ABSTRACT Background: The Rwandan government has set family planning (FP) as one of the goals and strategies to improve the health of the population. However, unmet needs for modern contraceptive methods are still a problem, as is the variance of modern contraceptive use among the five regions of Rwanda.   Aim: This study aimed at assessing key factors that contribute to the variance of modern contraceptive use between five regions of Rwanda. Methods: This study was a secondary analysis of the Rwanda Demographic health survey, 2010. A total of 492 clusters (urban/rural), composed by 12,792 households were selected in the survey; 13,790 women of reproductive age were systematically selected from selected households and interviewed about maternal and reproductive health issues. 6834 married women or living with their partners at the time of the survey were selected for this study. Results: Socio-economic and demographic characteristics of women, access to family planning (FP) information and women’s empowerment were associated with the variance of modern contraceptive use between the regions. Women’s empowerment was positively associated with modern contraceptive use in all regions. Access to information was associated with modern contraceptive use in all regions except in the North region (AOR: 1.24, 95%CI: O.8- 1.92). Conclusion: This study highlights that the variance of modern contraceptive use was associated to the way in which FP factors are associated with modern contraceptive use vary between regions and how different FP factors occur among regions. Further researches are needed to investigate potential factors on supply side that influence such variance.

Introduction: Lack of evidence-based information is an impediment to improve the food security and nutrition status of vulnerable tobacco tenant women and their children on smallholder farms in Malawi. Aim: To assess and describe the food accessibility and nutrition status of the tobacco tenant women of reproductive age and their under-five children on smallholder farms, as well as to determine and report correlational relationships amongst demographic and socio-economic factors, food accessibility measurements and nutrition status indicators. Design: Quantitative cross-sectional descriptive correlational study. Setting: Bwengu, Engucwini and Njuyu Extension Planning Areas, Mzimba North district, Malawi. Sample: 110 women of reproductive age sampled through a proportional systematic random sampling technique, and their 139 under-five children. The sample size was calculated using nQuery version 7 software based on 47% prevalence of malnutrition among under-five children in Malawi, estimated at 95% CI to the accuracy of 10%. Methodology: Data were captured through face-to-face interviews during the hunger season. Food accessibility was captured using the Household Food Insecurity Access Scale (HFIAS), Household Hunger Scale (HHS), Months of Adequate Household Food Provisioning (MAHFP) and Individual Dietary Diversity Scale (IDDS). Nutrition status was measured using anthropometry according to standard protocol. WHO Anthro software was used to compute Z-scores (W/A, H/A, W/H and BMI/A) for children, based on WHO standards. Microsoft Excel was used to calculate BMI for women, based on WHO cut-off points. Stata software was used to compute regression analyses to establish correlational relationships between independent and dependent variables. Ethical approval was obtained from the University of Pretoria, Natural and Agriculture Science Committee (Number EC151215- 028), as well as from the Mzuzu Agriculture Development Division in Malawi. Results: Mean age of the women was 27.3 ± 6 years and 28.8 ± 15 months for the children. The experience of food insecurity access was severe for 75% of the households. Nearly onefifth of households were severely hungry, and had adequate food for only about eight months of the year. The women and their children consumed a mean of two food groups in the previous 24 hours. For the women, 21% were malnourished. For the children, 20% were wasted, 31.3% were stunted and 34% were underweight. More male children were malnourished. For food accessibility measurements, the multivariable linear regression analysis was used. The significant factors influencing the severity of the experience of food insecurity access were loan access (P = 0.015) and household size (P = 0.000). For the prevalence of hunger, the significant factors were food security and nutrition training (P = 0.046), marital status (P = 0.045) and household size (P = 0.000). For the annual prevalence of hunger, the significant factors were labour (P = 0.038), income (P = 0.008) and household size (P = 0.001). For the dietary diversity, the significant factors were labour (P = 0.001), food security and nutrition decisions (P = 0.004), mother’s age (P = 0.033) and income (P = 0.000). Using the multivariable IV regression analysis, the significant factors influencing the BMI of the women were their age (P = 0.054), loan access (P = 0.004), HFIAS scores (P = 0.007) and HHS scores (P = 0.001). For the children’s weight-for-age, the significant factors were the mother’s BMI (P = 0.014), child’s sex (P = 0.005), assets (P = 0.014), mother’s age (P = 0.001) and child’s age (P = 0.015). Using the multivariable random-effects GLS regression analysis, the significant factors influencing the children’s height-for-age were the mother’s age (P = 0.004), child’s sex (P = 0.005), assets (P = 0.028) and HFIAS scores (P = 0.006). For the children’s weight-forheight, the significant factors were the mother’s BMI (P = 0.032), MAHFP scores (P = 0.029), child’s age (P = 0.008) and income (P = 0.001). For the children’s BMI-for-age, the significant factors were the mother’s BMI (P = 0.030), mother’s age (P = 0.029), income (P = 0.002) and assets (P = 0.047). Conclusion: The food accessibility and nutrition status of the tobacco tenant women and their children were seriously poor. The significant factors influencing food accessibility and nutrition status were loan access, household size, food security and nutrition training, marital status, labour, income, assets, food security and nutrition decisions, mother’s BMI, mother’s age, child’s age, child’s sex, HFIAS scores, HHS scores and MAHFP scores. The study findings offer clues to policy makers on where to direct interventions to improve food accessibility and nutrition status of the tobacco tenant women and their children in Malawi. / Dissertation (MSc)--University of Pretoria, 2017. / Human Nutrition / MSc / Unrestricted

Little is known about the barriers and facilitators to local food procurement among women of reproductive age (WRA). Therefore we conducted qualitative interviews with WRA in rural eastern and western NC (ENC and WNC) to learn of factors related to locally sourced food procurement. In-depth interviews were conducted among low-income White, Black, and Hispanic English-speaking WRA (N=62 (ENC: 37; WNC: 23) (18-44 years)). Independent coders used a consensus codebook to double-code all transcripts. Coders then came together to discuss and resolve coding discrepancies, and identified themes and salient quotes. Cross-cutting themes from both ENC and WNC participants included access to local food sources; acceptance of Supplemental Nutrition Assistance Program/Electronic Benefit Transfer (SNAP/EBT); freshness of produce; support for local agriculture; and the community aspect of local food sourcing. The in-depth understanding gained from this study could be used to guide tailored policy and intervention efforts aimed at promoting fruit and vegetable consumption among low-income WRA.

Background AIDS remains one of the world’s most serious health challenges affecting more females than men. The differences in the spread of Human Immunodeficiency Virus (HIV) among gender groups stem from biology, sexual behaviour and socially constructed gender differences between women and men in roles and responsibilities, access to resources and decision-making power. It could also be due to the females’ status in society which could be justified by lower economic and decision making ability. Purpose The purpose of this study was to explore and describe the role of gender in the spread of HIV among women of reproductive age in Ethiopia; with the view of developing gender sensitive HIV and AIDS prevention strategies. Methods The study used sequential mixed method with quantitative and qualitative paradigm. During first phase of the study, health facility based descriptive cross-sectional study design was used. Data was collected from 422 respondents using a structured questionnaire. Forty participants were recruited by purposive sampling from representatives working in reproductive health or related fields. Results About 83.2% of respondents reported that sexual intercourse discussion should be initiated by male partners. This showed that majority of respondents were dependent on their male partners in decision-making regarding sexual matters in their relationship. Multiple sexual partners were common among the respondents. One third of the respondents reported to have had intercourse with more than one partner during the past twelve months of the study period. Higher proportion of respondents (61.4%, n=259) had never used condom during sexual intercourse with their partner/s. As a result these risky sexual practices are a potential threat for spread of HIV and AIDS among women. Thus developed guidelines would alleviate the existing problems through implementation of strategies of HIV and AIDS prevention to enhance women’s status at household and different administrative structure level. Conclusion Gender disparities in relation to negotiating sexual relations among the study respondents were found to be still relevant. The culture that has placed men at the helm of leadership in sexual matters is strongly upheld and that includes who recommends use of preventive measures and who regulates when and how to enter into a sexual relationship. Guidelines for gender sensitive prevention strategies if applied appropriately would educate women and men to make decision about what directly affects their health / Health Studies / D. Litt. et Phil. (Health Studies)

This thesis adapts a life course approach in epidemiology to endometriosis. Endometriosis is a highly prevalent chronic disease affecting women in reproductive age. Firstly, the topic of this disease is introduced, the situation and current knowledge in Australia is discussed. Positive changes in a national level are presented. Secondly, early life exposers and maternal behaviour are investigated as possible risk and protective factors. A systematic review of early life factors identified a low birthweight and formula feeding of infants as risk factors for the development of endometriosis. Lastly, the relation of birthweight, weight at childhood and endometriosis was analysed using data of Australian Longitudinal Study on Women's Health. Other risk and protective factors were evaluated and included into the analysis. Logistic regression was used for determination of statistical significance. High weight at 10 years old was found to be a protective factor against endometriosis.

Background AIDS remains one of the world’s most serious health challenges affecting more females than men. The differences in the spread of Human Immunodeficiency Virus (HIV) among gender groups stem from biology, sexual behaviour and socially constructed gender differences between women and men in roles and responsibilities, access to resources and decision-making power. It could also be due to the females’ status in society which could be justified by lower economic and decision making ability. Purpose The purpose of this study was to explore and describe the role of gender in the spread of HIV among women of reproductive age in Ethiopia; with the view of developing gender sensitive HIV and AIDS prevention strategies. Methods The study used sequential mixed method with quantitative and qualitative paradigm. During first phase of the study, health facility based descriptive cross-sectional study design was used. Data was collected from 422 respondents using a structured questionnaire. Forty participants were recruited by purposive sampling from representatives working in reproductive health or related fields. Results About 83.2% of respondents reported that sexual intercourse discussion should be initiated by male partners. This showed that majority of respondents were dependent on their male partners in decision-making regarding sexual matters in their relationship. Multiple sexual partners were common among the respondents. One third of the respondents reported to have had intercourse with more than one partner during the past twelve months of the study period. Higher proportion of respondents (61.4%, n=259) had never used condom during sexual intercourse with their partner/s. As a result these risky sexual practices are a potential threat for spread of HIV and AIDS among women. Thus developed guidelines would alleviate the existing problems through implementation of strategies of HIV and AIDS prevention to enhance women’s status at household and different administrative structure level. Conclusion Gender disparities in relation to negotiating sexual relations among the study respondents were found to be still relevant. The culture that has placed men at the helm of leadership in sexual matters is strongly upheld and that includes who recommends use of preventive measures and who regulates when and how to enter into a sexual relationship. Guidelines for gender sensitive prevention strategies if applied appropriately would educate women and men to make decision about what directly affects their health / Health Studies / D. Litt. et Phil. (Health Studies)