Influence of integrated services on postpartum family planning use: a cross-sectional survey from urban Senegal.

BACKGROUND: Although the majority of postpartum women indicate a desire to delay a next birth, family planning (FP) methods are often not offered to, or taken up by, women in the first year postpartum. This study uses data from urban Senegal to examine exposure to FP information and services at the time of delivery and at child immunization appointments and to determine if these points of integration are associated with greater use of postpartum FP. METHODS: A representative, household sample of women, ages 15-49, was surveyed from six cities in Senegal in 2011. This study focuses on women who were within two years postpartum (n = 1879). We also include women who were surveyed through exit interviews after a visit to a high volume health facility in the same six cities; clients included were visiting the health facility for delivery, post-abortion care, postnatal care, and child immunization services (n = 794). Descriptive analyses are presented to examine exposure to FP services among postpartum women and women visiting the health facility. Logistic regression models are used to estimate the effect of integrated services on postpartum FP use in the household sample of women. Analyses were conducted using Stata version 12. RESULTS: Among exit interview clients, knowledge of integrated services is high but only a few reported receiving FP services. A majority of the women who did not receive FP services indicated an interest in receiving such information and services.Among the household sample of women up to two-years postpartum, those who received FP information at the time of delivery are more likely to be using modern FP postpartum than their counterparts who also delivered in a facility but did not receive such information. Exposure to FP services at an immunization visit was not significantly related to postpartum FP use. Another key finding is that women with greater self-efficacy are more likely to use a modern FP method. CONCLUSION: This study's findings lend strong support for the need to improve integration of FP services into maternal, newborn, and child health services with the goal of increasing postpartum women's use of FP methods in urban Senegal.

Strengthening Government Leadership in Family Planning Programming in Senegal: From Proof of Concept to Proof of Implementation in 2 Districts.

Given Senegal's limited resources, the country receives substantial support from externally funded partner organizations to provide family planning and maternal and child health services. These organizations often take a strong and sometimes independent role in implementing interventions with their own structures and personnel, thereby bypassing the government district health system. This article presents findings from the Initiative Sénégalaise de Santé Urbaine (ISSU) (Senegal Urban Health Initiative) that assessed in 2 districts, Diamniadio and Rufisque, the extent to which it was feasible to create stronger government ownership and leadership in implementing a simplified package of family planning interventions from among those previously tested in other districts. The simplified package consisted of both supply- and demand-side interventions, introduced in October 2014 and concluding at the end of 2015. The interventions included ensuring adequate human resources and contraceptive supplies, contraceptive technology updates for providers, special free family planning service days to bring services closer to where people live, family planning integration into other routine services, household visits for family planning education, religious sermons to clarify Islam's position on family planning, and radio broadcasts. District leadership in Diamniadio and Rufisque were actively involved in guiding and implementing interventions, and they also contributed some of their own resources to the project. However, reliance on external funding continued because district budgets were extremely limited. Monitoring data on the number of contraceptive methods provided by district facilities supported by a sister project, the Informed Push Model project, indicate overall improvement in contraceptive provision during the intervention period. In Diamniadio, contraceptive provision increased by 43% between the 6-month period prior to the ISSU interventions (November 2013 through April 2014) and a 6-month intervention period (November 2014 through April 2015), from about 8,000 units to nearly 12,000 units. In Rufisque, contraceptive provision increased by 30%, from more than 17,000 units to more than 22,000 units. Couple-years of protection provided in Diamniadio increased by 82% and in Rufisque by 56%. The experience in these 2 districts in Senegal suggests that it is feasible for districts to play a leadership role in implementing family planning services and mobilizing some of their own resources and that international projects can facilitate capacity building and sustainability within public-sector systems.

Informed push distribution of contraceptives in Senegal reduces stockouts and improves quality of family planning services.

Contraceptive use in Senegal is among the lowest in the world and has barely increased over the past 5 years, from 10% of married women in 2005 to 12% in 2011. Contraceptive stockouts in public facilities, where 85% of women access family planning services, are common. In 2011, we conducted a supply chain study of 33 public-sector facilities in Pikine and Guediawaye districts of the Dakar region to understand the magnitude and root causes of stockouts. The study included stock audits, surveys with 156 consumers, and interviews with facility staff, managers, and other stakeholders. At the facility level, stockouts of injectables and implants occurred, on average, 43% and 83% of the year, respectively. At least 60% of stockouts occurred despite stock availability at the national level. Data from interviews revealed that the current "pull-based" distribution system was complex and inefficient. In order to reduce stockout rates to the commercial-sector standard of 2% or less, the Government of Senegal and the Senegal Urban Reproductive Health Initiative developed the informed push distribution model (IPM) and pilot-tested it in Pikine district between February 2012 and July 2012. IPM brings the source of supply (a delivery truck loaded with supplies) closer to the source of demand (clients in health facilities) and streamlines the steps in between. With a professional logistician managing stock and deliveries, the health facilities no longer need to place and pick up orders. Stockouts of contraceptive pills, injectables, implants, and intrauterine devices (IUDs) were completely eliminated at the 14 public health facilities in Pikine over the 6-month pilot phase. The government expanded IPM to all 140 public facilities in the Dakar region, and 6 months later stockout rates throughout the region dropped to less than 2%. National coverage of the IPM is expected by July 2015.

A new species of Spirura Blanchard, 1849 (Nematoda: Spiruridae) parasite of Heliosciurus gambianus and Xerus erythropus (Rodentia: Sciuridae) in Senegal.

A new species of Spirura is described from the stomach of Heliosciurus gambianus and Xerus erythropus (Sciuridae). Considering the number of preanal papillae of males, Babero (1973 ) and Giannetto and Canestri Trotti (1995) proposed the subdivision of the genus into 2 groups; those with 4 pairs of preanal papillae (25 species) and with more than 4 pairs of preanal papillae (4 species). Spirura mounporti n. sp. belongs to the second, with 5 pairs of preanal papillae, and differs from Spirura infundibuliformis (McLeod, 1933) Anderson et al., 1993 , Spirura zapi ( Erickson, 1938 ) Chabaud et al., 1965 , Spirura leiperi Gupta and Trivedi, 1985, and Spirura michiganensis Sandground, 1935 in the number of pairs of pre-cloacal papillae. The new species further differs from other species of the genus in having 21 caudal papillae, in the ratio of spicules:body length, and in its morpho-anatomical characters.

Description of Oxynema xerusi n. sp. (Nematoda: Subuluroidea) parasitic in Xerus erythropus and Heliosciurus gambianus (Sciuridae) in Senegal.

A new species of the genus Oxynema Linstow 1899, is described from the African sciurids Xerus erythropus and Heliosciurus gambianus. Oxynema xerusi n. sp. is characterized by the lack of cervical and caudal alae and by having unequal spicules. It differs from the closest species, Oxynema linstowi Deshmukh, 1987 and Oxynema bioccai Campana-Rouget, 1956, by the number, shape, and distribution of the caudal papillae, the length of the spicules, and the ratio of spicule length to body length.