Behavioural determinants of women of reproductive age in the indigenous Talang Mamak Ethnic group.

The Talang Mamak tribe is an indigenous tribe that lives in groups (the extended family) in rural locations. All decisions are made after much deliberation. Traditional birth attendants are still used for childbirth. The objective of the study is to analyze the factors that influence reproductive health-needing behavior among Talang Mamak women of reproductive age. With 160 respondents, data was analyzed using logistic regression. The study discovered that education p = 0.001 with PR=4,738, knowledge p = 0.001 with PR=13,800, attitude p= 0.001 with PR=3,133, and tradition p= 0.001 with PR=226.66 are variables that influence the behavior of women of reproductive age toward needing reproductive health services. Among the five variables influencing the outcome, one stands out: tradition, which has an Exp(ß) value of 192.422. The multivariate results show that three variables are included in the modeling: tradition p = 0.001, knowledge p = 0.001, and education p = 0.001. Good traditions, good knowledge, and higher education in the Talang Mamak tribe have a more behavioral probability of needing reproductive health services in women of reproductive age 99%, while another 1% probability by other variables is not examined in this study.

La tribu Talang Mamak est une tribu indigène qui vit en groupes (la famille élargie) dans les zones rurales. Toutes les décisions sont prises après de longues délibérations. Les accoucheuses traditionnelles sont encore utilisées pour l'accouchement. L'objectif de l'étude est d'analyser les facteurs qui influencent le comportement en matière de santé reproductive chez les femmes Talang Mamak en âge de procréer. Avec 160 répondants, les données ont été analysées par régression logistique. L'étude a découvert que l'éducation p = 0,001 avec PR = 4 738, la connaissance p = 0,001 avec PR = 13 800, l'attitude p = 0,001 avec PR = 3 133 et la tradition p = 0,001 avec PR = 226,66 sont des variables qui influencent le comportement des femmes en situation de procréation. âge pour avoir besoin de services de santé reproductive. Parmi les cinq variables influençant le résultat, une se démarque : la tradition, qui a une valeur Exp(ß) de 192,422. Les résultats multivariés montrent que trois variables sont incluses dans la modélisation : tradition p = 0,001, connaissances p = 0,001 et éducation p = 0,001. Les bonnes traditions, les bonnes connaissances et l'enseignement supérieur dans la tribu Talang Mamak ont une probabilité comportementale plus élevée d'avoir besoin de services de santé reproductive chez les femmes en âge de procréer (99 %), tandis qu'une autre probabilité de 1 % selon d'autres variables n'est pas examinée dans cette étude.

School health-care team members' reflections of their promotion of sexual and reproductive health and rights (SRHR): Important but neglected.

OBJECTIVE: Young people are prioritized regarding the promotion and safeguarding of sexual and reproductive health and rights - SRHR. In Sweden, the school is seen as an important arena with members of the school health-care or SHC team as vital actors in this work. This study explored SRHR-related work in SHC teams in Sweden. METHODS: Within an explorative qualitative design, structured interviews were conducted with 33 nurses, counsellors, SHC unit managers and headmasters. Reflexive thematic analysis was applied, and two main themes found. RESULTS: SHC team members see SRHR as an urgent topic, but address it only 'when necessary', not systematically - and they experience a shortage of guidance and cooperation regarding SRHR-related work. Even in a country with agreement on the importance of SRHR for all and on providing holistic comprehensive sex education in schools, young people are left to chance - i.e., to the SRHR competence in the professionals they meet. CONCLUSION: SHC team members in Sweden see SRHR as an urgent topic but do not address it systematically. Moreover, they experience a shortage of guidance for their work. To avoid any professional stress of conscience and for equitable school health care regarding SRHR to be realized, research-informed policy needs to underline systematic, comparable and proactive practice.

Acceptability of a community-embedded intervention for improving adolescent sexual and reproductive health in south-east Nigeria: A qualitative study.

INTRODUCTION: Adolescents have limited access to quality sexual and reproductive health (SRH) services that are key to healthy sexual lives in many low and middle-income countries such as Nigeria. Hence, context-specific interventions are required to increase adolescents' access to and utilisation of SRH. This paper provides new knowledge on the acceptability of a community-embedded intervention to improve access to SRH information and services for adolescents in Ebonyi state, southeast Nigeria. METHODS: A community-embedded intervention was implemented for six months in selected communities. Thereafter the intervention was assessed for its acceptability using a total of 30 in-depth interviews and 18 focus group discussions conducted with policymakers, health service providers, school teachers, community gatekeepers, parents and adolescents who were purposively selected as relevant stakeholders on adolescent SRH. The interview transcripts were coded in NVivo 12 using a coding framework structured according to four key constructs of the theoretical framework for acceptability (TFA): affective attitude, intervention coherence, perceived effectiveness, and self-efficacy. The outputs of the coded transcripts were analysed, and the emergent themes from each of the four constructs of the TFA were identified. RESULTS: The intervention was acceptable to the stakeholders, from the findings of its positive effects, appropriateness, and positive impact on sexual behaviour. Policymakers were happy to be included in collaborating with multiple stakeholders to co-create multi-faceted interventions relevant to their work (positive affective attitude). The stakeholders understood how the interventions work and perceived them as appropriate at individual and community levels, with adequate and non-complex tools adaptable to different levels of stakeholders (intervention coherence). The intervention promoted mutualistic relations across stakeholders and sectors, including creating multiple platforms to reach the target audience, positive change in sexual behaviour, and cross-learning among policymakers, community gatekeepers, service providers, and adolescents (intervention effectiveness), which empowered them to have the confidence to provide and access SRH information and services (self-efficacy). CONCLUSIONS: Community-embedded interventions were acceptable as strong mechanisms for improving adolescents' access to SRH in the communities. Policymakers should promote the community-embedded strategy for holistic health promotion of adolescents.

Policy and practices shaping the delivery of health services to pregnant adolescents in informal urban settlements in Kenya.

In Kenya, the pregnancy rate of 15% among adolescents aged 15-19 years is alarmingly high. Adolescent girls living in informal urban settlements are exposed to rapid socio-economic transitions and multiple intersecting health risks and may be particularly disadvantaged in accessing sexual reproductive health services. Understanding vulnerabilities and service-seeking behaviours from different perspectives is important in order to support the development and implementation of progressive policies and services that meet adolescents' unique needs within urban informal settlements. This study explored policy makers, community health service providers' and community members' perceptions of access to, and delivery of, sexual reproductive health services for pregnant adolescents in one informal urban settlement in Nairobi. We employed qualitative methods with respondents throughout the health system, purposively sampled by gender and diversity of roles. We conducted focus group discussions with community members (n = 2 female-only; n = 2 male-only), key informant interviews with policy makers (n = 8), traditional birth attendants (n = 12), community health volunteers (CHVs) (n = 11), a nutritionist (n = 1), social workers (n = 2) and clinical officers (n = 2). We analysed the data using thematic analysis. Government policies and strategies on sexual and reproductive health for adolescents exist in Kenya and there are examples of innovative and inclusive practice within facilities. Key factors that support the provision of services to pregnant adolescents include devolved governance, and effective collaboration and partnerships, including with CHVs. However, inadequate financing and medical supplies, human resource shortages and stigmatizing attitudes from health providers and communities, mean that pregnant adolescents from informal urban settlements often miss out on critical services. The provision of quality, youth-friendly reproductive health services for this group requires policies and practice that seek to achieve reproductive justice through centring the needs and realities of pregnant adolescents, acknowledging the complex and intersecting social inequities they face.

The Urban Environment and Disparities in Sexual and Reproductive Health Outcomes in the Global South: a Scoping Review.

By 2050, the Global South will contain three-quarters of the world's urban inhabitants, yet no standardized categorizations of urban areas exist. This makes it challenging to compare sub-groups within cities. Sexual and reproductive health and rights (SRHR) are a critical component of ensuring that populations are healthy and productive, yet SRHR outcomes within and across urban settings vary significantly. A scoping review of the literature (2010-2022) was conducted to describe the current body of evidence on SRHR in urban settings in the Global South, understand disparities, and highlight promising approaches to improving urban SRHR outcomes. A total of 115 studies were identified, most from Kenya (30 articles; 26%), Nigeria (15; 13%), and India (16; 14%), focusing on family planning (56; 49%) and HIV/STIs (43; 37%). Findings suggest significant variation in access to services, and challenges such as gender inequality, safety, and precarious circumstances in employment and housing. Many of the studies (n = 84; 80%) focus on individual-level risks and do not consider how neighborhood environments, concentrated poverty, and social exclusion shape behaviors and norms related to SRHR. Research gaps in uniformly categorizing urban areas and key aspects of the urban environment make it challenging to understand the heterogeneity of urban environments, populations, and SRHR outcomes and compare across studies. Findings from this review may inform the development of holistic programs and policies targeting structural barriers to SRHR in urban environments to ensure services are inclusive, equitably available and accessible, and direct future research to fill identified gaps.

The role of midwives in implementing reproductive health services in Islamic Republic of Iran.

Background: It is essential to study the availability of reproductive health services and the capacities of providers, to provide evidence for improving service quality. Aims: To identify the role of midwives in the provision of reproductive health services and recommend improvements. Methods: A national review of government health resources in the Islamic Republic of Iran was conducted to explore available reproductive health services. Through semi-structured interviews with 30 midwives, information was collected about the compatibility of services with the capacity and scope of the activities of midwives. A panel of 12 experts was assembled to develop a proposed service package. The content analysis method was applied to data analysis and interpretation. Results: The service package developed covered 82 services that midwives can offer at the 8 healthcare facility groups. Although midwives were trained to manage a range of primary and gynaecological care services, certain essential aspects of reproductive health services were not being delivered on the frontline. These include sexually transmitted diseases and human papilloma virus management, diagnosis and treatment of common gynaecological problems, sexual education and counselling, and childbirth services. Midwives were not adequately engaged to provide reproductive health care at the secondary level. Conclusion: There are drawbacks to the current reproductive health service delivery in the Islamic Republic of Iran. The service package designed and proposed in this study aims to strengthen reproductive health care services and planning and better integration of midwife-led programmes.

Qualitative study of the roles of midwives in the provision of sexual and reproductive healthcare services in the Somaliland health system.

OBJECTIVES: To explore midwives' perspectives in providing sexual reproductive healthcare services in the Somaliland health system. METHODS: An exploratory qualitative design using focus group discussions (n=6) was used. The study was conducted in the capital of Somaliland, Hargeisa, at six maternal and child healthcare centres that provide sexual and reproductive healthcare (SRH) services. Qualified midwives (n=44) who had been working in the maternal and child health centres for a minimum of 1 year were recruited to participate, and only one did not participate due to illness. RESULTS: The results showed that Somaliland midwives face multiple challenges from a lack of formal arrangements, primarily written guidelines and policies, that explicitly define their role as healthcare professionals, which impact the quality of care they provide. They also reported feeling unsafe when practising according to their professional scope of practice due to challenging cultural norms, customary traditions and Somaliland's legal system. Finally, the midwives called for support, including training, institutional protection and psychological support, to enhance their ability and fulfil their role in SRH services in Somaliland. CONCLUSION: Midwives are essential to the provision of equitable SRH services to women and girls, yet are not fully supported by policies, laws or institutions, often living in fear of the consequences of their behaviours. Our research highlights the importance of understanding the context of Somaliland midwifery in order to better support the development of the midwifery workforce, stronger governance structures and midwifery leadership. Appropriately addressing these challenges faced by midwives can better sustain the profession and help to improve the quality of care provided to women and girls and ultimately enhance their reproductive health outcomes.

Sexual and reproductive health and rights in humanitarian settings: a matter of life and death.

It is estimated that approximately 4.3 million sexually active persons worldwide will receive poor and/or limited access to Sexual and Reproductive Health (SRH) services in their lifetime. Globally, approximately 200 million women and girls still endure female genital cutting, 33,000 child marriages occur daily, and a myriad of Sexual and Reproductive Health and Rights (SRHR) agenda gaps continue to remain unaddressed. These gaps are particularly pertinent for women and girls in humanitarian settings where SRH conditions including gender-based violence, unsafe abortions, and poor obstetric care are among the leading causes of female morbidity and mortality. Notably, the past decade has featured a record high number of forcibly displaced persons globally since World War II and has led to over 160 million persons requiring humanitarian aid globally, 32 million of whom are women and girls of reproductive age. Inadequate SRH service delivery continues to persist in humanitarian settings, with basic services insufficient or inaccessible, putting women and girls at higher risk for increased morbidity and mortality. This record number of displaced persons and the continued gaps that remain unaddressed pertaining to SRH in humanitarian settings require renewed urgency to create upstream solutions to this complex issue. This commentary discusses the gaps in the holistic management of SRH in humanitarian settings, explores why these gaps persist, and addresses the unique cultural, environmental, and political conditions which contribute to continued SRH service delivery inadequacies and increased morbidity and mortality for women and girls.

The role of midwives in implementing reproductive health services in Islamic Republic of Iran

Background: It is essential to study the availability of reproductive health services and the capacities of providers, to provide evidence for improving service quality. Aims: To identify the role of midwives in the provision of reproductive health services and recommend improvements. Methods: A national review of government health resources in the Islamic Republic of Iran was conducted to explore available reproductive health services. Through semi-structured interviews with 30 midwives, information was collected about the compatibility of services with the capacity and scope of the activities of midwives. A panel of 12 experts was assembled to develop a proposed service package. The content analysis method was applied to data analysis and interpretation. Results: The service package developed covered 82 services that midwives can offer at the 8 healthcare facility groups. Although midwives were trained to manage a range of primary and gynaecological care services, certain essential aspects of reproductive health services were not being delivered on the frontline. These include sexually transmitted diseases and human papilloma virus management, diagnosis and treatment of common gynaecological problems, sexual education and counselling, and childbirth services. Midwives were not adequately engaged to provide reproductive health care at the secondary level. Conclusion: There are drawbacks to the current reproductive health service delivery in the Islamic Republic of Iran. The service package designed and proposed in this study aims to strengthen reproductive health care services and planning and better integration of midwife-led programmes.

Evidence-informed framework for gender transformative continuing education interventions for midwives and midwifery associations.

INTRODUCTION: Continuing education for midwives is an important investment area to improve the quality of sexual and reproductive health services. Interventions must take into account and provide solutions for the systemic barriers and gender inequities faced by midwives. Our objective was to generate concepts and a theoretical framework of the range of factors and gender transformative considerations for the development of continuing education interventions for midwives. METHODS: A critical interpretive synthesis complemented by key informant interviews, focus groups, observations and document review was applied. Three electronic bibliographic databases (CINAHL, EMBASE and MEDLINE) were searched from July 2019 to September 2020 and were again updated in June 2021. A coding structure was created to guide the synthesis across the five sources of evidence. RESULTS: A total of 4519 records were retrieved through electronic searches and 103 documents were included in the critical interpretive synthesis. Additional evidence totalled 31 key informant interviews, 5 focus groups (Democratic Republic of Congo and Tanzania), 24 programme documents and field observations in the form of notes. The resulting theoretical framework outlines the key considerations including gender, the role of the midwifery association, political and health systems and external forces along with key enabling elements for the design, implementation and evaluation of gender transformative continuing education interventions. CONCLUSION: Investments in gender transformative continuing education for midwives, led by midwifery associations, can lead to the improvement of midwifery across all United Nations' target areas including governance, health workforce, health system arrangements and education.

Designing for two: How enhancing human-centered design with behavioral nudges unlocked breakthroughs to promote young women's psychological safety and access to reproductive care in Tanzania.

Adolescent girls and young women (AGYW; ages 15-24) in sub-Saharan Africa face many barriers to accessing preventive sexual and reproductive health (SRH) services. We drew upon the strengths of two complementary approaches, human-centered design and behavioral economics, to craft a holistic, highly-tailored, and empathetic intervention to motivate AGYW to seek contraception and HIV self-test kits at community drug shops. To encourage engagement, we embedded "nudge" strategies at different opportunity points (uncovered during our design research) along the care-seeking and service delivery journey. Our Malkia Klabu intervention is a loyalty program designed to enhance drug shops' role as SRH providers through which AGYW earned punches for shop purchases redeemable for small prizes; free SRH products could be requested at any time. From our 4-month pilot in Shinyanga, Tanzania, we assess the extent to which different behavioral nudge strategies motivated behaviors as predicted by synthesizing findings from (1) in-depth interviews with AGYW and shopkeepers, (2) shop program records, (3) shop observations, and (4) customer exit surveys. Overall, we find that AGYW and shopkeepers were motivated by many intervention features as intended and consistent with hypothesized mechanisms. We found strong evidence of social norms for helping to spread awareness of Malkia Klabu among peers, prize incentives for drawing AGYW back to shops, and the opt-out default membership gift of an HIV self-test kit for encouraging testing uptake and exploration of contraceptives. Shopkeepers in both arms noted increased community status from distributing HIV self-testing kits (ego). Malkia Klabu shopkeepers experienced increased customer traffic and business revenues (incentives), which reduced shopkeepers' gatekeeping tendencies and earned them additional recognition as champions of AGYW well-being. Integrating human-centered design and behavioral economics was effective for developing an innovative and effective intervention that simultaneously met the different needs of economic actors in support of public health priorities.

Integrated Health Care Delivery for Adolescents Living with and at Risk of HIV Infection: A Review of Models and Actions for Implementation.

Integrated service delivery, providing coordinated services in a convenient manner, is important in HIV prevention and treatment for adolescents as they have interconnected health care needs related to HIV care, sexual and reproductive health and disease prevention. This review aimed to (1) identify key components of adolescent-responsive integrated service delivery in low and middle-income countries, (2) describe projects that have implemented integrated models of HIV care for adolescents, and (3) develop action steps to support the implementation of sustainable integrated models. We developed an implementation science-informed conceptual framework for integrated delivery of HIV care to adolescents and applied the framework to summarize key data elements in ten studies or programs across seven countries. Key pillars of the framework included (1) the socioecological perspective, (2) community and health care system linkages, and (3) components of adolescent-focused care. The conceptual framework and action steps outlined can catalyze design, implementation, and optimization of HIV care for adolescents.

A Qualitative Analysis on Sexual and Reproductive Health Needs and Issues During COVID-19 Using a Reproductive Justice Framework.

The COVID-19 pandemic exacerbated existing health inequities, further exposing the challenges in meeting the sexual and reproductive health (SRH) needs, particularly for Black, Indigenous and People of Color (BIPOC). We interviewed 11 key informants through three focus groups to explore barriers and pathways to SRH care for BIPOC during COVID-19 in the United States. Reimagining reproductive health practices requires holistic practices and multisector pathways, a comprehensive reproductive justice approach. This includes interventions across the sexual and reproductive health continuum. Using a deductive-dominant approach grounded in reproductive justice values, we explore themes around SRH during COVID-19. Five themes for advancing reproductive justice were identified: "supremacy of birth"; police violence as a determinant of SR mental health; addressing quality of care outside of hospital settings; digital redlining; and centering joy, liberation, and humanity.

Reimagining young people's rights in South Asia: Learnings from #FlawsInLaws.

While the criminal justice system is an essential pillar in ensuring human rights for young people, especially their sexual and reproductive health and rights (SRHR), laws and regulations are often overused or misused regarding rights related to gender and sexuality. Sometimes this is explicit, but other times it works in less overt ways to undermine young people's rights. Therefore, in 2019, CREA joined with seven partners in South Asia to launch a campaign focusing on the impact of criminalisation of young people's sexuality - rethink young people's freedoms, reimagine their rights, and help them to realise their futures. Legal and policy advocacy has often promoted reform in a way that empowers the state to legislate on aspects of sexuality, including sexual identity, conduct, expression and reproduction - sometimes expanding rights protections, but sometimes putting rights at risk. Through the campaign, the partners sought to highlight the disconnected law and policy structures about young people and their sexuality (including criminalisation, lack of comprehensive sexuality education and lacune in SRHR services), envisioning arights-affirming environment for young people and the communities that support them. We contestedthe tendency to advocate for rights' recognition through distinct, issue-based initiatives rather than a holistic, intersectional approach.

Testing the effect of an integrated-intervention to promote access to sexual and reproductive healthcare and rights among women with disabilities in Ghana: a quasi-experimental study protocol.

BACKGROUND: There is evidence that women with disabilities (WWDs) experience the most difficulty accessing and using sexual and reproductive health and rights (SRHRs) services and information worldwide. However, there are currently no workable interventions to reach WWDs with essential SRHR services. This study aims to test the effect of an integrated health facility and individual-level intervention on access to SRHRs information and services among sexually active WWDs aged 15-49 years in Ghana. METHODS: A quasi-experimental study design with four arms will be implemented in four districts in the Northern region of Ghana to test the effect of three inter-related interventions. The inventions are (1) capacity building in disability-centred SRHRs information and service delivery for healthcare providers, (2) support for WWDs to access disability-unfriendly healthcare infrastructure, and (3) one-on-one regular SRHRs education, information provision, and referral. The first two interventions are at the health-facility level while the third one is at the individual/family level. The first arm of the experiment will expose eligible WWDs to all three interventions. In the second arm, WWDs will be exposed to only the two-health facility-level interventions. The third arm will expose WWDs to only the individual level intervention. The forth arm will constitute the control group. A total of 680 (170 in each arm) sexually active women with physical disability and visual impairments will take part in the study over a period of 12 months. To assess the effect of the interventions on key study outcomes (i.e. awareness about, and use of modern contraceptive, ANC attendance, and skilled delivery among parous women), pre- and post-intervention surveys will be conducted. Difference-in-Difference analysis will be used to examine the effect of each intervention in comparison to the control group, while controlling for confounders. Cost-effectiveness analyses will also be conducted on the three-intervention arms vis a vis changes in key outcome measures to identify which of the three interventions is likely to yield greater impact with lower costs. DISCUSSION: Lack of access to SRHRs information and services for WWDs is not only a violation of their right to appropriate and quality SRH care but could also undermine efforts to achieve equitable healthcare access as envisaged under SDG 3. This research is expected to generate evidence to inform local health programmes to increase access to SRHRs among WWDs by strengthening local health system capacity to provide disability-sensitive SRHRs services. Trial registration Name of the registry: Pan African Clinical Trials Registry (PACTR). Trial ID: 14591. Date of registration: 02/01/2020. URL of trial registry record: https://pactr.samrc.ac.za/Researcher/TrialRegister.aspx?TrialID=14591.

Women with disabilities (WWDs) experience a lot of difficulty accessing sexual and reproductive health and rights (SRHRs) services and information worldwide. However, there are currently no workable specific interventions to reach WWDs with essential SRHRs services. We propose to implement three interventions to enable WWDs in Ghana who are aged 15­49 years gain better access to SRHRs services and information. Our aim is show whether these interventions have beneficial effects by helping many more WWDs access and use SRHRs services and information like modern contraceptives. To achieve this objective, we will (1) train healthcare providers in ways to better provide SRHRs information and service to WWDs; (2) support WWDs to access disability-unfriendly healthcare infrastructure by creating access ramps at health facilities; (3) train and deploy community health volunteers to undertake one-on-one regular home visits to educate WWDs on SRHRs, provide information on SRHRs and refer WWDs to healthcare providers. A total of 680 sexually active women with physical and visual impairments will take part in the study over a period of 12 months. We will divide the women into four groups (170 in each group). The first group will be exposed to all the three interventions. The second group will be exposed to only interventions 1 and 2. The third group will be exposed to only intervention 3. The fourth group will not be exposed to any of the three interventions. Our study is expected to strengthen the local health system capacity to provide disability-sensitive SRHRs services.

Midwifery curricula inclusion of sexual and reproductive health in crisis settings in the Democratic Republic of Congo.

AIM: This discussion paper aims to argue for the inclusion of the Minimum Initial Service Package (MISP) for sexual and reproductive health in crisis settings in all midwifery curricula. BACKGROUND: The Democratic Republic of Congo continues to experience long-standing humanitarian crises that have affected the population's health, especially in relation to sexual violence and other sexual and reproductive health issues. The MISP was established in 1996 to meet the most vital sexual and reproductive health needs of crisis-affected populations and has become an international minimum standard in humanitarian response. DESIGN: Case study. METHODS: This paper is a case presentation describing the process and lessons learned related to the introduction of the MISP into the first- and third-year pre-service midwifery curricula at multiple midwifery education facilities in the Democratic Republic of Congo. RESULTS: Six main lessons were identified during the initial implementation phases of the revised midwifery curricula: seizing the opportunity to influence long-term change, engaging teamwork, addressing instructors' concerns, mobilizing resources for curriculum implementation, assessing school infrastructure readiness during field visits, and meeting immediate humanitarian needs with in-service training. The lessons learned may assist other nations experiencing humanitarian crises with the implementation of the MISP. CONCLUSIONS: This pre-service training strategy holds promise for both a sustainable and prompt solution to bridge the gap in competent human resources to deliver quality sexual and reproductive health services in humanitarian settings.

User - provider perspectives to overcome the challenges of TB/HIV service integration at Mulago National Referral Hospital _ Kampala.

BACKGROUND: Tuberculosis and Human Immunodeficiency Virus epidemics in sub-Saharan Africa have been closely related and persistent, proving a considerable burden for healthcare provision. This has complicated utilization of services, with noted opinions on the integration of these services from both users and providers of the services. OBJECTIVES: To establish the users and the provider's perspectives in overcoming the challenges of TB/HIV services integration at Mulago National Referral Hospital. METHODS: Descriptive cross-sectional design, with predominantly qualitative methods was used. Qualitative aspect adopted phenomenological design. Participants were randomly selected for FGDs and Key informants. An observation checklist collected quantitative data from the patients to measure level of services integration. FINDINGS: Level of service integration of TB/HIV services was at 68% (below the acceptable 100% level). Opinions from the users pointed to; increasing number of work-days for TB/HIV service provision, strengthening sensitisation and health education and integrating other services like reproductive health services, among others. Health care providers opinions pointed to increasing trainings for health workers, increasing staffing and need for more support from Ministry of Health. CONCLUSION: Opinions from both users and providers were similar. These ranged from increasing awareness to the users and healthcare providers about the integration of services.

Utilization and associated factors of reproductive health services among 20-39-year-old women in rural China: a cross-sectional study.

BACKGROUND: The use of reproductive health (RH) services is important to promote RH. However, little is known about RH services in rural areas, especially in low- and middle-income countries. China is the most populous country in the world, and 40.4% of its population is rural. Our study determined the utilization of and factors associated with RH services in rural China. METHODS: A cross-sectional study of 978 20- to 39-year-old women was performed in four villages of four cities in Hunan Province. A researcher-created structured questionnaire was used to collect the data. The data were entered into EpiData v3.0 and analysed using SPSS v18.0. Statistical significance was defined as a two-sided P-value of less than 0.05. Descriptive statistics were used to examine the socio-demographic factors and the use of RH services by the sample population. Chi-square tests were used to assess associations between categorical variables. Logistic regression analyses were performed to examine factors that correlated with the use of RH services. RESULTS: The top three services used were antenatal examinations (90.2%), postpartum visits (73.0%) and free folic acid supplements (71.6%). Age, monthly household income, employment, spousal education level, and artificial abortion history were associated with RH service utilization (P < 0.05). The most desired RH service was cervical/breast cancer prevention services (58.9%). The most preferred method participants used to obtain information on RH services was the internet. CONCLUSIONS: The utilization rate for RH services in rural China needs improvement. Future efforts should target high-risk populations of women by providing them with RH-related information and cultivating positive attitudes towards RH services.

Reproductive health (RH) services are recognized worldwide as a cost-effective strategy to promote RH. However, little is known about RH services in rural areas, especially in low- and middle-income countries. China is the most populous country in the world, and 40.4% of its population is rural. Due to the implementation of China's universal two-child policy, women between 20 and 39 years old are likely to experience more RH problems related to childbirth. Our study investigated the utilization of and factors associated with RH services in rural China. The top three services used among the 978 participants were antenatal examinations (90.2%), postpartum visits (73.0%) and free folic acid supplements (71.6%). Age, monthly household income, employment, spousal education level, and artificial abortion history were associated with RH service utilization. The participants most desired services pertained to the prevention of cervical/breast cancer, and the most preferred methods used to obtain information related to RH services was the internet.In conclusion, the utilization of RH services requires improvement, and future efforts should target high-risk populations of women by providing them with RH-related information and cultivating positive attitudes towards RH services.

The extent to which the design of available reproductive health interventions fit the reproductive health needs of adolescents living in urban poor settings of Kisenyi, Kampala, Uganda.

BACKGROUND: The rate at which informal urban settlements (slums) are developing in Low and Middle Income. Countries (LMICs) like Uganda is high. With this, comes the growing intersection between urbanization and the reproductive health of key populations. Currently, a number of interventions are being implemented to improve the Reproductive Health (RH) of adolescents in Kisenyi, the largest informal urban settlement in Kampala, the capital of Uganda. Despite these efforts, adolescent RH indicators have persistently remained poor in Kisenyi. This could be indicative of a gap between the provided and needed adolescent RH interventions. We assessed the fit between the available interventions and the RH needs of adolescents living in Kisenyi. METHODS: We conducted a qualitative study in July 2019-February 2020 in Kisenyi. The methodology was guided by the Word Health Organization global standards for quality-health care services for adolescents, the "For whom? Where? By whom? and What?" Framework of sexual RH service delivery and the realist evaluation approach. Eight focus group discussions were conducted with adolescents 15-19 years to explore their RH needs. The design and implementation of the available adolescent RH interventions were assessed by conducting Key Informant interviews with 10 RH service providers in Kisenyi. Validation meetings were held with adolescents and they scored the extent to which the various design features of the existing interventions fit the adolescents' RH needs. RESULTS: The available RH interventions focused on meeting the sexual RH needs like providing family planning services but less on social needs like livelihood and sanitation which the adolescents identified as equally important. While the providers designed intervention to target 10-24 year olds, the adolescents preferred to have interventions that specifically targeted the study population 15-19 years. Most interventions were facility-based while, the adolescents desired community based outreaches. CONCLUSION: The packaging and mode of delivery of interventions were perceived less holistic to meet the adolescents' needs. Most interventions were designed to address the sexual and family planning needs while ignoring the wider social and livelihood needs. More holistic and outreach-based programming that addresses RH within the broader context of livelihood and sanitation requirements are more likely to be effective.

Health care professionals' attitudes towards youth-friendly sexual and reproductive health services in Jordan: a cross-sectional study of physicians, midwives and nurses.

BACKGROUND: Youth-friendly sexual and reproductive health (SRH) services are thought to make such services for adolescents more accessible and acceptable; however, provider attitudes may still present an important barrier. Improving youth SRH service utilization has been recognized as a national priority in Jordan; however, existing services remain underutilized. Previous studies found that youth perceive SRH services to be inadequate and that providers are not supportive of their needs. The purpose of this study is measure provider attitudes towards youth-friendly SRH services and explore their variation according to individual characteristics among health care professionals in Jordan. METHODS: We measured provider attitudes towards youth-friendly SRH services using a scale that was developed and validated in Jordan. The scale consists of three subscales: (1) Attitudes towards SRH information and services offered to youth, (2) Norms and personal beliefs, and (3) Attitudes towards the policy and clinical environment. Possible scores range between 1 and 4, with higher scores reflecting more youth-friendly attitudes. Physicians, midwives and nurses working at either primary health centers, comprehensive care centers, or women's and children's health centers where services to adolescents are or should be offered were recruited from four governorates in Jordan using a two-stage, cluster sampling scheme. Differences in attitudes were assessed using simple and multivariable linear regression analysis. RESULTS: The sample consisted of 510 providers from four governorates in Jordan. The mean provider score on the full scale was 2.7, with a range of 2.0 to 3.8. On Subscales 1 and 2, physicians exhibited significantly more youth-friendly attitudes than nurses by scoring 0.17 points higher than nurses on Subscale 1 (95% CI: 0.02-0.32; p < 0.05) in adjusted analyses. Providers who had been previously trained in SRH issues scored 0.10 points higher (95% CI: 0.00-0.20; p < 0.05) than those who had not on Subscale 3. No differences were found according to provider characteristics on Subscale 2. Providers exhibited the lowest scores related to items referencing youth sexual behavior. CONCLUSIONS: Provider attitudes towards youth-friendly SRH service delivery highlight context-specific, cultural concerns. The limited variation in attitudes related to norms and personal beliefs may be a reflection that such beliefs are deeply held across Jordanian society. Last, as past training on SRH was significantly associated with higher scores, our results suggest opportunity for intervention to improve providers' confidence and knowledge.

Making sexual and reproductive (SRH) services easier for youth to access, organizing service delivery in a way that meets youth's needs, and supporting health care professionals to interact with youth in a friendly manner can make SRH services more youth-friendly. If SRH services are more youth-friendly, more youth may use them. In Jordan, steps have been taken to make SRH services more youth-friendly, but youth still do not believe that providers are supportive of their needs. This study aims to measure physician's, nurse's, and midwives' attitudes towards youth-friendly SRH services in Jordan. We also look at whether certain individual characteristics, such as age, type of service provider, etc. are related to provider attitudes We used a scale that tested in Jordan to measure provider attitudes. The scale focuses on three domains: (1) Attitudes towards SRH information and services offered to youth, (2) Norms and personal beliefs, and (3) Attitudes towards the policy and clinical environment. Possible scores range between 1 and 4, with higher scores reflecting more youth-friendly attitudes. Our sample includes 510 health care providers from four regions in Jordan. We used descriptive statistics and regression analysis to conduct our analysis. Our results show that physicians had more supportive attitudes than nurses or midwives on Subscales 1 and 3. Providers who reported having been trained in SRH issues in the past had higher scores on Subscale 3. No individual characteristics were related to Subscale 2. We find that in Jordan, provider attitudes may reflect deeply rooted cultural norms.