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Chemosphere ; 346: 140662, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37949182


Perchlorate, a widespread environmental contaminant originating from various industrial applications, agricultural practices, and natural sources, poses potential risks to ecosystems and human health. While previous studies have highlighted its influence on the thyroid endocrine system and its impact on gonadal maturation, reproduction, and sex hormone synthesis, the specific interplay between thyroid and steroid hormones, in this context, remains largely unexplored. Therefore, this study was undertaken to investigate the adverse effects and underlying mechanisms triggered by exposure to sodium perchlorate (SP) on reproductive endocrine activity in zebrafish. For 21 d, the fish were exposed to test SP concentrations (0, 3, 30, 300 mg/L), which were determined based on the exposure concentrations that induced various toxic effects in the fish, considering naturally occurring concentrations. Exposure to SP, except at 3 mg/L in males, significantly decreased the production of thyroid hormone (TH) in both female and male zebrafish. Moreover, gonadal steroid levels were markedly reduced in both sexes. The expression of hepatic vitellogenin (VTG) mRNA in female zebrafish was significantly decreased, whereas aromatase activity in male zebrafish was significantly elevated in the SP exposure groups. The reduced levels of THs and gonadal steroid hormones were strongly correlated. Abnormal responses to SP exposure led to reduced reproductive success in the 300 mg/L SP exposure group. These findings indicate that prolonged and continuous exposure to a specific concentration of SP may lead to long-term reproductive problems in zebrafish, primarily through hormonal imbalances and suppression of hepatic VTG mRNA expression.

Contaminantes Químicos del Agua , Pez Cebra , Animales , Humanos , Femenino , Masculino , Pez Cebra/metabolismo , Percloratos/toxicidad , Percloratos/metabolismo , Glándula Tiroides/metabolismo , Salud Reproductiva , Ecosistema , Gónadas , Hormonas Esteroides Gonadales/metabolismo , Reproducción , Esteroides/metabolismo , ARN Mensajero/metabolismo , Vitelogeninas/metabolismo , Contaminantes Químicos del Agua/metabolismo
Rev. int. androl. (Internet) ; 21(4): 1-9, oct.-dic. 2023. ilus, tab, graf
Artículo en Inglés | IBECS | ID: ibc-225999


Introduction: Radiofrequency electromagnetic fields (RF-EMFs) are one of the risk factors for male reproductive health and melatonin can be an ideal candidate for therapeutic development against RF-induced male fertility problems due to its antioxidant properties. The possible therapeutic role of melatonin in the destructive effects of 2100MHz RF radiation on rat sperm characteristics is investigated in the present study. Methods: Wistar albino rats were divided into four groups and the experiment continued for ninety consecutive days; Control, Melatonin (10mg/kg, subcutaneously), RF (2100MHz, thirty minutes per day, whole-body), and RF+Melatonin groups. Left caudal epididymis and ductus deferens tissues were placed in sperm wash solution (at 37°C) and dissected. The sperms were counted and stained. Measurements of the perinuclear ring of the manchette and posterior portion of the nucleus (ARC) were performed and the sperms were examined at an ultrastructural level. All of the parameters were evaluated statistically. Results: The percentages of abnormal sperm morphology were significantly increased with RF exposure, while the total sperm count was significantly decreased. RF exposure also showed harmful effects on acrosome, axoneme, mitochondrial sheath, and outer dense fibers at the ultrastructural level. The number of total sperms, sperms with normal morphology increased, and ultrastructural appearance returned to normal by melatonin administration. Discussion: The data showed that melatonin may be a beneficial therapeutic agent for long-term exposure of 2100MHz RF radiation-related reproductive impairments. (AU)

Introducción: Los campos electromagnéticos de radiofrecuencia (RF-EMF) son uno de los factores de riesgo para la salud reproductiva masculina y la melatonina puede ser un candidato ideal para el desarrollo terapéutico contra los problemas de fertilidad masculina inducidos por RF debido a sus propiedades antioxidantes. En el presente estudio se investiga el posible papel terapéutico de la melatonina en los efectos destructivos de la radiación RF de 2100MHz en las características del esperma de rata. Métodos: Se dividieron ratas albinas Wistar en 4 grupos y se continuó el experimento durante 90 días consecutivos: grupos control, melatonina (10mg/kg, por vía subcutánea), RF (2100MHz, 30min por día, cuerpo entero) y RF+melatonina. Los tejidos del epidídimo caudal izquierdo y del conducto deferente se colocaron en una solución de lavado de esperma (a 37°C) y se diseccionaron. Los espermatozoides fueron contados y teñidos. Se realizaron mediciones del anillo perinuclear del manchette y de la porción posterior del núcleo (ARC) y se examinaron los espermatozoides a nivel ultraestructural. Todos los parámetros fueron evaluados estadísticamente. Resultados: Los porcentajes de morfología anormal de los espermatozoides aumentaron significativamente con la exposición a RF, mientras que el recuento total de espermatozoides disminuyó significativamente. La exposición a RF también mostró efectos nocivos en el acrosoma, el axonema, la vaina mitocondrial y las fibras densas externas a nivel ultraestructural. El número total de espermatozoides, los espermatozoides con morfología normal aumentaron y la apariencia ultraestructural volvió a la normalidad mediante la administración de melatonina. Discusión: Los datos mostraron que la melatonina puede ser un agente terapéutico beneficioso para la exposición a largo plazo de las deficiencias reproductivas relacionadas con la radiación de RF de 2100MHz. (AU)

Animales , Ratas , Melatonina/efectos de la radiación , Melatonina/uso terapéutico , Salud Reproductiva , Semen/fisiología , Ratas Wistar , Ondas de Radio/efectos adversos , Infertilidad Masculina , Espermatogénesis
BMC Med Educ ; 23(1): 888, 2023 Nov 21.
Artículo en Inglés | MEDLINE | ID: mdl-37990221


BACKGROUND: Midwives' contribution to improving outcomes for women and newborns depends on factors such as quality of pre-service training, access to continuing professional development, and the presence of an enabling work environment. The absence of opportunities for career development increases the likelihood that health professionals, including midwives, will consider leaving the profession due to a lack of incentives to sustain and increase motivation to remain in the field. It also limits the opportunities to better contribute to policy, training, and research. This study aimed to assess the influence of a Master in Sexual and Reproductive Health (SRH) at the INFSS on midwives' career progression in Mali. METHODS: This mixed methods study was conducted using an online questionnaire, semi-structured interviews, and a document review. The study participants included graduates from two cohorts (N = 22) as well as employers, managers, and teachers of the graduates (N = 20). Data were analysed according to research questions, comparing, and contrasting answers between different groups of respondents. RESULTS: The study revealed that graduates enrolled in the programme primarily to improve their knowledge and skills in management and public health. The graduates' expected roles are those of programme and health project manager and participation in planning and monitoring activities at national or sub-national level. The managers expected the programme to reflect the needs of the health system and equip midwives with skills in management and planning. The Master enhanced opportunities for graduates to advance their career in fields they are not usually working in such as management, research, and supervision. However, the recognition of the master's degree and of the graduates' profile is not yet fully effective. CONCLUSION: The master's degree in SRH is a capacity building programme. Graduates developed skills and acquired advanced knowledge in research and management, as well as a postgraduate degree. However, the master programme needs to be better aligned with health system needs to increase the recognition of graduates' skills and have a more positive impact on graduates' careers.

Partería , Recién Nacido , Humanos , Femenino , Embarazo , Malí , Salud Reproductiva , Educación de Postgrado , Salud Pública/educación
Reprod Health ; 20(1): 172, 2023 Nov 22.
Artículo en Inglés | MEDLINE | ID: mdl-37990327


PURPOSE: The COVID-19 pandemic led to major service disruptions in the healthcare sector, especially regarding sexual and reproductive health services. However, the impact of the pandemic on Canadian adolescents is relatively unknown. This study aimed to investigate the impacts of the COVID-19 pandemic and associated public health measures on the sexual and reproductive health (SRH) of adolescents in Alberta, Canada. METHODS: A qualitative study using an interpretive description (ID) approach and community-based participatory research principles was conducted to capture the subjective experience and perceptions of adolescents and service providers. With the collaboration of the Adolescent Advisory Group and community partners, 18 adolescents and 15 service providers were recruited for the study through purposive sampling. Findings from the qualitative interviews were analyzed using thematic analysis. RESULTS: Three major themes emerged from the analysis: (1) COVID-19 SRH experience, (2) barriers to SRH, and (3) adolescent SRH strategies. Our findings highlight numerous barriers and challenges that prevented adolescents from accessing SRH education, products, and services. CONCLUSION: The COVID-19 pandemic had a profound impact on the SRH and the well-being of adolescents. Our study reflects the need for diverse SRH strategies to maintain continued access to SRH resources during disruptive events, such as the pandemic.

Access to sexual and reproductive health (SRH) services is a basic human right. All individuals require access to appropriate SRH services to maintain their optimal sexual and reproductive health. Adolescents require special guidance, support, and youth-friendly services in matters of SRH as they enter puberty and explore their sexual identity. However, during the COVID-19 pandemic, many health and SRH services were suspended. Access to SRH products and services became difficult due to public health restrictions, which has possible negative consequences for adolescents' SRH. The experiences of adolescents during the COVID-19 pandemic regarding their SRH are not reported in Alberta, Canada. Therefore, we explored the impacts of these public health restrictions on adolescents' SRH. We performed qualitative interviews with adolescents and SRH service providers to know their perspectives on how the pandemic influenced the SRH of adolescents. This paper provides insights into the barriers faced by adolescents while accessing SRH services during the pandemic, as well as their perceptions of digital strategies, such as mobile applications, and other recommendations for supporting SRH education and services. Based on the study findings, an adolescent-friendly mobile application will be developed to provide a virtual platform connecting adolescents to SRH educational resources, services, and support.

COVID-19 , Servicios de Salud Reproductiva , Adolescente , Humanos , Salud Reproductiva/educación , Pandemias , Alberta/epidemiología , COVID-19/epidemiología , Conducta Sexual
J Adolesc Health ; 73(6S): S81-S91, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37953014


PURPOSE: This study describes the patterns of pre-exposure prophylaxis (PrEP) use among adolescent girls and young women (AGYW) initiated on daily oral PrEP for the prevention of HIV, within routine sexual and reproductive health services in South Africa. METHODS: We analysed clinical and survey data from a nested cohort of 967 AGYW initiated on oral PrEP between January 2019 and December 2021 in four geographical clusters in South Africa. We describe the periods of PrEP use, and the proportion who discontinued and subsequently restarted PrEP. Logistic regression analyses were conducted to determine factors associated with early PrEP discontinuation, PrEP use for ≥4 months and PrEP restart. RESULTS: PrEP use for ≤1 month was high (68.6%), although 27% returned and restarted PrEP; and 9% restarted more than once. Initiating PrEP at a mobile clinic (AOR 2.10, 95% CI 1.51 - 2.93) and having a partner known to be HIV negative or whose HIV status was unknown (AOR 7.11, 95% CI 1.45 - 34.23; AOR 6.90, 95% CI 1.44 - 33.09) were associated with PrEP use for ≤1 month. AGYW receiving injectable contraceptives were more likely to restart PrEP (AOR 1.61, 95% CI 1.10 - 2.35). Compared to those aged 15-17 years, participants 18 - 20 and 21 - 24 years were less likely to restart PrEP (AOR 0.51, 95% CI 0.35 - 0.74; AOR 0.60, 95%, CI 0.41 - 0.87), as were those initiating PrEP at a mobile clinic compared to a fixed facility (AOR 0.66, 95% CI 0.47 - 0.92). DISCUSSION: Although early PrEP discontinuation was high, it appears that PrEP use is frequently cyclical in nature. Further research is needed to determine if these cycles of PrEP correlate to periods of perceived or actual vulnerability to HIV, which may also be cyclical. PrEP delivery presents a unique opportunity to address multiple unmet health needs of young people.

Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Servicios de Salud Reproductiva , Humanos , Femenino , Adolescente , Infecciones por VIH/prevención & control , Infecciones por VIH/tratamiento farmacológico , Sudáfrica , Fármacos Anti-VIH/uso terapéutico
BMJ Open ; 13(11): e073586, 2023 Nov 24.
Artículo en Inglés | MEDLINE | ID: mdl-38000827


OBJECTIVES: Negative views of healthcare providers towards adolescent sexual and reproductive health (SRH) services deter adolescents from seeking vital SRH services. This paper assessed the impact of an intervention on the views and perceptions of healthcare providers towards the provision of adolescent SRH services. DESIGN AND SETTING: A descriptive, cross-sectional, qualitative study was conducted between 14 October and 19 November 2021 in six local government areas (LGAs) in Ebonyi state, southeast Nigeria, after the implementation of an intervention comprising of training and supportive supervision. PARTICIPANTS AND DATA COLLECTION: Data were collected through: (1) two in-depth interviews (IDIs) with LGA healthcare managers; (2) six IDIs with LGA adolescent health programme managers; (3) two focus group discussions (FGDs) with 15 primary healthcare facility managers; (4) two FGDs with 20 patent medicine vendors and (5) two FGDs with 17 community health volunteers. A total of six FGDs were held with 52 healthcare providers. The interviews were conducted using pretested interview guides. Transcripts were coded in NVivo (V.12) and themes were identified through inductive analysis. RESULTS: As a result of the intervention, most healthcare providers started recognising the rights of adolescents to obtain contraceptive services and no longer deny them access to contraceptive services. The providers also became friendlier and were no longer harsh in their interactions with adolescents. There were some unique findings relative to whether the providers were formal or informal healthcare providers. It was found that the informal healthcare providers were bolder and more comfortable delivering SRH services to adolescents and reported improved patronage by the adolescents. The formal healthcare providers made their facilities more conducive for adolescents by creating safe spaces and introducing extracurricular activities. CONCLUSION: These findings highlight the importance of the constant capacity building of both formal and informal healthcare providers, which can address healthcare providers' biases, views and perceptions of delivering SRH services to adolescents.

Creación de Capacidad , Servicios de Salud Reproductiva , Humanos , Adolescente , Nigeria , Estudios Transversales , Accesibilidad a los Servicios de Salud , Conducta Sexual , Anticonceptivos , Personal de Salud , Salud Reproductiva , Investigación Cualitativa
Glob Health Action ; 16(1): 2279841, 2023 Dec 31.
Artículo en Inglés | MEDLINE | ID: mdl-38010100


BACKGROUND: Sexual and reproductive health literacy is a key to attaining and maintaining sexual and reproductive health, especially among young people in low-income countries, such as sub-Saharan Africa. While the importance of sexual and reproductive health literacy is gaining wider recognition, studies on the topic have been mainly concentrated in high-income (developed) countries. OBJECTIVE: The aim of this study was to provide a coherent summary and synthesis of the available evidence on sexual and reproductive health literacy among young people in sub-Saharan Africa, with implications for policy, interventions, and research. METHODS: The review was conducted using the Joanna Briggs Institute's methodology for reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline to enhance the clarity and transparency of the reporting process. PubMed, CINAHL, AJOL, AIM, and Google Scholar were searched for evidence from 18 March to 20 May 2022. RESULTS: The search provided 2,682 articles in total, of which only 24 met the eligibility criteria and were included in this review. The findings revealed persistent sexual and reproductive health information/knowledge gaps, poor sexual and reproductive health-related knowledge and practices, lack of exercising sexual and reproductive health knowledge, and multiple determinants of sexual and reproductive health literacy among young people, ranging from personal to larger structural conditions. CONCLUSION: The review found that sexual and reproductive health literacy among young people in sub-Saharan Africa is concerning and has not been fully researched. A deeper understanding of the issue is essential for designing and implementing effective interventions to improve sexual and reproductive health literacy and health outcomes among young people.

Alfabetización en Salud , Salud Reproductiva , Humanos , Adolescente , Conducta Sexual , África del Sur del Sahara
Rev Colomb Obstet Ginecol ; 74(3): 202-213, 2023 09 30.
Artículo en Inglés, Español | MEDLINE | ID: mdl-37937911


Objectives: As part of sexual and reproductive health, abortion is a woman's right in Colombia. However, not all the members of Colombian society recognize this right. The aim of this work is to understand the transformation of meanings after having to cope with voluntary termination of late pregnancy in women living in Colombia, as well as their interaction with family and friends and the health system. Material and methods: Hermeneutic research undertaken within a constructivist paradigm and analyzed from a feminist perspective using grounded theory techniques: coding, categorization and constant comparison. Nineteen semi-structured interviews were conducted among 18 women living in Colombia who underwent voluntary termination of late pregnancy defined as more than 20 weeks of gestation, accompanied by feticide and labor induction, in two Colombian cities between 2016 and 2020. Besides, two focus groups were conducted, one with some of the interviewees and another with feminist experts in order to cross-reference the information derived from the research process and delve deeper into the findings. Results: Women attached a negative and opposite meaning to voluntary termination of pregnancy, but once they found themselves in a situation that forced them to put an end to gestation, they transgressed their own meanings and those of society to find justifications to help them uphold their decision. This confrontation brought them to a place of profound and intimate reflection and led them to transform their lives. Conclusions: Meanings regarding abortion in women who undergo late pregnancy termination are usually contrary to this right in sexual and reproductive health. After the event, these meanings become transformed through a process of conscious reflection as women come face-to-face with their own meanings and those of society.

Objetivos: el aborto es un derecho en salud sexual y reproductiva de la mujer en Colombia, sin embargo no toda la sociedad colombiana reconoce este derecho. Este trabajo busca comprender la transformación de los significados después de haber afrontado una interrupción voluntaria del embarazo tardía, en mujeres residentes en Colombia, y su interacción con familiares, amigos y sistema de salud. Materiales y métodos: investigación hermenéutica desde un paradigma constructivista, el análisis se hizo desde una perspectiva feminista con técnicas de la teoría fundamentada: codificación, categorización y comparación constante. Se realizaron 19 entrevistas semiestructuradas a 18 mujeres residentes en Colombia que se sometieron a interrupción voluntaria del embarazo tardía definida por ser una gestación mayor a 20 semanas, acompañada de feticidio e inducción de parto, en dos ciudades colombianas, entre 2016 y 2020. Además, se realizaron dos grupos focales, uno con algunas de las entrevistadas, y otro con feministas expertas para triangular la información emergente del proceso investigativo y profundizar los hallazgos. Resultados: las mujeres tenían un significado negativo y contrario sobre la interrupción voluntaria del embarazo, pero cuando se encuentran inmersas en una situación que las obliga a terminar con la gestación, contravienen los significados propios y los de su sociedad y buscan justificaciones que les ayuden a mantener la decisión. Esta confrontación las hace reflexionar profunda e íntimamente y las lleva a transformar sus vidas. Conclusiones: los significados sobre el aborto, en las mujeres que se realizan interrupción voluntaria del embarazo tardía, generalmente son contrarios a este derecho en salud sexual y reproductiva. Posterior al evento estos significados se transforman por medio de la reflexión consciente de las mujeres al tener que enfrentar sus propios significados y los de la sociedad.

Aborto Inducido , Femenino , Humanos , Embarazo , Colombia
Sci Rep ; 13(1): 19962, 2023 11 15.
Artículo en Inglés | MEDLINE | ID: mdl-37968298


There is little information on the effects of exposure to light emitting diode (LED) illumination on the welfare of laboratory animals. Nesfatin-1, a satiety-regulation peptide present in various tissues, is found in the central nervous system and participates in the stress response. The present study investigated whether exposure to blue and white LED lights for 14 weeks affected growth and reproductive, biochemical and histopathological parameters in male Sprague Dawley (SD) rats as well as whether subcutaneous (SC) injection of nesfatin-1 (0.5 mg/kg bodyweight) in the last two weeks of the experimental period alleviated these effects. Forty male SD rats (21 days of age) were randomly allotted to 6 groups. The animals were exposed to routine fluorescent light (the control [C] and control + sesame oil [CS] groups) or blue/white LEDs (the blue-LED and white-LED groups), accompanied by nesfatin-1 administration (the blue-LED-N1 and white-LED-N1 groups). White-LED rats had significantly higher testis weights (p < 0.05) than control and blue-LED rats. Serum melatonin levels were significantly lower in blue-LED rats, but nesfatin-1 injection rescued melatonin levels in blue-LED-N1 rats (p < 0.05). Blue-LED rats showed the highest serum nesfatin-1 levels, but nesfatin-1 injection decreased nesfatin-1 levels in blue-LED-N1 rats (p < 0.0001). Blue-LED rats showed a significant reduction in sperm motility compared to the other groups (p < 0.0001). White and blue LED exposure caused significant negative histopathological changes in the testes, but nesfatin-1 administration reduced edema in the intertubular spaces, hyperemia in the interstitial cells, degeneration of spermatocytes and thinning of the tubular wall in the testicular tissues; these restorative effects were larger in blue-LED-N1 rats than white-LED-N1 rats. Blue and white LED exposures had negative effects on melatonin levels, testis weights and tissue health. Nesfatin-1 alleviated some of the negative effects of LED lighting.

Melatonina , Ratas , Masculino , Animales , Ratas Sprague-Dawley , Melatonina/farmacología , Salud Reproductiva , Motilidad Espermática , Testículo/patología
Reprod Health ; 20(1): 166, 2023 Nov 09.
Artículo en Inglés | MEDLINE | ID: mdl-37946289


INTRODUCTION: Girls' and women's health as well as social and economic wellbeing are often negatively impacted by early childbearing. In many parts of Africa, adolescent girls who get pregnant often drop out of school, resulting in widening gender inequalities in schooling and economic participation. Few interventions have focused on education and economic empowerment of adolescent mothers in the region. We aim to conduct a pilot randomized controlled trial in Blantyre (Malawi) and Ouagadougou (Burkina Faso) to examine the acceptability and feasibility of three interventions in improving educational and health outcomes among adolescent mothers and to estimate the effect and cost-effectiveness of the three interventions in facilitating (re)entry into school or vocational training. We will also test the effect of the interventions on their sexual and reproductive health (SRH) and mental health. INTERVENTIONS: The three interventions we will assess are: a cash transfer conditioned on (re)enrolment into school or vocational training, subsidized childcare, and life skills training offered through adolescent mothers' clubs. The life skills training will cover nurturing childcare, SRH, mental health, and financial literacy. Community health workers will facilitate the clubs. Each intervention will be implemented for 12 months. METHODS: We will conduct a baseline survey among adolescent mothers aged 10-19 years (N = 270, per site) enrolled following a household listing in select enumeration areas in each site. Adolescent mothers will be interviewed using a structured survey adapted from a previous survey on the lived experiences of pregnant and parenting adolescents in the two sites. Following the baseline survey, adolescent mothers will be individually randomly assigned to one of three study arms: arm one (adolescent mothers' clubs only); arm two (adolescent mothers' clubs + subsidized childcare), and arm three (adolescent mothers' clubs + subsidized childcare + cash transfer). At endline, we will re-administer the structured survey and assess the average treatment effect across the three groups following intent-to-treat (ITT) analysis, comparing school or vocational training attendance during the intervention period. We will also compare baseline and endline measures of SRH and mental health outcomes. Between the baseline and endline survey, we will conduct a process evaluation to examine the acceptability and feasibility of the interventions and to track the implementation of the interventions. DISCUSSION: Our research will generate evidence that provides insights on interventions that can enable adolescent mothers to continue their education, as well as improve their SRH and mental health. We aim to maximize the translation of the evidence into policy and action through sustained engagement from inception with key stakeholders and decision makers and strategic communication of research findings. Trial registration number AEARCTR-0009115, May 15, 2022.

Madres Adolescentes , Cuidado del Niño , Embarazo , Adolescente , Niño , Femenino , Humanos , Burkina Faso , Malaui , Salud Reproductiva , Proyectos Piloto , Madres , Evaluación de Resultado en la Atención de Salud , Ensayos Clínicos Controlados Aleatorios como Asunto
Health Policy Plan ; 38(Supplement_2): ii25-ii35, 2023 Nov 16.
Artículo en Inglés | MEDLINE | ID: mdl-37995266


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.

Servicios de Salud Reproductiva , Embarazo , Humanos , Adolescente , Femenino , Masculino , Kenia , Grupos Focales , Salud Reproductiva , Políticas
Reprod Health ; 20(1): 174, 2023 Nov 24.
Artículo en Inglés | MEDLINE | ID: mdl-37996929


BACKGROUND: Globally, there are 42 million women and girls estimated to be forcibly displaced. Adolescent girls and young women in humanitarian settings have their sexual and reproductive health (SRH) neglected. This systematic review aimed to describe SRH obstacles that adolescent girls and young women (10-24 years old) face in humanitarian settings in line with the Sustainable Development Goals. METHODS: We conducted a mixed-methods systematic review in six databases, focusing on migrant women ages 10 - 24and their SRH outcomes. The mixed-methods appraisal tool was used to evaluate the quality of the studies. This review follows PRISMA and the Systematic Review Guidelines from the Centre for Reviews and Dissemination recommendations. RESULTS: Among the 1290 studies screened by abstracts, 32 met the eligibility criteria: 15 were qualitative, 10 were quantitative and seven were mixed-methods studies. Most studies were performed in the last four years, in African countries. They discussed the increased frequency of adolescent pregnancies (16-23%), lack of contraceptive use and access (8-32%), poor menstrual hygiene management (lack of water, shortage of menstrual hygiene supplies), ignorance and stigma about sexually transmitted infections and HIV, a higher number of child, early and forced marriage or partnership and sexual and gender-based violence, challenging to obtain SRH information/knowledge/access, and unmet SRH needs. CONCLUSION: Migration is a current issue. Although there is a growing number of studies on adolescent girls and young women's SRH in humanitarian settings, this population remains overlooked, and face several challenges in SRH. There is a need for targeting interventions on SRH.

This systematic review describes the available evidence on the sexual and reproductive health (SRH) challenges faced by adolescent girls and young women in humanitarian settings. Thirty-two studies were analyzed, demonstrating poor SRH outcomes: higher incidence of adolescent pregnancy, lack of access to contraceptives and low rates of its use, precarious menstrual hygiene management (MHM), ignorance and stigma about sexually transmitted infections (STIs) and HIV, higher rates of child, early and forced marriage or partnership (CEFMP) and sexual and gender-based violence (SGBV). Identifying these challenges can help humanitarian actors address the SRH needs of these populations.

Servicios de Salud Reproductiva , Salud Reproductiva , Embarazo , Niño , Femenino , Adolescente , Humanos , Adulto Joven , Adulto , Higiene , Menstruación , Conducta Sexual
West Afr J Med ; 40(11 Suppl 1): S15, 2023 Nov 10.
Artículo en Inglés | MEDLINE | ID: mdl-37975305


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.

Servicios de Salud Reproductiva , Población Rural , Humanos , Adolescente , Adulto Joven , Adulto , Nigeria , Estudios Transversales , Encuestas y Cuestionarios
BMJ Glob Health ; 8(11)2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-37984894


BACKGROUND: Humanitarian settings, particularly those in low-income and middle-income countries (LMICs), present increased sexual and reproductive health (SRH) challenges for individuals and health systems. Previous infectious disease outbreaks in such settings have negatively impacted SRH services and outcomes, as fragmented health systems are further overstretched. The COVID-19 pandemic has magnified the SRH challenges in LMIC humanitarian settings on an unprecedented scale. However, understanding of the impacts of COVID-19 is lacking. This review aimed to understand how the COVID-19 pandemic has impacted SRH service coverage, utilisation and outcomes in LMIC humanitarian settings, to inform current and future humanitarian research, programming and practice. METHODS: A systematic review methodology was followed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards. Three search fields related to humanitarian settings, SRH and COVID-19 were applied, and limited to LMIC settings only. Three bibliographic databases and nine grey literature sources were searched. Articles meeting inclusion criteria at full-text screening were critically appraised using standardised tools. Data extraction was undertaken on included articles and analysed through narrative synthesis. RESULTS: In total, 7742 citations were screened and 42 were included in the review. All included studies were cross-sectional. The quality was mostly medium to high. Narrative synthesis identified the reduced provision of, and access to, SRH services, and increased morbidity including sexual and gender-based violence and unplanned pregnancies. Impacts on service uptake varied across and within settings. Adaptations to improve SRH service access including telemedicine were reported; however, implementation was hindered by resource constraints. CONCLUSIONS: The COVID-19 pandemic has indirectly negatively impacted SRH at the individual and health system levels in LMIC humanitarian settings. Further research on the impacts on service uptake is required. SRH programmers should target interventions to meet the increased SRH needs identified. Policy-makers must incorporate SRH into emergency preparedness and response planning to mitigate indirect impacts on SRH in future outbreaks.

COVID-19 , Servicios de Salud Reproductiva , Embarazo , Femenino , Humanos , Pandemias , Conducta Sexual , Salud Reproductiva
JAMA Netw Open ; 6(11): e2344877, 2023 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-38019515


Importance: People with disabilities face inequitable access to reproductive health (RH) services, yet the national prevalence of barriers to access experienced across disability types and statuses is unknown. Objective: To assess the national prevalence of barriers to RH access experienced by people with disabilities. Design, Setting, and Participants: This cross-sectional study analyzed results of an online probability-based national survey of RH experiences that was conducted from December 2021 to January 2022. The national sample consisted of English- and Spanish-speaking panel members of a market research firm. Panelists were invited to participate in a survey on their RH experiences and opinions. These participants were aged 15 to 49 years and assigned female at birth (AFAB). Weighted proportions were estimated, and bivariable and multivariable regression analyses were performed to assess associations between disability status and barriers to accessing RH services. Exposure: Using 5 of the 6 Washington Group Short Set on Functioning items, 8 dichotomous disability indicators were created: (1) vision, (2) hearing, (3) mobility, (4) activities of daily living, (5) communication, (6) overall disability status (a lot or more difficulty functioning in ≥1 domain), (7) some difficulty functioning (below the disability threshold; some or more difficulty functioning in ≥1 domain), and (8) multiple disabilities (a lot or more difficulty functioning in ≥2 domains). Main Outcomes and Measures: Number and types of barriers (logistical, access, cost, privacy, and interpersonal relationship) to accessing RH services in the past 3 years. Results: After exclusion, the final sample included 6956 people AFAB, with a mean (SD) age of 36.0 (8.3) years. Of these participants, 8.5% (95% CI, 7.6%-9.5%) met the disability threshold. Participants with disabilities compared with those without disabilities were disproportionately more likely to be non-Hispanic Black (18.8% [95% CI, 14.4%-24.1%] vs 13.2% [95% CI, 11.9%-14.5%]) or Hispanic or Latinx (completed survey in English: 18.1% [95% CI, 14.0%-23.0%] vs 14.6% [95% CI, 13.3%-16.0%]; completed survey in Spanish: 8.9% [95% CI, 6.2%-12.8%] vs 6.2% [95% CI, 5.4%-7.1%]) individuals, to identify as LGBTQAI (lesbian, gay, bisexual, transgender, queer [or questioning], asexual [or allied], intersex; 16.4% [95% CI, 12.3%-21.6%] vs 11.8% [95% CI, 10.6%-13.1%]), to live below the federal poverty level (27.3% [95% CI, 22.3%-32.8%] vs 10.7% [95% CI, 9.7%-11.9%]), and to ever experienced medical mistreatment (49.6% [95% CI, 43.7%-55.5%] vs 36.5% [95% CI, 34.8%-38.2%]). Among those who had ever tried to access RH services (n = 6027), people with disabilities vs without disabilities were more likely to experience barriers (69.0% [95% CI, 62.9%-74.5%] vs 43.0% [95% CI, 41.2%-44.9%]), which were most often logistical (50.7%; 95% CI, 44.2%-57.2%) and access (49.9%; 95% CI, 43.4%-56.4%) barriers. The disability domains with the highest proportion of people who experienced 3 or more barriers in the past 3 years included activities of daily living (75.3%; 95% CI, 61.1%-85.6%), communication (65.1%; 95% CI, 49.5%-78.1%), and multiple (59.9%; 95% CI, 45.6%-72.7%) disabilities. Conclusions and Relevance: This cross-sectional study found large disparities in access to RH services among people AFAB with disabilities. Findings indicated a need to alleviate barriers to RH care, including improving the transportation infrastructure and reinforcing patient-centered approaches that engender inclusivity in health care settings.

Actividades Cotidianas , Personas con Discapacidad , Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud , Servicios de Salud Reproductiva , Femenino , Humanos , Estudios Transversales , Minorías Sexuales y de Género , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad
J Adolesc Health ; 73(6S): S73-S80, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37953012


PURPOSE: Poor mental health is associated with sexual and reproductive health (SRH) risks, including human immunodeficiency virus (HIV) and pre-exposure prophylaxis discontinuation. Adolescents and young people (AYP) are vulnerable to HIV and depression. This paper describes the prevalence and severity of depression and associated factors in AYP accessing SRH services in South Africa. METHODS: A cross-sectional analysis of enrollment data (January 2019 to December 2021) from a cohort of individuals receiving pre-exposure prophylaxis services at eight clinics in three provinces in South Africa was conducted. Females (n = 1,074) and males (n = 231) aged 15-24 years were included. Interviewer-administered questionnaires were conducted, and the prevalence and severity of depression assessed using the Patient Health Questionnaire-9. Multivariate analysis was used to identify factors associated with depression. RESULTS: Over 40% of participants had experienced any depression symptoms (43.7% of females, 38.5% of males). For males, experiencing intimate partner violence was the only predictor of depression symptoms (adjusted odds ratio (AOR) 8.81, 95% confidence intervals (CI) 1.03-75.44). For females, living with both parents (AOR 1.70, 95% CI 1.15-2.51), having transactional sex (AOR 1.63, 95% CI 1.00-2.65), experiencing any intimate partner violence (AOR 1.96, 95% CI 1.34-2.89), and using drugs (AOR 1.78, 95% CI 1.03-3.11) were all positively associated with depression symptoms. Resilience was a protective factor against depression symptoms for both sexes (males: AOR 0.96, 95% CI 0.93-0.98; females: AOR 0.96, 95% CI 0.95-0.97). DISCUSSION: There is a high burden of depression among AYP accessing SRH services in South Africa. Mental health screening should be integrated into SRH and HIV prevention programs for AYP.

Infecciones por VIH , Masculino , Femenino , Humanos , Adulto Joven , Adolescente , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Infecciones por VIH/psicología , Salud Reproductiva , Salud Mental , Sudáfrica/epidemiología , Estudios Transversales , Conducta Sexual
J Adolesc Health ; 73(6S): S92-S100, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37953015


PURPOSE: This study describes a cohort of men seeking oral pre-exposure prophylaxis (PrEP) services and explores their patterns of PrEP use within an implementation project seeking to integrate PrEP provision within sexual and reproductive health services in public health clinics in South Africa. METHODS: Routine program and survey data from 364 males initiated on oral PrEP between July 2020 and May 2022 were analyzed. PrEP use was examined, including time to first discontinuation and restart patterns. Factors associated with early PrEP discontinuation and PrEP restart were analyzed. RESULTS: Despite primarily focusing on access for adolescent girls and young women, PrEP services reached males with HIV prevention needs. PrEP use for ≤1 month (early discontinuation) was high at 58%; however, 18% restarted on PrEP, with 4% restarting repeatedly. Having depression symptoms was associated with early PrEP discontinuation (adjusted odds ratio [AOR]: 1.71, 95% CI [confidence interval]: 1.06-2.78). Those ≥25 years were less likely to discontinue early, as were those with a partner treated for a sexually transmitted infection in the preceding three months (AOR: 0.33, 95% CI: 0.13-0.84) and those who had been circumcised (AOR: 0.59, 95% CI: 0.36-0.96). Those 18-20 years old were less likely to restart PrEP than those ≥25 years (AOR: 0.43, 95% CI: 0.19-0.97), as were those whose partner's HIV status was unknown (AOR: 0.33, 95% CI: 0.12-0.88). DISCUSSION: This study identified interest and uptake of oral PrEP among an underrepresented population of predominantly heterosexual males seeking sexual and reproductive health services. It found high rates of early PrEP discontinuation, with a subset returning to restart PrEP. Further research is needed to determine whether these periods of PrEP use are associated with periods of HIV risk.

Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Servicios de Salud Reproductiva , Masculino , Adolescente , Humanos , Femenino , Adulto Joven , Adulto , Infecciones por VIH/prevención & control , Infecciones por VIH/tratamiento farmacológico , Fármacos Anti-VIH/uso terapéutico , Sudáfrica , Encuestas y Cuestionarios
Reprod Health ; 20(1): 162, 2023 Oct 31.
Artículo en Inglés | MEDLINE | ID: mdl-37907933


BACKGROUND: Persons with disabilities (PwDs) face barriers in accessing sexual and reproductive health (SRH) services due to lack of knowledge and awareness, stigma and discrimination, and inadequate service provision. This study aimed to examine the determinants of SRH knowledge and awareness among PwDs in Ghana, and to explore their perceptions of the functionality of SRH services. METHODS: A sequential explanatory mixed-methods study design was used to collect and analyse quantitative (n = 402) and qualitative (n = 37) data from PwDs in two districts in Ghana. Quantitative data were analysed using descriptive and inferential statistics, while qualitative data was analysed thematically. RESULTS: Most of the participants had high awareness of SRH (94.3%), sexually transmitted infections (STIs) (92.5%) and HIV/AIDS (97.0%). Employment status was positively associated with SRH awareness [aOR = 1.62; 95% CI = 1.02, 2.59]. Disability type was a significant predictor of STI [aOR = 2.02; 95% CI = 1.39, 2.94] and HIV/AIDS [aOR = 2.32; 95% CI = 1.21, 4.44] awareness, with the visually impaired having higher odds than the physically disabled. Age group was also a significant predictor of STI awareness, with older respondents having higher odds than younger ones [aOR = 1.76; CI = 1.01,3.05 for 30-39 years; aOR = 2.48; CI = 1.22, 5.05 for 40-49 years]. The qualitative findings revealed four main themes: conceptualisation of SRH, active engagement in SRH information seeking, tensions between knowledge and religious beliefs and perceived utility of SRH services. CONCLUSION: Despite the high levels of SRH knowledge and awareness among PwDs, there are significant gaps and challenges related to disability type, age group, misconceptions, beliefs, and service non-functionality that limit the utility of SRH services. The findings call for tailored education to reduce misconceptions and put in pragmatic steps to deliver quality SRH services and information to PwDs. Further research is needed to assess the sexual lives of PwDs and explore the perspectives of all relevant stakeholders, including service providers and policymakers on how to enhance SRH outcomes for PwDs in Ghana.

People with disability often encounter barriers in access sexual and reproductive health (SRH) services. These challenges arise from a lack of understanding and awareness about these services, stigma, and discrimination as well as unavailability of these services. This study sought to assess the extent of SRH knowledge and awareness among persons with disabilities (PwDs) in Ghana and to investigate their perceptions of the functionality of SRH services. To accomplish this, a study design that combined both quantitative and qualitative research methods was employed. The study collected and analysed data from 402 PwDs in two districts of Ghana. The quantitative data were subjected to descriptive and inferential statistical analyses, whereas the qualitative data, were thematically analysed. The findings indicated that a substantial number of participants demonstrated high awareness of SRH, including sexually transmitted infections (STIs) and HIV/AIDS. The participants' employment status was positively associated with their level of SRH awareness. Additionally, the type of disability played a significant role in predicting awareness of STIs and HIV/AIDS. Visually impaired individuals exhibited a greater likelihood of awareness compared to those with physical disabilities. Age also influenced STI awareness, with older respondents showing higher levels of awareness than their younger counterparts. Qualitative analyses unveiled four main themes: how SRH is conceptualised, the active seeking of SRH information, the tension between knowledge and religious beliefs, and the perceived usefulness of SRH services. The study concluded that PwDs have a high level of SRH knowledge and awareness. However, it identified gaps and challenges that stem from differences in disability type, age group, misconceptions, religious beliefs, and the effectiveness of the services provided. To address these issues, the study recommends tailored educational interventions to meet the unique needs and concerns of PwDs in relation to SRH. Furthermore, enhancing the quality and accessibility of SRH services for this population is suggested. The study underscores the need for further research on the sexual lives of PwDs and the views of stakeholders on how to enhance their SRH outcomes are needed.

Síndrome de Inmunodeficiencia Adquirida , Personas con Discapacidad , Servicios de Salud Reproductiva , Enfermedades de Transmisión Sexual , Humanos , Ghana , Conducta Sexual , Salud Reproductiva