Assessing nurses' knowledge and attitudes towards promoting female condom use in South African primary healthcare clinics.

BACKGROUND: Female condoms protect against unplanned pregnancies and sexually transmitted infections (STIs) including HIV; however, their uptake is very low in South Africa. Nurses are frontline healthcare workers and are uniquely positioned to promote their use to their clients. This study assesses nurses' knowledge of, attitudes to, and practices regarding the promotion of female condoms at selected primary healthcare facilities in the King Sabata Dalindyebo sub-district of the Eastern Cape, South Africa. METHODS: A descriptive cross-sectional study was conducted from April to May 2021 at five community health centres in the King Sabata Dalindyebo sub-district, South Africa. A total of 139 nurses completed a self-administered questionnaire. Data were analysed using simple descriptive statistics. RESULTS: The majority of the participants (82.7%) were knowledgeable about the female condom. Some participants did not have a good attitude and willingness to promote female condom use to their clients. Junior nurses (enrolled nursing assistants and newly qualified professional nurses) were less knowledgeable about the female condom than more qualified and older nurses. There was no significant association between level of knowledge and attitude or willingness to promote the use of the female condom. CONCLUSION: This study found good knowledge of the female condom among the nurses; however, the knowledge did not translate into a willingness to promote the device at their health facilities. Capacity building of the junior nurses will fill the knowledge gaps identified. Studies exploring the sociocultural issues around the female condom are needed in the region.

Prevalence and correlates of induced abortion: results of a facility-based cross-sectional survey of parturient women living with HIV in South Africa.

BACKGROUND: There is a paucity of studies examining the prevalence and correlates of induced abortion among women living with HIV. Our study fills this gap by examining the prevalence and correlates of induced abortion among parturient women living with HIV in Eastern Cape, South Africa. METHODS: We analysed cross-sectional survey data of the East London Prospective Cohort Study, which took place between September 2015 and May 2016 in three large maternity facilities in the Buffalo/Amathole districts of the Eastern Cape Province of South Africa. A total of 1709 parturient women living with HIV who gave birth over the study period were recruited. We carried out descriptive and inferential statistics. RESULTS: The prevalence of induced abortion was 19% (95% CI: 17.2-20.9%), but varied by women's socio-demographic characteristics. Induced abortion prevalence was higher among women aged 25 years and over (21.4%), than among women aged less than 25 years (11.0%). Those ever married or cohabiting (26.8%) reported a higher level of induced abortion than those never-married women (15.6%). Those already diagnosed HIV positive before their index pregnancy (20.2%) had a higher prevalence of induced abortion than those diagnosed during their index pregnancy (14.1%). In the adjusted logistic regression, women were more likely to have ever induced abortion if they were ever married or cohabiting (aOR; 1.86 95% CI; 1.43-2.41), ever smoked (aOR: 1.51; 95% CI: 1.01-2.28) and diagnosed with HIV before their index pregnancy (aOR:1.44; 95% CI: 1.02-2.05) but less likely if younger than 25 years (aOR; 0.51 95% CI:0.35-0.73). CONCLUSION: About one in five women living with HIV had ever induced abortion in the study settings, indicating that abortion service is one of the main reproductive health services needed by women living with HIV in South Africa. This is an indication that the need for abortion is somewhat high in this group of women. The finding, therefore, highlights the need for concerted efforts from all stakeholders to address the unmet need for contraception among women living with HIV to prevent unintended pregnancy.

There is a paucity of studies examining the prevalence and correlates of induced abortion among women living with HIV. Our study fills this gap by examining the prevalence and correlates of induced abortion among parturient women living with HIV in Eastern Cape, South Africa. We analysed a cross-sectional survey data of the East London Prospective Cohort Study, which took place between September 2015 and May 2016 in three large maternity facilities in the Buffalo/Amathole districts of the Eastern Cape Province of South Africa. A total of 1709 parturient women living with HIV who gave birth over the study period were recruited. We carried out descriptive and inferential statistics. The prevalence of induced abortion was 19%, but varied by women's sociodemographic characteristics. Induced abortion prevalence was higher among women aged 25 years and over (21.4%), ever married (26.8%), those already diagnosed HIV positive before their index pregnancy (20.2%). About one in five women living with HIV had ever induced abortion in the study settings, indicating that abortion service is one of the main reproductive health services needed by women living with HIV in South Africa. This is an indication that the need for abortion is somewhat high in this women. The finding, therefore, highlights the need for concerted efforts from all stakeholders to address the unmet need for contraception among women living with HIV to prevent unintended pregnancy.

Factors Associated With Peripartum Virologic Suppression in Eastern Cape Province, South Africa: A Retrospective Cross-Sectional Analysis.

BACKGROUND: This study describes the characteristics of pregnant women on antiretroviral therapy (ART) and the rate of peripartum virologic suppression in a large prevention of mother-to-child transmission cohort who delivered in some selected maternity centers in Eastern Cape Province, South Africa. In addition, the study examines the factors associated with virologic suppression in the cohort. METHODS: This multicenter, retrospective cross-sectional analysis included medical data of 1709 women with human immunodeficiency virus between September 2015 and May 2016 in Eastern Cape Province. The main outcome measure was the rate of peripartum virologic suppression, defined as viral load (VL) <1000 copies/mL and undetectable viremia (VL <20 copies/mL). Correlates of peripartum virologic suppression and undetectable viremia were examined by fitting logistic regression model analysis. RESULTS: Of 1463 women with available VL results, the overall rate of peripartum suppression was 82%, and undetectable viremia was 56.9%. Being aged 24 years or younger (adjusted odds ratio [AOR], 0.68 [95% confidence interval {CI}, .48-.94]), smoking during pregnancy (AOR, 0.50 [95% CI, .28-.90]), and starting ART in the first trimester were associated with lower odds of viral suppression (<1000 copies/mL). Women who had never defaulted ART had an increased odds of having an undetectable VL (AOR, 3.09 [95% CI, 2.12-4.49]) and virologic suppression (AOR, 3.88 [95% CI, 2.62-5.74]) compared to those who defaulted. CONCLUSIONS: More than half of the women achieved undetectable VL, and 4 in 5 women achieved viral suppression at delivery in the region. Early antenatal booking, combined with enhanced adherence support for pregnant women on ART, would be crucial toward achieving the goal of elimination of mother-to-child transmission in the region.

Barriers to and facilitators of HIV serostatus disclosure to sexual partners among postpartum women living with HIV in South Africa.

BACKGROUND: Disclosure of HIV serostatus to a sexual partner can facilitate partner's support and testing and better treatment outcomes. Studies examining changes in disclosure rates of serostatus from delivery and postpartum periods are scarce. Our study fills this gap by using a follow-up survey of postpartum women with HIV to examine if disclosure prevalence has improved compared to the proportion recorded at childbirth. We further assessed the reasons for non-disclosure and correlates of serostatus disclosure to sexual partners. METHODS: We conducted a cross-sectional analytical study (exit interview) with a final sample of 485 postpartum women with HIV drawn from the East London Prospective Cohort study database between January and May 2018. Disclosure of HIV status to partner was based on self-reporting. We fitted adjusted and unadjusted logistic regression models and also conducted descriptive statistical analyses. Sampling weights were used to correct for sampling errors. RESULTS: Overall, 81.8% of women in the study cohort had disclosed their status to their partners, representing a 7.4 percentage point increase since child delivery. After adjusting for important covariates, women were more likely to disclose their status if they were married [adjusted odds ratio (AOR): 3.10; 95% confidence interval (CI):1.39-6.91] but were less likely to disclose if they used alcohol [AOR: 0.61; 95% CI:0.37-0.99] or had reported adherence to ART [AOR: 0.59; 95% CI:0.36-0.96]. Fear of rejection, stigma or being judged, new or casual relationships, and having a violent partner were the main reasons for not disclosing HIV status to sexual partners. CONCLUSION: We found a relatively higher rate of HIV status disclosure in the cohort compared to the rate recorded at childbirth, suggesting an improvement over time. Also, complicated relationship dynamics and fear of social exclusion still constitute barriers to HIV status disclosure to sexual partners despite patients' counselling.

Cross-sectional study of prevalence and determinants of uncontrolled hypertension among South African adult residents of Mkhondo municipality.

BACKGROUND: Achieving the blood pressure treatment target in individuals with hypertension is a serious global health challenge. Furthermore, the actual burden of uncontrolled hypertension is poorly understood, especially in the developing countries. Therefore, this study comprehensively examined the prevalence and factors associated with uncontrolled hypertension in individuals receiving care at the primary healthcare facilities in the rural areas of Mkhondo Municipality in the Mpumalanga Province, South Africa. METHODS: In this cross-sectional study, 329 individuals attending care for hypertension were recruited from January 2019 to June 2019 at three primary healthcare centres, namely, Piet Retief hospital, Mkhondo town clinic and Thandukukhanya community health centre. Uncontrolled hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg in accordance with the South African Hypertension Society guideline (2014). Multiple logistic regression (Forward LR method) analysis was used to identify the significant determinants of uncontrolled hypertension. RESULTS: The majority of the participants were 55 years old and above (69.0%), Zulus (81.2%), non-smokers (84.19%) and had been diagnosed with hypertension for more than a year prior to the study (72.64%). The overall prevalence of uncontrolled hypertension was 56.83% (n = 187) with no significant difference between sexes, 57.38% male versus 56.88% female, respectively. In the multiple logistic regression model analysis after adjusting for confounding variables, obesity (AOR = 2.90; 95% CI 1.66-5.05), physical activity (AOR = 4.79; 95% CI 2.15-10.65) and HDL-C (AOR = 5.66; 95% CI 3.33-9.60) were the significant and independent determinants of uncontrolled hypertension in the cohort. CONCLUSION: The high prevalence of uncontrolled hypertension in the study setting can be largely attributed to obesity, physical activity and dyslipidaemia. Treatment will require the collaborative efforts of individuals, clinicians and health authorities. All these determinants should be addressed decisively so as to achieve the treatment blood pressure targets in the study population.

Provision of immediate postpartum contraception to women living with HIV in the Eastern Cape, South Africa; a cross-sectional analysis.

BACKGROUND: Universal access to contraception is an important strategy adopted by the South African government to reduce the high rate of unintended pregnancies, especially in women living with HIV. In this article, we describe the choices of contraception and also, examine the influencing factors of the choices of contraception in the immediate postpartum period in parturient women with HIV in the Eastern Cape, South Africa. METHODS: In this prospective cross-sectional study, 1617 parturient women with HIV completed a survey on the choice of contraception received in the immediate postpartum period (within 72 h) across three large maternity services in the Eastern Cape between September 2015 to May 2016. Additional information was extracted from their medical records. Choices of contraception were categorised as; short-acting (injectables), long-acting reversible (intrauterine device and implants) and permanent contraception (tubal ligation). Adjusted and unadjusted logistic regression models were employed to determine the influencing factors of the choices of contraception received by the cohort. RESULTS: Participants were predominantly single (69.1%), unemployed (75.1%), had a grade 7-12 level of education (88.4%) and were HIV positive before their index pregnancy (81.3%). The prevalence of immediate postpartum contraception was high (n = 1507; 93.2%) with Injectables being the preferred choice in the majority of the participants (n = 1218; 75.3%). After controlling for all relevant covariates, single marital status was associated with a higher likelihood of immediate postpartum contraceptive initiation (AOR; 1.82 95% CI 1.10-3.03). Overall, women were more likely to initiate a long-acting reversible and irreversible methods when older than 35 years and having had more than two children. CONCLUSIONS: We found a high prevalence of immediate postpartum contraception with a preference for Injectables in the study setting. Long-term monitoring of this cohort will elucidate on contraceptive discontinuation and risk of unintended pregnancies in the region. Ensuring universal access to contraceptives is an important strategy to reduce the rate of unintended pregnancies at the population level. This strategy was adopted by the South African government with a vision of stemming the tide of unintended pregnancies among women living with HIV. In this study, the choices of contraception adopted by women living with HIV following the delivery of their babies were explored. In addition, the study highlights the factors that predict these choices. Participants were asked the choice of contraception they had received prior to being discharged from the maternity centres where they had delivered their babies. The various types of contraception were then categorised by their duration of action. Three distinct groups emerged; short-acting injectables, long acting reversible contraceptives and permanent methods. Of the 1617 women included in the study, 1117 were single and 1314 knew their HIV status prior to the onset of the index pregnancy. Almost all the women (1507 out of 1617) received one form of contraception before leaving the hospital. Many women (1218 out of 1617) chose injectable contraception (short-acting contraception) over the other types of contraception. Women who were older than 34 years and who had three or more children were more likely to choose a long-acting reversible contraceptive and permanent method over the short-acting contraception or nothing. In conclusion, given the short duration of action of the predominant method adopted by these women, a long-term follow up of the study participants will provide more information on the continued use of contraception and risk for unintended pregnancies.

Low awareness and use of post-exposure prophylaxis among adolescents and young adults in South Africa: implications for the prevention of new HIV infections.

The vulnerability of adolescents and young adults in South Africa to HIV and sexual violence is well documented. Post-exposure prophylaxis (PEP) is available for victims of sexual abuse in the country but awareness of this measure is required to maximise its HIV-prevention benefits. This study examined levels of PEP awareness and its correlates and the uptake of PEP among 772 students (16-24 years) in a South African university using stratified random sampling. Overall, we included more females (477) than males (295), reflecting the male-female ratio at the university. Adjusted and unadjusted logistic regression models were used to determine correlates of PEP awareness, which was low (24.1%), particularly among those who experienced sexual violence in the past year (19.8%) compared those who had not (24.8%). Only 2.6% of participants had used PEP, while 7.5% had seen it, and 14.6% knew where to get it. In the adjusted model, adequate family support (AOR: 2.22; CI: 1.54-3.20) and prior HIV testing (AOR: 2.65; CI: 1.59-4.42) were associated with a higher likelihood of PEP awareness. The study concluded that awareness of PEP was low in the study setting and especially among those who need it. Social marketing of PEP is needed in the study settings to realise the maximum benefits of PEP in preventing new HIV infections.

Reasons for the Early Introduction of Complementary Feeding to HIV-Exposed Infants in the Eastern Cape, South Africa: An Exploratory Qualitative Study.

Exclusive breastfeeding has many health benefits for the baby and the mother. This study explored the reasons for the early introduction of supplementary feeding before six months, and the issues faced by parturient women in practicing exclusive breast feeding (EBF) for their HIV-exposed infants in the Eastern Cape, South Africa. Narratives from 319 parturient women with HIV (aged 18 years and above) were collected at three hospitals in the Eastern Cape through semi-structured interviews over a period of five months. Qualitative data were analysed using thematic content analysis. The maternal perception of HIV transmission from breast milk influenced the decision for the immediate introduction of formula feeding. Breast sores, lumps, surgery and perceived insufficiency of milk influenced the decision of mothers to initiate formula feeding within the first two months. However, mothers who initiated complementary feeding after two months were driven by factors common among newborns (refusal of breast milk, baby crying inconsolably and fear of losing weight) and social factors (economic or financial hardships and work-related challenges). Additionally, advice from family members weighed heavily in the decision to switch to complementary feeding, contrary to the healthcare providers' recommendations. Early complementary feeding for HIV-exposed infants is influenced by maternal perceptions of breast milk transmission, breast and infant factors and socio-economic and cultural practices in the region. Thus, behavioural interventions tailored towards promoting exclusive breastfeeding practices in this population, starting from the pre-natal and continuing during the post-partum period, should also target the immediate family members. National policy should focus on creating an EBF-friendly environment at the workplace for women.

Inequality in uptake of isoniazid prevention therapy and Mantoux test among pregnant women with HIV in the Eastern Cape, South Africa.

BACKGROUND: HIV-associated tuberculosis (TB) is a major cause of death among pregnant women in South Africa. Isoniazid prevention therapy (IPT) strategy was implemented in South Africa concurrently with life-long antiretroviral therapy (ART) to reduce the TB-associated morbidity and mortality in individuals living with HIV. This study assessed the extent of the implementation of IPT and the performance of the Mantoux test by geographic settings of health facilities and residences of pregnant women living with HIV in the Eastern Cape, South Africa. METHODS: We conducted a data analysis of 1709 pregnant women enrolled in the new electronic database of the prevention of mother-to-child transmission programme of the East London Prospective Cohort Study. Relevant data on place of residence and antenatal care, performance of the Mantoux test and subsequent initiation of IPT were obtained. Descriptive and inferential statistics were employed to analyse the geographical variations and accessibility to Mantoux test and IPT. RESULTS: The analysis shows that Mantoux test was performed on 803 pregnant women (47%) with significant geographical variation. After controlling for relevant covariates, pregnant women who resided in rural areas (AOR:0.63; CI: 0.47-0.84) compared to those who resided in urban areas were significantly less likely to receive Mantoux test. The rate of uptake of IPT was 79% with significant geographic variations. In the unadjusted model, rural place of residence (UOR:0.68; CI: 0.49-0.96) was independently associated with lower likelihood of uptake of INH prophylaxis; however, the effect was not significant after controlling for important covariates. CONCLUSIONS: The high uptake rate of isoniazid prevention therapy in pregnant women living with HIV at the study sites is commendable; however, concerted efforts are needed to address the inequality gaps in the roll-out of IPT. Poor performance of Mantoux test is a serious concern and requires the attention of TB programme managers and other relevant authorities.

Concerns about contracting HIV, knowing partners' HIV sero-status and discussion of HIV/STI with sexual partners as determinants of uptake of HIV testing.

Worldwide, adolescents and young adults (aged 15-25 years) account for the highest proportion of new HIV infections, yet the uptake of HIV testing among this cohort is sub-optimal. Understanding factors that predict the uptake of HIV testing among adolescents and young adults is critical for designing effective and relevant interventions to increase testing. Drawing from the psychosocial constructs of the Health Belief Model, the study examined the effects of HIV risk perception, discussion of HIV with partners and knowing partners' HIV status on HIV testing uptake among adolescents and young adults in two Nigerian universities. The study was conducted in 2018 and was cross-sectional in design, with a final sample of 784 male and female students selected using stratified random sampling. Adjusted and unadjusted logistic regression models were used to examine the effect of HIV risk perception, discussion of HIV with partners and knowing partners' HIV status on HIV testing uptake. Only 50.6% of participants had ever tested for HIV with 30.7% being tested in the last year, with no significant differences by sex. After controlling for other covariates (age, sex and being sexually active), knowing partners' HIV status, having discussed HIV with partners and being very concerned about contracting HIV were found to be significantly associated with ever being tested for HIV and recent HIV testing uptake. Uptake of HIV testing was found to be low in the study setting and fell short of the first '90%' UNAIDS target. Age-appropriate strategies, targeting open communication on HIV/STIs and disclosure of sero-status between sexual partners are required to promote uptake of HIV testing among young adults and adolescents in Nigeria.

Factors affecting adherence to antiretroviral therapy among pregnant women in the Eastern Cape, South Africa.

BACKGROUND: Context-specific factors influence adherence to antiretroviral therapy (ART) among pregnant women living with HIV. Gaps exist in the understanding of the reasons for the variable outcomes of the prevention of mother-to-child transmission (PMTCT) programme at the health facility level in South Africa. This study examined adherence levels and reasons for non-adherence during pregnancy in a cohort of parturient women enrolled in the PMTCT programme in the Eastern Cape, South Africa. METHODS: This was a mixed-methods study involving 1709 parturient women in the Eastern Cape, South Africa. We conducted a multi-centre retrospective analysis of the mother-infant pair in the PMTCT electronic database in 2016. Semi-structured interviews of purposively selected parturient women with self-reported poor adherence (n = 177) were conducted to gain understanding of the main barriers to adherence. Binary logistic regression was used to determine the independent predictors of ART non-adherence. RESULTS: A high proportion (69.0%) of women reported perfect adherence. In the logistic regression analysis, after adjusting for confounding factors, marital status, cigarette smoking, alcohol use and non-disclosure to a family member were the independent predictors of non-adherence. Analysis of the qualitative data revealed that drug-related side-effects, being away from home, forgetfulness, non-disclosure, stigma and work-related demand were among the main reasons for non-adherence to ART. CONCLUSIONS: Non-adherence to the antiretroviral therapy among pregnant women in this setting is associated with lifestyle behaviours, HIV-related stigma and ART side-effects. In order to eliminate mother-to-child transmission of HIV, clinicians need to screen for these factors at every antenatal clinic visit.

Use of traditional and modern contraceptives among childbearing women: findings from a mixed methods study in two southwestern Nigerian states.

BACKGROUND: Contraceptive use has numerous health benefits such as preventing unplanned pregnancies, ensuring optimum spacing between births, reducing maternal and child mortality, and improving the lives of women and children in general. This study examines the level of contraceptive use, its determinants, reasons for non-use of contraception among women in the reproductive age group (18-49 years) in two southwestern Nigerian states. METHODS: The study adopted an interviewer-administered questionnaire to collect data from 809 participants selected using a 3-stage cluster random sampling technique. We also conducted 46 in-depth interviews. In order to investigate the association between the socio-demographic variables and use of contraceptive methods, we estimated the binary logistic regression models. RESULTS: The findings indicated that knowledge of any methods of contraception was almost universal among the participants. The rates of ever use and current use of contraception was 80 and 66.6%, respectively. However, only 43.9% of the participants had ever used any modern contraceptive methods, considered to be more reliable. The fear of side effects of modern contraceptive methods drove women to rely on less effective traditional methods (withdrawal and rhythm methods). Some women employed crude and unproven contraceptive methods to prevent pregnancies. CONCLUSION: Our findings show that the rate of contraceptive use was high in the study setting. However, many women chose less effective traditional contraceptive methods over more effective modern contraceptive methods due to fear of side effects of the latter. Patient education on the various options of modern contraceptives, their side effects and management would be crucial towards expanding the family planning services in the study setting.

High rate of unplanned pregnancy in the context of integrated family planning and HIV care services in South Africa.

BACKGROUND: Integration of family planning services into HIV care was implemented in South Africa as a core strategy aimed at reducing unintended pregnancies among childbearing women living with HIV. However, it is unclear whether this strategy has made any significant impact at the population level. This paper describes the prevalence and correlates of self-reported unplanned pregnancy among HIV-infected parturient women attending three large maternity centres in the Eastern Cape, South Africa. We also compare unplanned pregnancy rates between HIV-infected parturient women already in care (who have benefitted from services' integration) and newly diagnosed parturient women (who have not benefitted from services' integration). METHODS: Drawing from the baseline data of the East London Prospective Cohort Study (ELPCS), data of 594 parturient women living with HIV in the Eastern Cape were included. Chi-square statistics and binary logistics regression were employed to determine the correlates of unplanned pregnancy among the cohort. RESULTS: The prevalence of unplanned pregnancy was 71% (n = 422) with a higher rate among parturient women newly diagnosed during the index pregnancy (87%). Unplanned pregnancy was significantly associated with younger age, single status, HIV diagnosis at booking, high parity and previous abortion. Women who reported unplanned pregnancy were more likely to book late and have lower CD4 counts. After adjusting for confounding variables, having one child and five to seven children (AOR = 2.2; CI = 1.3-3.1), age less than 21 years (AOR = 3.3; CI = 1.1-9.8), late booking after 27 weeks (AOR = 2.7; CI = 1.5-5.0), not married (AOR = 4.3; CI = 2.7-6.8) and HIV diagnosis at booking (AOR = 3.0; CI = 1.6-5.8) were the significant correlates of unplanned pregnancy in the cohort. CONCLUSION: Unplanned pregnancy remains high overall among parturient women living with HIV in the region, however, with significant reduction among those who were exposed to integrated services. The study confirms that integration of HIV care and family planning services is an important strategy to reduce unplanned pregnancy among women living with HIV. The study's findings have significant implications for the elimination of mother-to-child transmission of HIV in South Africa. Innovative interventions are needed to further consolidate and maximise the benefit of the integration of family planning services with HIV care.

Reasons for Discontinuation of Implanon among Users in Buffalo City Metropolitan Municipality, South Africa: A Cross-Sectional Study.

Early discontinuation of implanon, a long-acting, reversible contraceptive among reproductive age women in South Africa is a serious public health concern. The aim of this study was to examine the reasons for discontinuation of implanon among its previous users. This descriptive cross-sectional study involved 188 consecutively selected participants in two large family planning clinics in Buffalo Metropolitan Municipality, East London, South Africa. Descriptive statistics was conducted using SPSS version 22.0. The mean duration of use was 11.2±7.1 months. Side effects such as heavy bleeding, severe headache and painful arm were the main reasons for discontinuation of implanon (71.3%). Some participants discontinued implanon because they were receiving other medical treatments: 24 participants on the anti-retroviral drugs, one on antipsychotic and antituberculosis drugs, respectively, necessitating removal. Few participants reported wrong positioning (3.2%) and desire for more pregnancies (4.3%) as reasons for discontinuation. The side effects of implanon were the reason for early discontinuation of implanon among women who still needed contraception. Pre-insertion counselling should empower women towards making informed decision on discontinuation and transition to other options.

Ageing, exposure to pollution, and interactions between climate change and local seasons as oxidant conditions predicting incident hematologic malignancy at KINSHASA University clinics, Democratic Republic of CONGO (DRC).

BACKGROUND: The global burden of hematologic malignancy (HM) is rapidly rising with aging, exposure to polluted environments, and global and local climate variability all being well-established conditions of oxidative stress. However, there is currently no information on the extent and predictors of HM at Kinshasa University Clinics (KUC), DR Congo (DRC). This study evaluated the impact of bio-clinical factors, exposure to polluted environments, and interactions between global climate changes (EL Nino and La Nina) and local climate (dry and rainy seasons) on the incidence of HM. METHODS: This hospital-based prospective cohort study was conducted at Kinshasa University Clinics in DR Congo. A total of 105 black African adult patients with anaemia between 2009 and 2016 were included. HM was confirmed by morphological typing according to the French-American-British (FAB) Classification System. Gender, age, exposure to traffic pollution and garages/stations, global climate variability (El Nino and La Nina), and local climate (dry and rainy seasons) were potential independent variables to predict incident HM using Cox regression analysis and Kaplan Meier curves. RESULTS: Out of the total 105 patients, 63 experienced incident HM, with an incidence rate of 60%. After adjusting for gender, HIV/AIDS, and other bio-clinical factors, the most significant independent predictors of HM were age ≥ 55 years (HR = 2.4; 95% CI 1.4-4.3; P = 0.003), exposure to pollution and garages or stations (HR = 4.9; 95% CI 2-12.1; P < 0.001), combined local dry season + La Nina (HR = 4.6; 95%CI 1.8-11.8; P < 0.001), and combined local dry season + El Nino (HR = 4; 95% CI 1.6-9.7; P = 0.004). HM types included acute myeloid leukaemia (28.6% n = 18), multiple myeloma (22.2% n = 14), myelodysplastic syndromes (15.9% n = 10), chronic myeloid leukaemia (15.9% n = 10), chronic lymphoid leukaemia (9.5% n = 6), and acute lymphoid leukaemia (7.9% n = 5). After adjusting for confounders using Cox regression analysis, age ≥ 55 years, exposure to pollution, combined local dry season + La Nina and combined local dry season + El Nino were the most significant predictors of incident hematologic malignancy. CONCLUSION: These findings highlight the importance of aging, pollution, the dry season, El Nino and La Nina as related to global warming as determinants of hematologic malignancies among African patients from Kinshasa, DR Congo. Cancer registries in DRC and other African countries will provide more robust database for future researches on haematological malignancies in the region.

Unplanned pregnancy-risks and use of emergency contraception: a survey of two Nigerian Universities.

BACKGROUND: The vulnerabilities of young women of low socio-economic status and those with little or no formal education tend to dominate the discourse on unplanned pregnancy, unsafe abortion and emergency contraception (EC) in sub-Saharan Africa. This article draws on a survey conducted among female undergraduate students to shed light on sexual behaviour and the dynamics of emergency contraceptive use among this cohort. METHODS: The survey involved 420 female undergraduate students drawn using a multistage sampling technique, while a self-administered questionnaire was used for data collection. Univariate and bivariate analyses were applied to examine the factors associated with the use of emergency contraception. RESULTS: Of the 176 female students who reported being sexually active in the year preceding the survey, only 38.6% reported the use of condom during the entire year. Of those who reported unplanned pregnancy anxiety n = 94, about 30.1% used EC, 20.4% used non-EC pills as EC, while others reported having used no EC. A few respondents (n = 3) had terminated a pregnancy under unsafe conditions. Awareness of EC (p < 0.001), knowledge of timing of EC (p = 0.001), perceived risk of unplanned pregnancy (p < 0.001), and level of study (p = 0.013), were significantly correlated with the use of EC. CONCLUSION: The study revealed that educated youths engaged in high-risk sexual activities and also, sought recourse to unproven and unsafe contraceptive methods. Poor knowledge of EC methods and timing of use, as well as wrong perception about EC side effects, are barriers to the utilisation of EC for the prevention of unplanned pregnancy among the study participants.

Use of non-emergency contraceptive pills and concoctions as emergency contraception among Nigerian University students: results of a qualitative study.

BACKGROUND: Emergency contraception (EC) can significantly reduce the rate of unintended pregnancies and unsafe abortions especially in sub-Saharan Africa. Despite the increasing awareness of EC among educated young women in Nigeria, the rate of utilisation remains low. This study therefore explores the main barriers to the use of EC among female university students by analysing their knowledge of emergency contraception, methods ever used, perceived efficacy, and its acceptability. METHODS: This paper brings together the findings from several focus groups (N = 5) and in-depth interviews (N = 20) conducted amongst unmarried female undergraduate students in two Nigerian universities. RESULTS: Participants considered the use of condom and abstinence as the most effective methods of preventing unplanned pregnancy. However, many participants were misinformed about emergency contraception. Generally, participants relied on unconventional and unproven ECs; Ampiclox, "Alabukun", salt water solution, and lime and potash and perceived them to be effective in preventing unplanned pregnancies. Furthermore, respondents' narratives about methods of preventing unwanted pregnancies revealed that inadequate information on emergency contraception, reliance on unproven crude contraceptive methods, and misconception about modern contraception constitute barriers to the use of emergency contraception. CONCLUSIONS: The findings suggested that female university students are misinformed about emergency contraception and their reliance on unproven ECs constitutes a barrier to the use of approved EC methods. These barriers have serious implications for prevention of unplanned pregnancies in the cohort. Behavioural interventions targeting the use of unproven emergency contraceptive methods and misperceptions about ECs would be crucial for this cohort in Nigeria.

Female sex, poverty and globalization as determinants of obesity among rural South African type 2 diabetics: a cross-sectional study.

BACKGROUND: Countries in Sub-Saharan Africa have recently been experiencing increases in the prevalence of obesity, type 2 diabetes mellitus (T2DM) and other non-communicable diseases in both urban and rural areas. Despite their growing influence on population health in the region, there is a paucity of epidemiological studies on the twin epidemic of obesity and T2DM, particularly in the rural communities in South Africa. We investigated the prevalence and the determinants of overall obesity among patients with T2DM in rural and semi-urban areas surrounding the town of Mthatha, South Africa. METHODS: This hospital-based cross-sectional study was conducted among patients with T2DM attending the outpatient department at Mthatha General Hospital, Eastern Cape Province, South Africa. Data were obtained from 327 participants using standardized questionnaires that included items on sex, age, level of education, type of residence, employment status, smoking status, physical activity, diet and alcohol intake. After taking measurements of height and weight, participants were defined as obese if their body mass index exceeded 30 kg/m(2). Univariate and multivariate logistic regression analyses were performed to identify the determinants of obesity in our sample population. RESULTS: We found that 60.2% of our sample population were defined as obese. In our univariate analyses, female sex (p < 0.001), age ≥50 years (p = 0.023), rural residence (p < 0.001), excessive alcohol intake (p = 0.002), current cigarette smoking (p < 0.001), level of education (p < 0.001), regular consumption of soft drinks (p < 0.001) and unemployment (p = 0.043) were found to be positively and significantly associated with obesity. In the multivariate logistic regression analysis, female sex (p < 0.001), unemployment (p = 0.012) and level of education (p < 0.001) were found to be independent determinants of obesity. CONCLUSION: We found that female sex, educational attainment, unemployment and current cigarette smoking were positively associated with obesity among the study participants. Lifestyle changes, poverty reduction and public education are urgently needed to address the growing obesity epidemic in rural areas of South Africa.

Colistin utilization at a tertiary hospital in South Africa: an opportunity for antimicrobial stewardship practices.

Introduction. Colistin (polymyxin E) has emerged as a last-resort treatment option for multidrug-resistant infections.Hypothesis/Gap Statement. Studies on the use, safety and efficacy of colistin in South Africa are limited.Aim. This study aims to describe the use of colistin and its clinical outcomes at a tertiary public hospital in South Africa.Methodology. We conducted a retrospective review of adult and paediatric patients who received parenteral colistin between 2015 and 2019.Results. A total of 69 patients (26 adults, 13 children and 30 neonates) were reviewed. Acinetobacter baumannii was the most common causative pathogen isolated (70.1 %). Colistin was predominately used to treat septicaemia (75.4 %). It was primarily administered as definitive therapy (71.0 %) and as monotherapy (56.5 %). It was used in 11.5 % of adults with infections susceptible to other antibiotics. Loading doses of intravenous colistin were administered in only 15 (57.7 %) adult patients. Neurotoxicity and nephrotoxicity occurred in 5.8 % and 43.5 % of patients, respectively. Clinical cure was achieved in 37 (53.6 %) patients. On multivariate logistic regression analysis, adults [adjusted odds ratio (aOR), 25.54; 95 % CI, 2.73-238.65; P < 0.01] and children (aOR, 8.56; 95 % CI, 1.06-69.10; P < 0.05) had higher odds of death than neonates.Conclusion. The study identified significant stewardship opportunities to improve colistin prescription and administration. Achieving optimal patient outcomes necessitates a multidisciplinary approach and vigilant monitoring of colistin use.

Prevalence of vitamin D deficiency and its association with cardiometabolic risk factors among healthcare workers in the Eastern Cape province, South Africa; cross-sectional study.

This study assesses the prevalence of Vitamin D deficiency and its potential association with cardiometabolic risk factors among South African adults residing in the Eastern Cape province. In this cross-sectional study, 1244 healthcare workers (HCWs) completed a self-administered questionnaire and venous blood samples were drawn at two academic hospitals in the Eastern Cape. History of hypertension and diabetes mellitus were self-reported. Participants were categorised as obese if their body mass index (BMI) ≥ 30 kg/m2. Participants were classified as having metabolic syndrome if they had hypertension, diabetes mellitus and obesity. Vitamin D [25(OH)D] deficiency was defined as venous blood concentrations < 50 nmol/L. Associations between vitamin D deficiency and participants' characteristics were assessed using multivariate logistic regression model analysis. The prevalence of vitamin D deficiency was 28.5% (n = 355), of whom 292 were female. Among the participants who were deficient in vitamin D, the prevalence of obesity, diabetes mellitus, hypertension, chronic kidney disease, and metabolic syndrome was 64.9% (n = 230), 9% (n = 32), 16.6% (n = 59), 2.3% (n = 8) and 18% (n = 64), respectively. In the adjusted multivariate logistic regression model, black Africans (AOR = 2.87; 95% CI 1.52-5.43) and individuals ≥ 42 years (AOR = 1.37; 95% CI 1.07-1.77) were more likely to exhibit vitamin D deficiency. However, there was no significant association by age, sex, and cardiometabolic markers. More than one in four healthcare workers was deficient in vitamin D among the study sample, especially the black Africans and older individuals. Further studies are needed at the population level to elucidate on the vitamin D status in the region.