Bosiljka Djikanovic

Factors associated with intimate partner violence against women in Serbia: a cross-sectional study

Background This study aimed to identify factors associated with intimate partner violence against women living in Belgrade, Serbia. Method A cross-sectional, population based household survey was conducted in Belgrade as part of the WHO Multi-country Study on Womens Health and Domestic Violence, using a standard questionnaire. Face-to-face interviews were conducted with 1456 women aged 15–49 years. Data used in this study were from a subset of 886 women who ever cohabited with their male intimate partners. The association between various factors at individual and relationship levels and reported physical or sexual partner violence, or both, was assessed by univariate and multivariate logistic regression analysis. Results Multivariate logistic regression modelling revealed that partner violence was significantly associated with a number of factors relating to the male partner: daily alcohol consumption (AOR 4.25, 95% CI 1.78 to 10.11), having affairs (AOR 3.97, 95% CI 1.62 to 9.57), fighting with other men (AOR 3.62, 95% CI 1.91 to 6.88), his mother having experienced spousal abuse (AOR 2.71, 95% CI 1.40 to 5.23) and he himself being beaten as a child (AOR 3.14, 95% CI 1.48 to 6.63). Among the factors related to the women, only forced or unwanted first sexual intercourse was independently associated with exposure to partner violence (AOR 2.50, 95% CI 1.05 to 5.96). Conclusion The majority of factors associated with intimate partner violence related to the male partner; in particular his childhood experiences of violence in his own family. Long-term violence prevention programmes should target boys growing up in families with domestic violence.

Help-seeking behaviour of Serbian women who experienced intimate partner violence

OBJECTIVE This study aimed to identify whom women in Serbia approach for help in case of intimate partner violence (IPV), their reasons for seeking help and their satisfaction with the received help. METHODS A cross-sectional, population-based household survey of a random sample of women aged 15-49 years was conducted in Belgrade (WHO Multi-country Study on Womens Health and Domestic Violence against Women). A standard questionnaire was administered by trained interviewers through face-to-face interviews. RESULTS The questionnaire was completed by 1456 women and 1196 of them ever had an intimate partner. Almost one in four ever-partnered women reported experiencing either physical and/or sexual violence, at least once in their life. Among these abused women, ≈ 22% had ever sought help from formal institutions. Police and health services were most commonly approached (12% and 10% of abused women, respectively). Satisfaction with services was highest for health services and legal advice and lowest for police and social services. Women sought help especially when violence had a severe impact on them or when they saw that their children suffered. Women who did not seek help stated that they believed that the violence was bearable or had ended. Other reasons for not seeking help were fear of undesirable consequences of seeking help and lack of trust in institutions. CONCLUSIONS From the abused womens perspective, health care services are the institutions with the highest potential to help women in cases of IPV. Developing a comprehensive health sector response is of critical importance to ensure appropriate care and referral.

Maternal satisfaction with organized perinatal care in Serbian public hospitals

BackgroundUnderstanding the experiences and expectations of women across the continuum of antenatal, perinatal, and postnatal care is important to assess the quality of maternal care and to determine problematic areas which could be improved. The objective of this study was to identify the factors associated with maternal satisfaction with hospital-based perinatal care in Serbia.MethodsOur survey was conducted from January 2009 to January 2010 using a 28-item, self-administered questionnaire. The sample consisted of 50% of women who expected childbirths during the study period from all 76 public institutions with obstetric departments in Serbia. The following three composite outcome variables were constructed: satisfaction with technical and professional aspects of care; communication and interpersonal aspects of care; and environmental factors.ResultsWe analyzed 34,431 completed questionnaires (84.2% of the study sample). The highest and lowest average satisfaction scores (4.43 and 3.25, respectively) referred to the overall participation of midwives during delivery and the quality of food served in the hospital, respectively. Younger mothers and multiparas were less concerned with the environmental conditions (OR = 0.55, p = 0.006; OR = 1.82, p = 0.004). Final model indicated that mothers informed of patients’ rights, pregnancy and delivery through the Maternal Counseling Service were more likely to be satisfied with all three outcome variables. The highest value of the Pearson’s coefficient of correlation was between the overall satisfaction score and satisfaction with communication and interpersonal aspects of care.ConclusionsOur study illuminated the importance of interpersonal aspects of care and education for maternal satisfaction. Improvement of the environmental conditions in hospitals, the WHO program, Baby-friendly Hospital, and above all providing all pregnant women with antenatal education, are recommendations which would more strongly affect the perceptions of quality and satisfaction with perinatal care in Serbian public hospitals by women.

Systematic review of studies investigating the association between dietary habits and cutaneous malignant melanoma

OBJECTIVE Several papers have dealt with diet as a risk factor for cutaneous malignant melanoma (CMM). This study aimed to synthesize available data on the topic. STUDY DESIGN A systematic review of observational studies assessing the association between dietary habits and CMM was performed. METHODS Electronic databases were used to identify eligible articles. Quality was assessed through the Newcastle-Ottawa scale. Case-control and cohort studies evaluating the intake of food/nutrients through the assessment of dietary habits and the occurrence of CMM were considered eligible. Data comparing the highest and lowest levels of consumption were collected from single studies and described qualitatively as data combination was not possible. Results were reported as percentages on the basis of relative risks and odds ratios. RESULTS Eighteen studies reported in 21 articles were selected. Cohort studies showed better quality than case-control studies. Most articles did not detect any significant association between food/nutrient intake and CMM, except for limited evidence of a protective role associated with fish, vegetables and fruit. Risk reduction was shown to be 35-37%, 40-57% and 34-46%, respectively, in studies reporting significant results. Similarly, few articles showed protective roles of beta-carotene and vitamins A, C, D and E, with risk reduction of 64%, 37-43%, 41%, 15-39% and 50-66%, respectively. CONCLUSION A trend towards reduced risk of CMM associated with higher intake of fish, vegetables and fruit, as well as beta-carotene and vitamins A, C, D and E, has been shown but further research is needed to provide decisive data.

Differencies in the Level of Knowledge on Cervical Cancer among Health Care Students, Midwives and Patients in Serbia

BACKGROUND Level of midwife knowledge is particularly important because of their role in the cervical cancer prevention programme. The aim of this study was to examine differences in the level of knowledge among health care students, midwives and women in the general population of Serbia. MATERIALS AND METHODS A cross-sectional approach was used with health care students of the medical shool, midwives in their practice, and women visiting a chosen general practitioner as respondents. RESULTS In comparison with the students and midwives, women had lower level of knowledge of causative agents of the cervical cancer, genital warts, HPV types, screening for cervical cancer as well as about the target population for vaccine and its role. Differences in the numbers of right answers of respondents were statistically significant (p<0.001). Four or more correct answers were obtained from 22.7% women, 35.3% from midwives and 83.8% from students. CONCLUSIONS Midwives should improve their own level of knowledge related to preventive practice for cervical cancer, as well as their personal compliance with recommended practices, in order to be qualified and credible promoters of cervical cancer control among women in Serbia.

Inequalities in intentions to quit smoking in Serbia: data from 2006 National Health Survey.

OBJECTIVES The prevalence of smoking is very high in Serbia. A wide range of tobacco control measures and activities have been undertaken to encourage smoking cessation, but it is not known whether smokers in Serbia are willing to quit, and if inequalities exist between them. This study analysed intentions to quit smoking, using the Stages of Change Model, among a population of current and/or former adult smokers in Serbia, and compared socio-economic and demographic characteristics. STUDY DESIGN Cross-sectional study on a nationally representative population sample, using data from the 2006 National Health Survey. The sample consisted of 5905 current or former daily smokers. METHODS Logistical regression analysis was used to identify associations between socio-economic and demographic characteristics of former/current smokers, and their stage of change in terms of smoking (precontemplation, contemplation, preparation, action, maintenance and termination). RESULTS More than one-fifth (22%) of current smokers did not intend to quit smoking (precontemplation stage). Women were twice as likely to contemplate quitting compared with men [odds ratio (OR) 2.08, 95% confidence interval (CI) 1.68-2.58]. However, women were less successful in quitting smoking (termination stage) than men (OR 0.64, 95% CI 0.52-0.79). In addition to gender, educational inequalities in intentions to quit smoking were identified; less-educated individuals were less willing to quit smoking (preparation and action stages) regardless of their socio-economic status or chronic disease status. CONCLUSION Tobacco control interventions should be sensitive to gender and educational inequalities in quitting smoking.

Differences in the use of contraception between Roma and non-Roma women in Serbia

BACKGROUND Unwanted pregnancies are still common in Central and Eastern European countries, including Serbia. Little is known about the use of contraception in different ethnic groups. This research was undertaken to investigate the use of contraception between Roma and non-Roma women in Serbia and factors associated with it. METHODS Data from the 2010 Multiple Indicator Cluster Survey (MICS4) conducted in Serbia were used. This research included 1082 Roma and 2145 non-Roma women aged 15-49. Univariate and multivariate logistic regression analyses were used to analyze socio-demographic factors associated with the use of contraception in both population groups. RESULTS Roma women use any type of contraception more often than non-Roma women. However, Roma women rely more on traditional and unsafe methods such as withdrawal and lactational amenorrhea method, but significantly less on modern methods such as pill, condom and intrauterine device. Place of living (region) is also associated with contraceptive usage. CONCLUSIONS Inequalities in the use of contraception between Roma and non-Roma women exist. Promoting modern methods of contraception and education about the importance of the use of contraception should be in the focus of national health policies and strategies related to reproductive health to reduce these inequalities.

Family planning among women in urban and rural areas in Serbia

INTRODUCTION Family planning is an important aspect of population policy at the state level, because the demographic trends in Serbia are very unfavorable. OBJECTIVE The objective of this study was to examine the differences in family planning between the women in rural and urban areas of Serbia. METHODS This study represents the secondary analysis of the National Health Survey of the population in Serbia from 2006, which was conducted as a cross sectional study, on a representative sample of the population. RESULTS The respondents who used condoms as a method of contraception, were often younger, better educated, had better financial status, lived in Vojvodina, and had no children. CONCLUSION Our study showed that there were differences in terms of family planning between the women of urban and rural areas, however, these differences could be explained by differences in age and education.

‘The Devil has entered you’: A qualitative study of Men Who Have Sex With Men (MSM) and the stigma and discrimination they experience from healthcare professionals and the general community in Bosnia and Herzegovina

Men who have sex with men (MSM) are often exposed to unequal treatment in societies worldwide as well as to various forms of stigma and discrimination in healthcare services. Bosnia and Herzegovina (B&H) is a postconflict developing country located in Southeast Europe and the Western Balkans, where little is known about the experiences of MSM regarding their communities and interactions with healthcare services. The aim of this study was to explore the types of experiences MSM face and to assess the level of stigma and discrimination they are exposed to in this setting. We conducted twelve in-depth face-to-face interviews with MSM who were 16 to 45 years old and residing in B&H. The main findings indicated that they all experienced various levels of stigma, discrimination, prejudice and inequities in treatment and attitudes from different segments of society, including the health care sector, that prevented them from fully developing their human and health potential. Additionally, these experiences were adversely related to opportunities to receive good quality health care services due to the insufficiently educated and old-fashioned health professionals who sometimes believed in black magic practices. The findings present numerous opportunities for educational trainings and structural reform to create a society that provides and guarantees equal opportunities for all.

Development of a scale for evaluating the severity of disfigurements caused by injuries disease or surgery

Background/Aim. Medico-legal aspect of physical disfigurements has been subject of few scientific researches. The aim of this study was to establish a standardized instrument for forensic evaluation of all kinds of physical disfigurements, which has not existed until now. Methods. The research was conducted in 3 phases: the first one – drafting a list of disfigurements; the second phase – evaluation of the draft of the disfigurement list provided by 11 experts (plastic surgery lecturers) by the use of the Delphy method; the third one during which 51 medical doctors, members of Serbian Association of Plastic, Reconstructive and Aesthetic Surgery were evaluating the list of disfigurements. Results. Totally 176 individual physical disfigurements were described in the first phase of research. In the second phase, 217 disfigurements were established which were classified into 5 degrees of severity 0 – none/very small, 1 – small, 2 – medium, 3 – large, 4 – very large disfigurements. In the third phase, 217 disfigurements were evaluated. Conclusion. The first 4-point ordinal scale was established, rating 217 disfigurements, which showed high level of compatibility in practice and which can be used as an instrument for standardization of disfigurements in giving of forensic expertise.