Examining service delivery patterns before and after implementation of a direct-to-patient telehealth service providing medication abortion in Australia.

In August 2016, MSI Australia (MSIA) brought to scale a direct-to-patient telehealth medication abortion service. We used MSIA's patient management systems from January 2015 to December 2018 to assess changes in the proportion of abortion patients obtaining care after 13 weeks' gestation, proportion of abortion patients obtaining medication abortion versus procedural abortion and proportion of abortion patients from regional and remote versus metropolitan areas. The proportions of abortion patients obtaining care before 13 weeks' gestational duration and those from regional and remote residents did not change between the pre- and post-periods. We observed an increase in medication abortion use that was greater among those in regional and remote areas than those in metropolitan areas.

Feasibility and effectiveness of preconception check-ups at workplaces in Japan.

OBJECTIVES: Despite the recent increase in infertility and perinatal complications, preconception care is not commonly available in Japan. Working women are considered to have the greatest need for preconception care, as increasingly they marry and have children later in life. This study aimed to assess the feasibility and effectiveness of preconception check-ups in the workplace. METHODS: We provided 51 female employees aged 18-39 years with free preconception check-ups, including additional blood tests and an online medical questionnaire, during mandatory health check-ups at their workplace. A doctor provided online counseling based on the check-up results. We assessed fertility knowledge using the Cardiff Fertility Knowledge Scale (CFKS-J) and childbearing desire pre- and postintervention. RESULTS: Preconception check-ups revealed various potential risk factors for future pregnancies, including underweight (12%), obesity (20%), Chlamydia trachomatis IgG antibody positivity (22%), low rubella IgG antibody levels (47%), iron deficiency (12%), and 25-hydroxyvitamin D levels <30 ng/mL (98%). Postintervention, the participants reported high satisfaction with the check-ups and significantly advanced their reproductive plans (P = .008). Furthermore, 95% of the participants indicated an intention to seek medical attention or make lifestyle changes. The postintervention CFKS-J score (mean [SD]) was higher than the preintervention score (71.7 [19.3] vs 63.0 [22.0]; P = .006). CONCLUSIONS: We developed a preconception check-up package that can be integrated into workplace health examinations, complemented by tailored counseling. This novel check-up package is a feasible and effective approach for improving preconception health and fertility awareness.

FACTORS INFLUENCING ACCESS AND UTILIZATION OF REPRODUCTIVE HEALTH SERVICES AMONG ADOLESCENTS IN URBAN AND RURAL COMMUNITIES IN RIVERS STATE, NIGERIA.

INTRODUCTION: Adolescents face multiple barriers in accessing information and health care services. Rural and urban differences in access to and use of reproductive health services (RHS) exist but the extent is unclear. We identified and compared the factors influencing access to and utilization of RHS among adolescents in urban and rural communities in Rivers State, Nigeria. METHODOLOGY: A comparative cross-sectional study design was used. In sequential explanatory mixed methods. First, a quantitative survey interviewed 507 adolescents, 255 in urban and 252 in rural communities. This was followed by a narrative approach to qualitative inquiry using focused group discussions. Access and utilization were determined, and predictors of access and utilization were derived from multivariate logistic regression models using adjusted odd ratios. RESULTS: The median ages and interquartile ranges were 16.0 (14-19) and 14.0 (12-16) years for urban and rural respondents respectively. Utilization of RHS was low, 65 (25.5%) in urban, 57 (22.6%) in rural. Access to services was also low, 81 (31.76%) urban versus 8 (3.17%) rural have economic access to RHS. Age, level of education, awareness of RHS, and sexual experience were predictors of access and utilization in both communities, beliefs that condoms can prevent STIs/ HIV, and exposure to mass and socio-media influenced access and utilization of RHS. Specifically, the age group (15-19 years) of respondents was found to be a significant predictor of utilization of RHS for both urban (cOR=4.32, 95% CI; 0.82-22.69, p=0.001) and rural (aOR=7.65, 95% CI; 1.99-29.40, p=0.003) adolescents. The barriers to the utilization of RHS were ignorance, lack of awareness, parental influence, and financial constraints. CONCLUSION: Adolescents in urban areas have more access (3 in 10) and utilization of RHS compared with their rural (3 in 100) counterparts. There is a need to promote information and education on RHS among adolescents, especially in rural areas.

Reproductive health service use and associated factors among youths in Becho district, southwest Ethiopia.

Background: Young people are less informed, less experienced, and less at ease when it comes to accessing reproductive health services than adults. Though youth-friendly services are designed to accommodate the unique needs of youth, in developing countries like Ethiopia, studies on the level of utilization of reproductive health services are limited. Objectives: This study determined the level of reproductive health (RH) service use and associated factors among youths. Methods: A community-based cross-sectional study was conducted in Becho district, Illubabor zone, southwest Ethiopia. A multistage random sampling technique was used to select 702 youths, regardless of their marital status. A pre-tested interviewer-administered questionnaire was used to collect data. The questionnaire includes questions on socio-demographic characteristics, sexual and reproductive health characteristics, knowledge, and components of RH assessment. The data was entered into Epidata version 3.1 and analyzed using SPSS version 22. Multivariable binary logistic regression analysis was used to identify factors associated with the utilization of reproductive health services at a p < 0.05. Results: A total of 647 youths participated in the study, constituting a response rate of 92.1%. Male youths made up 51.5% of the respondents, with an average (±SD) age of 19.38 (±2.69) years. Reproductive health (RH) services were utilized by 43.9% of youths. Knowledge of RH services (AOR = 4.11; 95% CI: 2.77, 6.09), discussion with family (AOR = 2.18; 95% CI: 1.38, 3.45), history of sexual exposure (AOR = 2.94; 95% CI: 1.95, 4.43), shorter distance from a health facility (AOR = 2.42; 95% CI: 1.63, 3.57), and history of reproductive health problems (AOR = 2.4; 95% CI: 1.34, 4.31) were associated with RH service utilization. Conclusion: The use of reproductive health services among youths is found to be low. Knowledge about reproductive health services, discussion with parents, sexual exposure, distance, and previous experience with reproductive health problems shaped the utilization of RH services by youth. Improving knowledge through information dissemination, creating awareness to increase parent-child intimacy, and expanding health services should be emphasized.

Sexual reproductive health service utilization and associated factors among undergraduate students of Addis Ababa University in Ethiopia.

BACKGROUND: Making clinical services attractive to the younger generation has remained a challenge. Students in higher education continue to underutilize sexual and reproductive health services. This group is exposed to a very hostile environment and has a highly mobile and unprotected lifestyle, often resulting in an early sexual debut, physical and drug abuse, and sexually transmitted infections. OBJECTIVE: The aim of this study was to assess sexual reproductive health services and associated factors among undergraduate students of Addis Ababa University 2022. METHOD: An Institution-based cross-sectional study was been conducted among 419 randomly selected students and data were collected by using semi-structured and pre-tested questionnaire. Data were entered to Epi info data 7.0 and exported to SPSS version 21.0 for further analysis. Both binary and multiple logistic regression analysis was used to identify factors at P < 0.05 with 95% CI and AOR. RESULTS: When queried, all 419 youths agreed to participate in the study, for a response rate of 100%. The mean age of the respondents was 22 years. The majority of respondents (371, 88.5%) were between the ages of 19 and 24, and 221 (52.7%) were female. More than half of those polled (273, or 65.2%) were third-year students, while 59, or 14.1%, were first-year students. About 206 (49.2%) of participants lived with their father and mother, but 138 (32.9%) had never discussed sexual and reproductive health. Finally, 205 respondents (or 48.9%) had ever used the Sexual and Reproductive Health Services. College of business (AOR (95% CI) 3.546 (1.62-7.79), respondents who live with only their mother (AOR (95% CI) 9.37 (2.78-31.51) and who live alone (AOR (95% CI) 5.75 (2.40-13.79), positive attitude toward SRHS (AOR (95% CI) 3.15 (1.71-5.80), good knowledge (AOR (95% CI) 4.16 (2.27-7.64), frequency of discussing SRHS(AOR (95% CI) 1.93 (1.12-3.346), Convenient location of youth RHs (AOR (95% CI) 8.31 (1.61-42.93), Fee of RH services (AOR (95% CI) 12.34 (6.48-23.49) and Satisfied to received RH services (AOR (95% CI) 4.59 (2.54-8.33) were independent predictors of utilized SRHS among undergraduate students. CONCLUSION AND RECOMMENDATION: The prevalence of utilization of sexual and reproductive health services was determined to be low in this study, with identified factors increasing the likelihood of utilization being attitude, knowledge, satisfaction, discussion, fee for RH services, and location, in that order. On the other hand, poor knowledge and a negative attitude toward SRHS posed risks that contributed to reproductive health issues, so we worked on advocating for services that were available in a nearby location and raising awareness. Therefore, policymakers and health planners would be better off strengthening the urgent need to ensure adequate SRHS, knowledge, and attitude building among undergraduate students in higher education in Ethiopia.

Alarming Trends of Cesarean Section-Time to Rethink: Evidence From a Large-Scale Cross-sectional Sample Survey in India.

BACKGROUND: Cesarean section (CS) delivery rate has increased significantly both globally and in India, thereby posing a burden on overstretched health systems. OBJECTIVE: This study plans to understand the factors associated with CS rate with an objective to (1) analyze the trends of CS delivery from 1998-99 to 2019-21 and (2) understand the proximate determinants of CS deliveries in India. METHODS: Analysis of secondary data (National Family Health Survey) of a nationally representative sample of 230,870 women (year 2019-21) was undertaken to explore the trends, distribution, and determinants of CS deliveries in India and within states. Multivariable analyses were performed to determine the proximate variables associated with CS and elective CS. The relative interaction effect of confounding factors, such as number of antenatal care (ANC) visits, place of residence, and wealth status, on cesarean delivery was assessed. A composite index was generated using trust, support, and intimate partner violence variables (termed the partner human capital index [PHI]) to study its influence on CS deliveries, with a low PHI indicating abusive partner and a high PHI indicating supportive partner. Statewise spatial distribution of the most significantly associated factors, namely, wealth quintile and ANC checkups, were also analyzed. RESULTS: The overall prevalence of CS was 21.50% (49,634/230,870) which had risen from 16.72% (2312/13,829) in 1998-99. The adjusted odds of CS deliveries were significantly higher among women who were highly educated (odds ratio [OR] 7.30, 95% CI 7.02-7.60; P<.001), had 4 or more ANC visits (OR 2.28, 95% CI 2.15-2.42; P<.001), belonging to the high-wealth quintile (OR 7.87, 95% CI 7.57-8.18; P<.001), and from urban regions. Increasing educational level of the head of the household (OR 3.05, 95% CI 2.94-3.16; P<.001) was also found to be a significant determinant of CS deliveries. The odds of selection of elective and emergency CS were also significantly higher among women from richer families (OR 1.66, 95% CI 1.25-2.21; P<.001) and those belonging to Christian religion (OR 1.67, 95% CI 1.14-2.43; P=.008). Adjusting the cesarean delivery by PHI, the odds of outcome were significantly higher among women with moderate and high PHI compared with those with low PHI (OR 1.46, 95% CI 1.36-1.56 and OR 1.61, 95% CI 1.49-1.74, respectively; P<.001 for both). The interaction effect result reiterates that women with more than 4 ANC checkups, high PHI, and belonging to the richer wealth quintile were more likely to undergo cesarean delivery (OR 22.22, 95% CI 14.99-32.93; P<.001) compared with those with no ANC visit, low PHI, and poorest women. CONCLUSIONS: The increasing trend of CS deliveries across India is raising concerns. Better education, wealth, and good support from the partner have been incriminated as the contributory factors. There is a need to institute proper monitoring mechanisms to assess the need for CS, especially when performed electively.

Predictors of STD Screening From the Indigenist Stress-Coping Model Among Native Adults With Binge Substance Use.

Objective: The American Indian/Alaska Native (AI/AN) population in the U.S. is thriving in spite of settler colonialist efforts of erasure. AI/AN people, however, continue to experience persistent health disparities including a disproportionate burden of substance use and sexually transmitted diseases/infections (STDs/STIs), as well as a disproportionate lack of public health STD screening services and STD prevention interventions grounded in AI/AN social contexts, experiences, and epistemologies. The present study explored how stressors and protective factors based on the Indigenist Stress Coping framework predict STD screening outcomes among Native adults. Methods: We analyzed baseline self-report data from 254 Native adults ages 18-55 years with recent binge substance use who were enrolled in an evaluation of "EMPWR," a two-session STD risk reduction program in a rural, reservation-based community in the U.S. Southwest. Logistic regression models with robust variance were used to estimate odds ratios of lifetime STD testing for the theoretical stressors and cultural buffers. Results: A little over half the sample were males (52.5%, n = 136), with a mean age of 33.6 years (SD = 8.8). The majority (76.7%, n = 195) reported having ever been screened for STD in their life. Discrimination score were significantly associated with lifetime STD testing: The higher discrimination was associated with lower odds of STD testing in the fully adjusted model (aOR = 0.40, 95%CI: 0.18, 0.92). The effects of AI/AN-specific cultural buffer such as participation in traditional practices on STD testing outcomes was in the expected positive direction, even though the association was not statistically significant. Household size was significantly associated with STD screening: The higher the number of people lived together in the house, the higher the odds of STD testing in the fully adjusted model (aOR = 1.19, 95%CI: 1.04, 1.38). Conclusion: Our findings suggest that STD prevention programs should take into consideration AI/AN-specific historical traumatic stressors such as lifetime discrimination encounters and how these interact to drive or discourage sexual health services at local clinics. In addition, larger household size may be a protective factor functioning as a form of social support, and the extended family's role should be taken into consideration. Future research should consider improvement in measurements of AI/AN enculturation constructs.

Disability and sexual and reproductive health service utilisation in Uganda: an intersectional analysis of demographic and health surveys between 2006 and 2016.

BACKGROUND: The United Nations through universal health coverage, including sexual and reproductive health (SRH), pledges to include all people, leaving no one behind. However, people with disabilities continue to experience multiple barriers in accessing SRH services. Studies analysing the impacts of disability in conjunction with other social identities and health determinants reveal a complex pattern in SRH service use. Framed within a larger mixed methods study conducted in Uganda, we examined how disability, among other key social determinants of health (SDH), was associated with the use of SRH services. METHODS: We analysed data from repeated cross-sectional national surveys, the Uganda Demographic and Health Surveys (DHS) of 2006, 2011, and 2016. The three outcomes of interest were antenatal care visits, HIV testing, and modern contraception use. Our main exposure of interest was the type of disability, classified according to six functional dimensions: seeing, hearing, walking/climbing steps, remembering/concentrating, communicating, and self-care. We performed descriptive and multivariable logistic regression analyses, which controlled for covariates such as survey year, sex, age, place of residence, education, and wealth index. Interaction terms between disability and other factors such as sex, education, and wealth index were explored. Regression analyses were informed by an intersectionality framework to highlight social and health disparities within groups. RESULTS: From 2006 to 2016, 15.5-18.5% of study participants lived with some form of disability. Over the same period, the overall prevalence of at least four antenatal care visits increased from 48.3 to 61.0%, while overall HIV testing prevalence rose from 30.8 to 92.4% and the overall prevalence of modern contraception use increased from 18.6 to 34.2%. The DHS year, highest education level attained, and wealth index were the most consistent determinants of SRH service utilisation. People with different types of disabilities did not have the same SRH use patterns. Interactions between disability type and wealth index were associated with neither HIV testing nor the use of modern contraception. Women who were wealthy with hearing difficulty (Odds Ratio (OR) = 0.15, 95%CI 0.03 - 0.87) or with communication difficulty (OR = 0.17, 95%CI 0.03 - 0.82) had lower odds of having had optimal antenatal care visits compared to women without disabilities who were poorer. CONCLUSION: This study provided evidence that SRH service use prevalence increased over time in Uganda and highlights the importance of studying SRH and the different disability types when examining SDH. The SDH are pivotal to the attainment of universal health coverage, including SRH services, for all people irrespective of their social identities.

Utilization of youth-friendly reproductive health service and associated factors among youth in Aleta Wondo town, southern Ethiopia, 2020.

Background: Youth faces various sexual and reproductive health problems in developing countries like Ethiopia. Major health problems like unintended pregnancy, unsafe abortion, and sexually transmitted infections are common among youth in Ethiopia. This study aimed to determine the level of utilization of youth-friendly reproductive health services and associated factors among youth in Aleta Wondo town, southern Ethiopia, from 20 to 30 June 2020. Methods: A community-based cross-sectional study was conducted among youths of Aleta Wondo town from 20 to 30 June 2020. A total of 421 study participants were selected from households of selected kebeles in the town by using a systematic random sampling method. Data were collected using structured pretested face-to-face interviewer-administered questionnaires. The data were entered using Epi-data version 4.4.2 and exported to SPSS version 25 for analysis. Bivariate and multivariate logistic regression models were used to determine factors significantly associated with the utilization of youth-friendly reproductive health services. Adjusted odds ratio and 95% confidence interval with p value of <0.05 were considered to declare statistical significance. Results: The level of utilization of youth-friendly reproductive health services was 32.8% (95% confidence interval = 28.0%-37.0%). Youth-friendly service utilization was significantly associated with being female gender (adjusted odds ratio = 2.20, 95% confidence interval = 1.34-3.62), living alone (adjusted odds ratio = 2.99, 95% confidence interval = 1.48-5.77), who had not ever discussed with their parents (adjusted odds ratio = 0.46, 95% confidence interval = 0.27-0.81), have visited service required and missed service (adjusted odds ratio = 1.96, 95% confidence interval = 1.19-3.24), and have sexual partner (adjusted odds ratio = 4.52, 95% confidence interval = 2.75-7.44). Conclusion: Youth-friendly reproductive health service utilization among youth Aleta Wondo town was low. Factors like gender, current living place, have ever discussed in reproductive health issues with their parents, have visited health facility and missed service, and having sexual partner were predictors of youth-friendly service utilization. It is better to work in collaboration with youth clubs and schoolteachers to scale up youth-friendly service.

Challenges Faced by Female Out-of-School Adolescents in Accessing and Utilizing Sexual and Reproductive Health Service: A Qualitative Exploratory Study in Southwest, Ethiopia.

INTRODUCTION: Due to the limited access to sexual and reproductive health service, out-of-school-adolescents become at a higher risk for early marriage, early pregnancy early parenthood, and poor health outcomes over their life course. Hence, the aim of this study was to explore the challenges faced by female out-of-school adolescents in accessing sexual and reproductive health service in Bench-Sheko zone. METHODS: A community-based qualitative exploratory study was carried out from November 01/2020 to December 01/2020 among selected out-of-school adolescents residing in rural and urban districts of Bench-Sheko Zone, and healthcare professionals working in the local health centers. FGD participants and healthcare providers were purposely selected for this study. Eight focus group discussions and 8 in-depth interviews were conducted among female out-of-school adolescents, and health care professionals, respectively. RESULT: The study revealed that out-of-school adolescents encounter several challenges in accessing sexual reproductive health service which includes socio-cultural barriers, health system barriers, perceived legal barrier, inadequate information regarding sexual reproductive health service, and low parent-adolescent communication. CONCLUSION: The finding suggests the need to engage community influencers (religious leaders, community leaders, and elders) in overcoming the socio-cultural barriers. Program planners and policy makers have better make an effort to create adolescent friendly environments in SRH service areas. Furthermore, implementing community-based awareness raising programs, parental involvement in sexual reproductive health programs, and encouraging parent-adolescent communication on sexual reproductive health issues could improve sexual reproductive health service utilization by out-of-school adolescents in the study area.

What do service providers in Southern Ethiopia say about barriers to using youth-friendly sexual and reproductive health services for adolescents?: Qualitative study.

BACKGROUND: In Ethiopia, the utilization coverage of adolescent-friendly health services (AFSRHs) ranged only from 9 to 55% and it was the lowest of all Sub-Saharan African countries in 2016. Little is known why adolescents were not accessing the existing services to the side of healthcare providers. OBJECTIVE: The aim of this study is to explore contextual perceived and actual barriers to accessing AFSRHs by adolescents in Southern Ethiopia. METHODS: Phenomenological study design supplemented with observation was used to explore perceived and actual barriers to accessing AFSRHs in 2020. Criterion sampling was used to select study participants. In-depth interviews with healthcare providers and non-specialist sexual and reproductive healthcare providers were conducted. Transcribed interviews and observations were imported to Open Code 4.02 for coding, categorizing, and creating themes. Finally, barriers to accessing existing services were explained using thematic analysis. RESULTS: The study explores contextual barriers to accessing sexual and reproductive health services in five emergent themes. According to providers' points of view, the barriers include ranging from providers (e.g. poor providers' competency), health facilities (e.g. supply constraints and unsupportive environment), adolescents (e.g. perceived lack of information and attitude towards SRHs), community (e.g. lack of parental and social support), and broader health system (e.g. poor implementation and multi-sectorial engagement). CONCLUSION: As to providers, adolescents face multiple barriers to accessing youth friendly sexual and reproductive health services. Healthcare facilities and all levels of the healthcare system should implement varieties of approaches to increase access to the services for adolescents. Given the lack of progress in utilization of adolescents- youth friendly sexual and reproductive services, the existing strategy should be re-evaluated and new interventions at all levels of the healthcare system are needed. Moreover, implementation research is required at system level factors.

Reproductive health services utilization and its associated factors among secondary school youths in Woreta town, South Gondar, North West Ethiopia: a cross sectional study.

OBJECTIVE: The aim of this study was to assess reproductive health service utilization and its associated factors among secondary school students in Woreta town, South Gondar, North east Ethiopia 2018. RESULT: Out of the total 376 selected students, 345 were participated in the study with a response rate of 94%. Of these respondents, 85 (24.6%) of them utilized at least one reproductive health services in the past 1 year. Voluntary testing and counseling for HIV/AIDS and Family planning services were utilized by 47 (55.3%) and 43 (50.6%) of youths respectively. Being grade 11-12 (AOR = 5.299, 95% CI 2.019, 13.912, P = 0.001) and closeness of the service facility to their home (AOR = 2.76, 95% CI 1.168, 6.525, P = 0.021) were significantly associated with students' reproductive health service utilization. This low service utilization might make students prone for different reproductive health risks; which in turn can increase school dropout rate, and has impact on individual's future life as well as the country's youth health policy from meeting its goal. Therefore, it needs a great effort and attention of all the concerned bodies including parents, school staffs, and health professionals to improve the service utilization in schools.

[Analysis on reproductive health service, demographics and characteristics of internal migrant population in three municipalities of China].

Objective: To investigate the utilization of reproductive health services and relating factors among internal migrant population in Beijing, Shanghai and Chongqing. Methods: A multi-stage cluster sampling method was adopted in this cross-sectional study, conducted in Beijing, Shanghai and Chongqing from August 2014 to August 2015. Standard methods on statistics and nonlinear canonical correlation were applied. Results: Out of the 6 545 internal migrant persons, 41.76% ever used the reproductive health services in the past year. Results from the nonlinear canonical correlation analysis revealed that the utilization of reproductive health services was correlated with the demographic features (=0.28, P<0.000 1) and characteristics of the population mobility (=0.21, P<0.000 1), respectively. For the above said demographic features, canonical variable L(1) which represented the demographic features was mainly determined by area, occupation and education attainment. Canonical variable M(1) that reflected the utilization of reproductive health services, was mainly determined by factors as free contraceptives, education on contraception/reproductive health, and pregnancy diagnosis/antenatal care. As for the characteristics of the population mobility, canonical variable U(1), which represented population mobility characteristics, was mainly determined by factors as purpose of migration, current pattern of residence and the length of annual stay in the area. Again, the canonical variable V(1), reflecting the use of reproductive health services was mainly determined by factors as free contraceptives, check-up on reproductive tract infection, education on contraception/reproductive health, and pregnancy diagnosis/antenatal care. Conclusions: The utilization of reproductive health services was low among the internal migrant population under study. Responsible departments for health and family planning in those cities should make internal migrants attach importance to reproductive health.

How to do it: setting up a PrEP service in an integrated sexual reproductive health service setting.

Pre-exposure prophylaxis for HIV (PrEP) has been shown to reduce transmission of HIV in a number of trials; however, there is limited evidence regarding the optimal way to deliver PrEP through pre-existing UK services, particularly through fully integrated drop-in sexual health service models. PrEP in the form of Truvada was launched in Wales in July 2017. We set up a PrEP service to be delivered via our drop-in integrated sexual reproductive health service. In the first 5 months of PrEP service provision, we found unforeseen levels of comorbidity, polypharmacy and renal impairment in our cohort of PrEP patients. As a result, we have altered our service model and all patients are now followed up in booked appointment PrEP clinics run by members of the HIV team. Those patients with estimated glomerular filtration rate (eGFR) of 60-70 mL/min or with eGFR of 60-80 mL/min and with comorbidities impacting on renal function are monitored every 4-6 weeks initially, and PrEP has been incorporated into our pre-existing virtual HIV renal clinic for discussion with a renal physician. The PrEP team clinicians report that monitoring and managing the PrEP cohort is now easier in its appointment-only format, although some patients have reported that they would prefer a drop-in system.

Disparities in the use of mobile phone for seeking childbirth services among women in the urban areas: Bangladesh Urban Health Survey.

BACKGROUND: In Bangladesh, similar to its other South Asian counterparts, shortage of health workers along with inadequate infrastructure constitute some of the major obstacles for the equitable provision of reproductive healthcare services, particularly among the marginalized and underserved neighbourhoods. However, given the rapidly expanding broadband communication and mobile phone market in the country, the application of eHealth and mHealth technologies offer a window of opportunities to minimise the impact of socioeconomic barriers and promote the utilization of maternal healthcare services thereby. In the present study we aimed to investigate 1) the prevalence of usage of mobile phones for seeking childbirth services, 2) neighbourhood and socioeconomic disparities in the use, and 3) association between using mobile phones and the uptake of postnatal care among mothers and neonates. METHODS: Data for the present study came from Bangladesh Urban Health Survey 2013. Study subjects were 9014 married women aged between 15 and 49 years. RESULTS: The overall rate of use of mobile phone was highest in City Corporation non-Slum areas (16.2%) and lowest in City Corporation Slum areas (7.4%). The odds of using mobile for seeking childbirth services were significantly higher among those who were living in non-slum areas, and lower among those who never attended school and lived in poorer households. Results also indicated that women in the slum areas who used mobile phone for childbirth service seeking, were 4.3 times [OR = 4.250;95% CI = 1.856-9.734] more likely to receive postnatal care for themselves, and those from outside the city-corporation areas were 2.7 times [OR = 2.707;95% CI = 1.712-4.279] more likely to receive postnatal care for the newborn. CONCLUSION: Neighbourhood, educational and economic factors were significantly associated with the mobile phone utilization status among urban women. Promoting access to better education and sustainable income earning should be regarded as an integral part to the expansion of mHealth for maternal healthcare seeking behaviour.

Provider-controlled or user-dependent contraceptive methods: Levels and pattern among married women of reproductive age in China, 1988-2006.

OBJECTIVES: To explore levels and patterns in contraceptive use since the introduction of informed choice in reproductive health services in China since 1994, and to assess the implications of reproductive health service needs among married women of reproductive age in China. MATERIAL AND METHODS: Data from Chinese nationwide surveys of family planning and reproductive health undertaken in 1988, 1997, 2001, and 2006 were analyzed to assess levels and trends in patterns of contraceptive use among married women by age, residence, and number of children. Contraceptive methods were classified into two categories: provider-controlled and user-dependent methods. RESULTS: The provider-controlled pattern for contraceptive use was predominant regardless of whether women were free to choose their own contraceptives. Older, rural women, and those with more than one child preferred provider-controlled contraceptive methods; this trend has changed little after 1997. In contrast, the user-controlled methods were preferred by young, urban women, strikingly with no or only one child, and geographically in more affluent areas in north or southwest China. CONCLUSION: A preference for user-dependent methods is noted in the urban areas but inclination towards provider-controlled contraceptive methods is still prevalent in rural areas in China.

Evaluación rápida de la situación de los servicios de salud sexual y reproductiva en el marco de la epidemia del zika en el Perú / Rapid assessment of the situation of the sexual and reproductive health services in the framework of Zika virus epidemic in Peru

En América Latina, los primeros meses del 2016 estuvieron marcados por crecientes reportes de microcefalia, que poco después se demostró estaba causado por el virus zika. Inicialmente su transmisión fue caracterizada como metaxénica (a través del mosquito del dengue, Aedes aegypti), para luego encontrarse evidencias de transmisión sexual. Por ello, el Ministerio de Salud (MINSA) del Perú solicitó evaluar la capacidad de respuesta de sus servicios de salud reproductiva en las áreas de mayor riesgo de contagio, el área nororiental del Perú y Lima, a fin de identificar necesidades y nudos críticos y elaborar un plan de mejora de la oferta de servicios. En el caso de Lima, también se incluyeron dos establecimientos de EsSalud. Mediante entrevistas individuales, grupales, listas de chequeo y guías de observación, se analizaron variables claves del sistema de salud. El presupuesto en las regiones fue siempre menor al solicitado, mientras que el de planificación familiar recibía otros usos. Los horarios de atención fueron limitados, en tanto que se requiere actualizar las competencias del personal para usar el dispositivo intrauterino (DIU) y métodos de larga duración. El 83% de establecimientos tenía desabastecimiento del inyectable mensual, mientras que 17% presentó substock. Asimismo, resultó clara la necesidad de capacitar al personal para la prevención del zika durante las relaciones sexuales, así como antes y durante el embarazo. No se reconoció los vínculos con la violencia sexual. Los servicios orientados a usuarias/os adolescentes brindaban atención con horarios restringidos, además de otras limitaciones a su acceso. Solo el 22% de usuarias había recibido información de parte de los proveedores.

In Latin America, the first months of 2016 were marked by the increasing reports of microcephaly, which was shortly afterwards shown to have been caused by the Zika virus. Initially, its transmission was typified as metaxenic (caused by the Dengue mosquito Aedes aegypti); later, evidences of sexual transmission were detected. Thus, the Ministry of Health of Peru required to evaluate the response capacity of the reproductive health services to needs and critical knots and to draft a plan to improve the offer. In the case of Lima, EsSalud facilities were also included. Through individual and group interviews, and check lists and observation lists, key variables of the health system were analyzed. The budget of the regions was always lower than that requested; the family planning budget was expended in other uses. Office hours were limited. The staff skills on both intrauterine device (IUD) and long-acting reversible contraception (LARC) use needed to be updated. 83% of the facilities had shortage of monthly injectable contraception, and 17% were sub-stocked. Likewise, the staff needed to be trained on Zika prevention during sexual activity, and before and during pregnancy. The links with sexual violence were not recognized. The services for adolescent users had restricted office hours, and other access limitations. Only 22% of the users had received information from the suppliers.

Reproductive health service utilization and social determinants among married female rural-to-urban migrants in two metropolises, China.

Reproductive health (RH) education and services of female migrants in China have become an important health issue. This research aimed to investigate the RH knowledge and utilization among married female migrants, and to explore the influencing factors from the perspectives of population and sociology. We conducted a cross-section survey in Shenzhen and Wuhan, China, using the purposive sampling method. A total of 1021 rural-to-urban married migrants were recruited, with 997 valid survey results obtained. A face-to-face structured questionnaire survey was used, with primary focus on knowledge of fertility, contraception, family planning policy and sexual transmitted diseases/acquired immunodeficiency syndrome (STD/AIDs), and RH service utilization. The results showed that the RH service utilization (38.0%) was at a low level in married migrants and the accessibility of RH service was poor. Females who migrated to (OR=0.32) Wuhan obtained fewer RH consultations than those in Shenzhen. The workers with high school education received additional RH consultations and checkup services than those with other background education, apart from the white collar workers who received extra RH consultations and checkup services than the blue collar workers (P<0.05). We can draw a conclusion that the utilization of RH services in married female migrants remains at a low level in China. RH service utilization can be improved via the relevant health departments by enhancing the responsibility of maternal and health care in the community health service center.

Presenting risk information in sexual and reproductive health care.

OBJECTIVES: Presenting risk information to patients is an important part of clinical encounters. Good risk communication improves patient satisfaction with their care and the decisions they make. In sexual and reproductive healthcare (SRH), women frequently need to make decisions based on their perceived risk. Risk perception can be altered by how actual risk is presented to patients. METHODS: Databases were searched using MeSH terms combined with a keyword search for articles relevant to SRH; the search was limited to English language. RESULTS: Personalised risk communication where a risk score is provided, increases knowledge and slightly increases uptake of screening tests. Decision aids improve a patient's knowledge of the options, create realistic expectations of their benefits and harms, reduce difficulty with decision-making, and increase participation in the process. The most effective way to present risks uses a range of structured, tailored presentation styles; interactive formats are best. Framing the information improves patient understanding. Most people understand natural frequencies or event rates better than probability formats with varying denominators. Expressing changes in risk as an absolute risk reduction or relative risk reduction with baseline risk formats improves understanding. Descriptive terms such as 'low risk' or 'high risk' should be quantified as a frequency rather than a percentage. Using a consistent denominator to portray risk is recommended. Using the 'number needed to treat' and visual aids puts benefits or risks into perspective. The duration of risk should be presented. CONCLUSION: Presenting risk information to patients can be optimised using a number of strategies.

Reproductive health service utilization and associated factors: the case of north Shewa zone youth, Amhara region, Ethiopia.

INTRODUCTION: Many youth are less informed, less experienced and less comfortable in utilizing reproductive health services. In the Sub-Saharan region the adolescents account for a higher proportion of new HIV infections and unmet need for reproductive health (RH) services. This study assessed reproductive health service utilization and associated factors among the youth in Amhara Region, Ethiopia. METHODS: A community based cross-sectional study was conducted from June 15-July 30, 2014. Three hundred ninety one youth were selected by systematic random sampling technique and interviewed using structured questionnaire. Data were anlyzed using SPSS windows version 20. Multiple logistic regression was done to control potential confounding variables. P-values <0.05 were considered statistically significant. RESULTS: Three hundred and nighty one in-school and out-of-school youth were interviewed; 256 (65.5%) participants were in school and 209 (53.5%) were males. Almost all respondents (93.9%) had heard about reproductive health services and a third 129 (33%) had ever practiced sexual intercourse and 54.7% of them had utilized at least one reproductive health services. Never had sexual intercourse (AOR=3.693, 95%CI: 1.266, 10.775), families that asked their children about friends (parental monitoring) (AOR=1.892, 95%CI: 1.026, 3.491), know where service provided (AOR=3.273, 95%CI: 1.158, 9.247), youths who reads newspaper readers (AOR=3.787, 95%CI: 1.849were independent predictors of youth reproductive service utilization at 95 % CI and p-value <0.05%. CONCLUSION: Even though the youth have information about reproductive health services, youth reproductive health services utilization is very low. Therefore, building life skill, facilitating parent to child communication, establishing and strengthening of youth centres and increasing awareness for youth about those services are important steps to improve adolescents' reproductive health (RH) service utilization.