female genital mutilation.

Effect of COVID-19 pandemic on female sexual function in women with female genital mutilation.

We aimed to evaluate the impact of the COVID-19 pandemic on female sexual function in women with female genital mutilation (FGM) in Somalia. This cross-sectional study was conducted on women with FGM attending the gynaecologic outpatient clinic of our hospital, between March and June 2021, using a validated Female Sexual Function Index (FSFI) questionnaire with a physical examination based on FGM typing. Those women who refused to participate, those with mental illness, uncontrolled systemic disease, drug, alcohol, or khat addiction, pregnant, genital prolapse, gynaecological or urological cancer, previous pelvic surgery, premature ovarian failure, genital skin diseases, drug use that affects sexual function and those with or suspected of having COVID-19 infection were excluded. A total of 201 sexually active women enrolled, with a mean age of 29 (14-55) years. Comparison of FSFI scores and the COVID-19 pandemic, a statistically significant worsening in the mean FSFI scores and all its domains (p<.001, for each). All of the domains of the FSFI were determined higher before and during the pandemic except pain. There is a decline in female sexual functioning during the COVID-19 outbreak in women with FGM. FGM is a major public health concern necessitating urgent response in Somalia.Impact statementWhat is already known on this subject? As it stands, there is a body of research on sexual behaviour during COVID-19 pandemic, but a lack of conclusive evidence. However, our knowledge of the sexual function of women with FGM during the COVID-19 pandemic is largely based on very limited data.What do the results of this study add? There is a decline in female sexual functioning during COVID-19 pandemic in women with female genital mutilation in Somalia.What are the implications of these findings for clinical practice and/or further research? FGM is a major public health problem necessitating urgent response worldwide. There is an urgent need to implement FGM prevention programmes and raise public awareness in order to eradicate this harmful practice.

Combining Theory and Research to Validate a Social Norms Framework Addressing Female Genital Mutilation.

Female Genital Mutilation (FGM) is a harmful practice with no benefits and considerable harm to girls and women who undergo it. In 2016, the United Nations Joint Program to Eliminate FGM, funded the development and subsequent validation of a monitoring and evaluation framework to understand the relationship between social norms and practicing FGM. Evidence on the framework was gathered through a pilot study in Ethiopia. This paper uses cross-sectional quantitative data from the pilot to operationalize the framework and determine what factors are associated with practicing FGM. A total of 554 and 481 participants answered the question "Have you undergone FGM?" and "Do you know a family member who has undergone FGM?" respectively. Overall, 65% of participants said they had undergone FGM and 32% said they knew someone in their family who had undergone FGM. Predictors of not undergoing FGM included most progressive attitudes vs. less progressive attitudes about FGM and relationship to identity [OR: 1.9 (95% CI: 1.1-3.3)]; region [Afar vs. Addis Ababa: OR: 0.09 (95% CI: 0.02-0.5); Southern Nations Nationalities and People's Regions vs. Addis Ababa: OR: 0.1 (95% CI: 0.05-0.3)], being 36 years old and above vs. 10-19 years (OR: 0.2 (95% CI: 0.1 to 0.7)) and being single, never married vs. married or engaged (OR: 2.8 (95% CI: 1.1-7.0)]. Predictors of knowing a family member who has not undergone FGM included: Higher knowledge vs. lower knowledge [OR: 0.3 (95% CI: 0.1-0.5)]; if the family expected you to abandon FGM, you had a greater odds of knowing a family member who had not undergone FGM [43.6 (95% CI: 2.7-687.8)]; coming from Southern Nations, Nationalities and People's Region was associated with a lower odds of knowing a family member who had not undergone FGM [0.3 (95% CI: 0.1-0.6)]. Being a female influential vs. female caregiver was associated with a higher odds of knowing a family member who had not undergone FGM [2.9 (95% CI: 1.01-5.2)]. This paper has allowed us to validate a theory and research based social norms framework, specifically examining how social and behavior change communication can be used as a mechanism for shifting norms around a given harmful practice. Now that this model has been developed and validated, it is likely to provide a foundation to study the direct and indirect impacts of social norms programming on changing harmful practices, such as FGM.

Glycaemic control during the lockdown for COVID-19 in adults with type 1 diabetes: A meta-analysis of observational studies.

AIMS: To assess the effects of lockdown due to COVID-19 pandemic on glucose metrics, measured by glucose monitoring systems, in adult individuals with type 1 diabetes. METHODS: We conducted a systematic literature search for English language articles from MEDLINE, Scopus and Web of Science up to February 28, 2021, using "diabetes", "lockdown", and "glucose" as key search terms. Time in range (TIR) was the main outcome; other metrics were time above range (TAR), time below range (TBR), mean blood glucose (MBG) and its variability (%CV), estimated HbA1c (eA1c) or glucose management indicator (GMI). RESULTS: Seventeen studies for a total of 3,441 individuals with type 1 diabetes were included in the analysis. In the lockdown period, TIR 70-180 mg/dl increased by 3.05% (95% CI 1.67-4.43%; p < 0.0001) while TAR (>180 mg/dL and > 250 mg/dL) declined by 3.39% (-5.14 to -1.63%) and 1.96% (-2.51 to -1.42%), respectively (p < 0.0001 for both). Both TBR < 70 and <54 mg/dL remained unchanged. MBG slightly decreased by 5.40 mg/dL (-7.29 to -3.51 mg/dL; p < 0.0001) along with a reduction in %CV. Pooled eA1c and GMI decreased by 0.18% (-0.24 to -0.11%; p < 0.0001) and a similar reduction was observed when GMI alone was considered (0.15%, -0.23 to -0.07%; p < 0.0001). Sensor use was only slightly but not significantly reduced during lockdown. CONCLUSIONS: This meta-analysis shows that well-controlled people with type 1 diabetes on both MDI and CSII with continuous or flash glucose monitoring did not experience a deterioration in glucose control throughout the COVID-19 lockdown, showing a modest, though statistically significant improvement in many glucose control parameters.

Forecasting the Trend of COVID-19 Considering the Impacts of Public Health Interventions: An Application of FGM and Buffer Level.

PURPOSE: COVID-19 is still showing a tendency of spreading around the world. In order to improve the subsequent control of COVID-19, it is essential to conduct a study on measuring and predicting the scale of the outbreak in the future. METHODS: This paper uses rolling mechanism and grid search to find the best fractional order of Fractional Order Accumulation Grey Model (FGM). Buffer level is proposed based on the general form of weakening buffer operator to measure the effect of government control measurements on the epidemic. And the buffer level is associated with the Government Response Stringency index and the Mobility Index. RESULTS: Firstly, the model proposed in this paper dominates the ARIMA model which has been widely used in predicting the confirmed COVID-19 cases. Secondly, in the process of using the buffer level to modify the FGM, this paper finds that government measurements require the active cooperation of the public and often have a time lag when they are effective. Only when government increase its stringency and the public observe the order can the spread of COVID-19 be slowed down. If there is only the controlling measure and the public does not react actively, it will not slow down the epidemic. Thirdly, according to the Mobility Index and Government Response Stringency Index in December, this paper predicts the cumulative confirmed cases of the end of January in different scenarios according to different buffer levels. The study suggests that the world should continue to maintain high vigilance and take corresponding control measures for the outbreak of COVID-19. CONCLUSIONS: Government's control measures and public's abidance are both important in this battle with COVID-19. Governments control measures have time-lag effect and the time lag is about 9 days. When the government increases its stringency and the public cooperates with the government, we must consider the weaken buffer operator with proper buffer level in the prediction process. These prediction methods can be considered in the prediction of COVID-19 confirmed cases in the future or the trend of other epidemics.

Reduction of hypoglycaemia, lifestyle modifications and psychological distress during lockdown following SARS-CoV-2 outbreak in type 1 diabetes.

AIMS: To assess changes in glucose metrics and their association with psychological distress and lifestyle changes in patients with type 1 diabetes (T1D) using flash glucose monitoring (FGM) during lockdown following severe acute respiratory syndrome coronavirus 2 outbreak. MATERIALS AND METHODS: Single-centre, observational, retrospective study enrolling T1D patients who attended a remote visit on April 2020 at the Endocrinology division of the University Hospital Policlinico Consorziale, Bari, Italy. Lockdown-related changes in physical activity level and dietary habits were assessed on a semi-quantitative basis. Changes in general well-being were assessed by the General Health Questionnaire-12 items with a binary scoring system. Glucose metrics were obtained from the Libreview platform for the first 2 weeks of February 2020 (T0) and the last 2 weeks before the phone visit (T1). RESULTS: Out of 84 patients assessed for eligibility, 48 had sufficient FGM data to be included in the analysis. FGM data analysis revealed significant reductions in coefficient of variation, number of hypoglycaemic events, and time below range, while no changes were found in time in range, time above range, mean sensor glucose, and glucose management indicator. Moreover, the frequency of sweets consumption was inversely related to the occurrence of hypoglycaemic events during lockdown. CONCLUSIONS: Lockdown-related lifestyle changes, albeit unhealthy, may lead to reduction in FGM-derived measures of hypoglycaemia and glycaemic variability in patients with T1D.