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1.
Reprod Health ; 18(1): 96, 2021 May 17.
Artículo en Inglés | MEDLINE | ID: mdl-34001169

RESUMEN

INTRODUCTION: Despite evidence from recent Demographic Health Surveys that show 98% of the adult Pakistani population have an awareness of at least one modern contraceptive method, only 25% of married couples in Pakistan used a modern method of contraception. Of the modern contraceptive methods, LARC usage has increased only from 2.1 to 3%. This low uptake is puzzling in the context of high awareness of LARC methods and its availability through public sector facilities at subsidized costs. This study aimed to understand the social influences in initiating and continuing use of an LARC methods for contraception in a rural setting in Pakistan. METHODS: In-depth interviews were conducted with 27 women who were using a LARC method for contraception. Data was managed using NVivo 12 and themes were identified using a content analysis approach to analyze the transcripts. RESULTS: Four key themes, supported by sub-themes relating to a temporal model, were identified to explain women's experiences with initiating and continuing use of a LARC. The themes were (i) Use of trusted networks for information on LARCs; (ii) Personal motivation and family support in decision to use LARC; (iii) Choice of LARC methods and access to providers; and (iv) Social and professional support instrumental in long term use of LARC. Results highlight the significant role of immediate social network of female family members in supporting the women in initiating LARCs and maintaining the method's use. CONCLUSION: This study contributes to an in depth understanding of the decision-making process of women who adopted LARC and maintained its use. Women who proceeded to use an LARC and who persisted with its use despite the experience of side effects and social pressures, were able to do so with support from other female family members and spouse.


Asunto(s)
Anticoncepción/estadística & datos numéricos , Toma de Decisiones , Servicios de Planificación Familiar/estadística & datos numéricos , Anticoncepción Reversible de Larga Duración/estadística & datos numéricos , Red Social , Adulto , Intervalo entre Nacimientos , Consejo , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Entrevistas como Asunto , Masculino , Estado Civil , Pakistán , Investigación Cualitativa , Adulto Joven
2.
BMC Public Health ; 21(1): 946, 2021 05 19.
Artículo en Inglés | MEDLINE | ID: mdl-34006237

RESUMEN

INTRODUCTION: After testing the interventions for improving the prevalence of contraceptive use, very few studies have measured the long-term effects thereafter the end of the implementation. This study aimed to measure Yam Daabo interventions' effects on contraceptive use in Burkina Faso at twelve months after completion of the intervention. METHODS: Yam Daabo was a two-group, multi-intervention, single-blind, cluster randomized controlled trial. Interventions comprised refresher training for the provider, a counseling tool, supportive supervision, availability of contraceptive services 7 days a week, client appointment cards, and invitation letters for partners. We used generalized linear mixed-effects models (log Poisson) to compare the modern contraceptive prevalence at 12 months post-intervention in the two groups. We collected data between September and November 2018. We conducted an intention-to-treat analysis and adjusted the prevalence ratios on cluster effects and unbalanced baseline characteristics. RESULTS: Twelve months after the completion of the Yam Daabo trial, we interviewed 87.4% (485 out of 555 women with available data at 12 months, that is, 247/276 in the intervention group (89.5%) and 238/279 in the control group (85.3%). No difference was observed in the use of hormonal contraceptive methods between the intervention and control groups (adjusted prevalence ratio = 1.21; 95% confidence interval [CI] = [0.91-1.61], p = 0.191). By contrast, women in the intervention group were more likely to use long-acting reversible contraceptives (LARC) than those in the control group (adjusted prevalence ratio = 1.35; 95% CI = [1.08-1.69], p = 0.008). CONCLUSION: Twelve months after completion of the intervention, we found no significant difference in hormonal contraceptive use between women in the intervention and their control group counterparts. However, women in the intervention group were significantly more likely to use long-acting reversible contraceptives than those in the control group. TRIAL REGISTRATION: The trial registration number at the Pan African Clinical Trials Registry is PACTR201609001784334 . The date of the first registration is 27/09/2016.


Asunto(s)
Dioscorea , Servicios de Planificación Familiar , Burkina Faso , Anticoncepción , Femenino , Humanos , Periodo Posparto , Embarazo , Método Simple Ciego
3.
Gan To Kagaku Ryoho ; 48(5): 635-638, 2021 May.
Artículo en Japonés | MEDLINE | ID: mdl-34006702

RESUMEN

Most of the warnings about the contraceptive period when using medicines are described as"fixed period"in the package insert, and it is necessary for healthcare professionals to provide information on the specific contraceptive period when using medicines that require contraception. There are many situations where we have trouble. Furthermore, the presence or absence of a description that requires contraception and the contraceptive period differ even though the drugs are the same in Japan and overseas. For example, paclitaxel injection(albumin suspension type)in the package insert in Japan, an appropriate contraceptive period for a certain period have been given to female and male are required. In contrast, different warnings of contraception have been given to female and male another in Europe for 1 month and 6 months after administration, and in the United States for 6 months and for 3 months. The description of the contraceptive period in the package insert in Japan needs to be described after clearly stating the specific period, and it is necessary to describe detailed information including the contraceptive method in materials such as interview forms.


Asunto(s)
Anticoncepción , Preparaciones Farmacéuticas , Europa (Continente) , Femenino , Humanos , Japón , Masculino , Factores de Tiempo , Estados Unidos
4.
Gan To Kagaku Ryoho ; 48(5): 639-643, 2021 May.
Artículo en Japonés | MEDLINE | ID: mdl-34006703

RESUMEN

Many of oncology pharmaceuticals have ovotoxicity and/or genotoxicity. Ovarian reserve, numbers of healthy oocytes in the ovary, gradually decreases in aging, but abruptly decreases when young female cancer patients are exposed to ovotoxic pharmaceuticals. Therefore increasing number of young patients undergo fertility preservation in which oocytes or ovarian tissue are retrieved and cryopreserved before chemotherapy. The deterioration of the quality of oocytes in aging is called "oocyte aging", and the function of DNA repair in the oocytes are known to be deteriorated in aging. Similar to those from U. S. Food and Drug Administration and European Medicines Agency, labeling guidance in Japan recommends"5×T1/2 plus 6 months"of contraception period after the cessation of genotoxic pharmaceuticals, based on mouse model experiments. However, the teratogenicity of pharmaceuticals has been generally found when administered during the 4th to 10th weeks of pregnancy, and healthy children were born even when they originated from the oocytes or ovarian tissue which had been retrieved immediately after chemotherapy. We caregivers should carefully provide information to the female patients and their partners who get unexpectedly pregnant during the above‒mentioned contraception period.


Asunto(s)
Preservación de la Fertilidad , Neoplasias , Preparaciones Farmacéuticas , Anticoncepción , Criopreservación , Femenino , Humanos , Japón , Neoplasias/tratamiento farmacológico , Recuperación del Oocito
5.
Gan To Kagaku Ryoho ; 48(5): 644-648, 2021 May.
Artículo en Japonés | MEDLINE | ID: mdl-34006704

RESUMEN

Fertility preservation for male cancer patients is gradually being recognized and the network for clinical practice has progressed, accompanied with the increasing number of local governments which give a subsidy for their sperm cryopreservation. Sperm cryopreservation is recommended, not only for the risk of azoospermia but also for the possibility of increased risk of malformation due to sperm DNA damage. On the other hand, there is no sufficient evidence for the necessity of contraception, its proper duration, and effects depending on the action sites of the corresponding cancer medicine, making it difficult for clinicians to achieve consensus. Here, we discuss the current and future informational provision of contraception and fertility preservation for male cancer patients.


Asunto(s)
Preservación de la Fertilidad , Neoplasias , Anticoncepción , Criopreservación , Humanos , Consentimiento Informado , Masculino , Neoplasias/tratamiento farmacológico , Espermatozoides
6.
BMC Health Serv Res ; 21(1): 405, 2021 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-33933101

RESUMEN

BACKGROUND: Access to contraceptive services is a cornerstone of human well-being. While Community Health Volunteers (CHVs) promote family planning in Kenya, the unmet need for contraceptives among youth remains high. CHVs seem to pay little specific attention to the contraceptive needs of the youth. METHODS: We conducted a qualitative study exploring the role of CHVs in increasing access and uptake of contraceptive services among youth aged 18-24 years in Narok and Homabay Counties, Kenya. We undertook 37 interviews and 15 focus group discussions involving CHVs, youth, community members, community leaders, youth leaders and health programme managers. Data were recorded, transcribed, translated, coded and thematically analysed, according to a framework that included community, CHV and health system-related factors. RESULTS: CHVs often operated in traditional contexts that challenge contraceptive use among unmarried female and male youth and young married couples. Yet many CHVs seemed to have overcome this potential 'barrier' as well as reigning misconceptions about contraceptives. While private and facility-based public contraceptive services were somehow available, CHVs were the preferred service provider for many youth due to ease of access and saving time and transport costs. This was influenced by varied perceptions among youth of CHVs' knowledge, skills and attitudes regarding contraceptives and provider-client interaction, and specifically their commitment to maintain confidentiality. CONCLUSIONS: CHVs have the potential to increase access to contraceptives for young people, reducing unmet need for contraceptives. Their knowledge, skills and attitudes need strengthening through training and supervision, while incentives to motivate them and broadening the range of contraceptives they are allowed to offer should be considered.


Asunto(s)
Anticonceptivos , Salud Pública , Adolescente , Adulto , Anticoncepción , Servicios de Planificación Familiar , Femenino , Humanos , Kenia , Masculino , Voluntarios , Adulto Joven
8.
J Pak Med Assoc ; 71(3): 993-996, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-34057960

RESUMEN

A cross-sectional survey was conducted from February 2016 to September 2016 to assess the knowledge, attitude and practices regarding contraceptive implants among women of childbearing age visiting the Reproductive Health Services Centre, Civil Hospital, Karachi. A total of 396 adult, non-pregnant, married women of childbearing age, between 18 and 49 years, were interviewed using a structured questionnaire. Only 153 (38.6%) of the respondents had any knowledge about implants, out of whom 122 (79.7%) had acquired the information from family planning clinics. Almost two thirds of the respondents, 267(67.4%) were in favour of using implants as a contraceptive method. Moreover, 244 (61.6%) respondents were of the opinion that if given a choice, they will use implanon, though out of the 316 (79.8%) respondents who had ever used contraceptives, only 3 (0.9%) used implants. Despite a favourable attitude, limited knowledge and poor practices of the respondents were the highlights of the study findings.


Asunto(s)
Anticonceptivos , Conocimientos, Actitudes y Práctica en Salud , Adolescente , Adulto , Anticoncepción , Conducta Anticonceptiva , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Adulto Joven
9.
Pan Afr Med J ; 38: 156, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33995763

RESUMEN

Introduction: low socioeconomic status is a risk factor for maternal death and contraceptive use has been shown to reduce maternal deaths in those poor settings. Despite the tremendous benefits of contraceptives in the regulation of reproductive health indicators, its use in less developed countries continue to remain unacceptably low. The purpose of this study was primarily to assess the contraceptive method mix and then determine the predictors of contraceptive use in the Cameroon Development Corporation (CDC) plantation camps. Methods: mix sampling was used. Firstly, two CDC camp localities (Tiko and Pena Mboko) were purposively selected. Pre-existing clusters within these localities were then randomly selected and then eligible participants within the sampled clusters systematically selected. Using the main street junction as starting point, direction of sample collection was determined by spinning a plastic bottle. From the start of street junction and moving in direction of the bottle pointer, all households left to the principal investigator were visited in search of eligible participants which were sexually active women aged 15-49 years who gave consent/assent. One participant was selected per household. We used pretested interviewer-administered questionnaires that covered information on socio-demographic characteristics, reproductive health and contraceptive use. Statistical significance was set at p-value ≤ 0.05. Results: six hundred and thirty four (634) sexually active women aged 15-49 years were included in the study; majority were 25-35 years (246; 38.8%). The current contraceptive prevalence was 63.1% [59.3-66.8] (400); of which 312 participants (78%) used a single method while 88 (22%) participants used contraceptives in combination. The most common methods in use were rhythm (196; 49%), male condom (109; 27.2%) and implants (63; 15.8%). When adjusted, statistically significant determinants for contraceptive use were age range and marital status such that odds of using contraceptives was lower in women < 35 years and those cohabiting (AOR= 0.71 [0.50-1.00] and AOR=0.62 [0.44-0.87] respectively). Conclusion: current contraceptive practice in the CDC plantation camps is geared toward less effective traditional methods than the more effective modern methods. More health education is needed to adjust this paradigm.


Asunto(s)
Conducta Anticonceptiva/estadística & datos numéricos , Anticoncepción/estadística & datos numéricos , Anticonceptivos/administración & dosificación , Adolescente , Adulto , Factores de Edad , Camerún , Estudios Transversales , Femenino , Humanos , Estado Civil , Persona de Mediana Edad , Salud Reproductiva , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
10.
Reprod Health ; 18(1): 104, 2021 May 25.
Artículo en Inglés | MEDLINE | ID: mdl-34034741

RESUMEN

BACKGROUND: Sexual and reproductive health and right of adolescents is a global priority as the reproductive choices made by them have a massive impact on their health, wellbeing, education, and economy. Teenage pregnancy is a public health issue and a demographic challenge in Ethiopia. Increasing access to contraceptive services for sexually active adolescents will prevent pregnancies and related complications. However, little is known about the trends in contraceptive use and its determinants among adolescent girls in Ethiopia. Therefore, this study was designed to examine the trends and factors associated with contraceptive use among sexually active girls aged 15-19 years in Ethiopia by using Ethiopian demographic and health survey data. METHODS: Four Ethiopian demographic and health survey data were used to examine trends of contraceptive methods use. To identify factors associated with contraceptive use, the 2016 Ethiopian demographic and health survey data were used. The data was downloaded from the demographic and health survey program database and extracted for sexually active adolescent girls. Data were weighted for analysis and analyzed using SPSS version 21. Descriptive analysis was used to describe the independent variables of the study. A multivariable logistic regression model was used to identify factors associated with contraceptive use and adjusted odds ratios with 95% confidence interval were presented for significant variables. Variables with a p-value less than 0.05 were considered as significantly associated with contraceptive use. RESULTS: Contraceptive method use had increased significantly from 6.9% in 2000 to 39.6% in 2016 among sexually active adolescent girls in Ethiopia. The odds of contraceptive use were lower among female adolescents who had no formal education (AOR 0.044; 95% CI 0.008-0.231) and attended primary education (AOR 0.101; 95% CI 0.024-0.414). But the odds were higher among adolescents from a wealthy background (AOR 3.662; 95% CI 1.353-9.913) and those who have visited health facilities and were informed about family planning (AOR 3.115; 95% CI 1.385-7.007). CONCLUSION: There is an increment in the trend of contraceptive use among sexually active female adolescents in Ethiopia between 2000 and 2016. Significant variations in the use of modern contraception by wealth status, educational level and visited a health facility, and being informed about family planning were observed. Improving the economic and educational status of young women, and provision of information may help in improving contraceptive use in Ethiopia.


Asunto(s)
Conducta Anticonceptiva/estadística & datos numéricos , Anticoncepción/estadística & datos numéricos , Servicios de Planificación Familiar/estadística & datos numéricos , Adolescente , Conducta Anticonceptiva/tendencias , Anticonceptivos , Estudios Transversales , Demografía , Etiopía , Femenino , Encuestas Epidemiológicas , Humanos , Embarazo , Salud Reproductiva , Salud Sexual , Factores Socioeconómicos
11.
Reprod Health ; 18(1): 105, 2021 May 25.
Artículo en Inglés | MEDLINE | ID: mdl-34034757

RESUMEN

BACKGROUND: Youth ages 15 to 24, who comprise a large portion of sub-Saharan Africa, face a higher burden of unmet contraceptive need than adults. Despite increased international and national commitments to improving young people's access to contraception, significant barriers impede their access to a full range of methods. To further explore these barriers among youth in Kenya, Nigeria, and Uganda, we conducted a qualitative study to capture the challenges that affect contraceptive method decisionmaking and complicate youth access to the full method mix. METHODS: To understand factors that impact young people's contraceptive decisionmaking process across all three countries, we conducted a total of 35 focus group discussions with 171 youth ages 15 to 24 and 130 in-depth interviews with key stakeholders working in youth family planning. Questionnaires aligned with the High Impact Practices in Family Planning's elements of adolescent-friendly contraceptive services. Data were coded with MAXQDA and analyzed using a framework for contraceptive decisionmaking to identify relevant patterns and themes. RESULTS: In all three countries, youth reported that condoms are the most commonly sought contraceptive method because they are easiest to access and because youth have limited knowledge of other methods. Youth from diverse settings shared uncertainty and concern about the safety and side effects of many methods other than condoms, complicating their ability to take full advantage of other available methods. While most youth in Kenya, Nigeria, and Uganda reported at least moderate confidence in obtaining the information needed to help choose a method, and only a few youth reported that they are completely unable to access contraceptives, other barriers still present a major deterrent for youth, including cost, inconvenient facility hours and long wait times, and stigma from family, community members, and providers. CONCLUSIONS: Young people's ability to fully exercise their method choice remains limited despite availability of services, leading them to take the path of least resistance. Program implementers and policymakers should consider the diverse and often interconnected barriers that youth face in attempting to enjoy the benefits of a full spectrum of contraceptive methods and design multi-level interventions to mitigate such barriers.


Asunto(s)
Conducta Anticonceptiva , Anticoncepción , Anticonceptivos/provisión & distribución , Toma de Decisiones , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud , Adolescente , Adulto , Atención a la Salud , Servicios de Planificación Familiar , Femenino , Humanos , Kenia , Masculino , Nigeria , Investigación Cualitativa , Uganda , Incertidumbre , Adulto Joven
12.
Lancet Glob Health ; 9(6): e793-e801, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-34019835

RESUMEN

BACKGROUND: Although hindrances to the sexual and reproductive health of women are expected because of COVID-19, the actual effect of the pandemic on contraceptive use and unintended pregnancy risk in women, particularly in sub-Saharan Africa, remains largely unknown. We aimed to examine population-level changes in the need for and use of contraception by women during the COVID-19 pandemic, determine if these changes differed by sociodemographic characteristics, and compare observed changes during the COVID-19 pandemic with trends in the 2 preceding years. METHODS: In this study, we used four rounds of Performance Monitoring for Action (PMA) population-based survey data collected in four geographies: two at the country level (Burkina Faso and Kenya) and two at the subnational level (Kinshasa, Democratic Republic of the Congo and Lagos, Nigeria). These geographies were selected for this study as they completed surveys immediately before the onset of COVID-19 and implemented a follow-up specific to COVID-19. The first round comprised the baseline PMA panel survey implemented between November, 2019, and February, 2020 (referred to as baseline). The second round comprised telephone-based follow-up surveys between May 28 and July 20, 2020 (referred to as COVID-19 follow-up). The third and fourth rounds comprised two previous cross-sectional survey rounds implemented in the same geographies between 2017 and 2019. FINDINGS: Our analyses were restricted to 7245 women in union (married or living with a partner, as if married) who were interviewed at baseline and COVID-19 follow-up. The proportion of women in need of contraception significantly increased in Lagos only, by 5·81 percentage points (from 74·5% to 80·3%). Contraceptive use among women in need increased significantly in the two rural geographies, with a 17·37 percentage point increase in rural Burkina Faso (30·7% to 48·1%) and a 7·35 percentage point increase in rural Kenya (71·6% to 78·9%). These overall trends mask several distinct patterns by sociodemographic group. Specifically, there was an increase in the need for contraception among nulliparous women across all geographies investigated. INTERPRETATION: Our findings do not support the anticipated deleterious effect of COVID-19 on access to and use of contraceptive services by women in the earliest stages of the pandemic. Although these results are largely encouraging, we warn that these trends might not be sustainable throughout prolonged economic hardship and service disruptions. FUNDING: Bill & Melinda Gates Foundation. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.


Asunto(s)
/epidemiología , Anticoncepción/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud , Adolescente , Adulto , África del Sur del Sahara/epidemiología , Estudios de Cohortes , Femenino , Encuestas de Atención de la Salud , Humanos , Persona de Mediana Edad , Adulto Joven
13.
Pan Afr Med J ; 38: 121, 2021.
Artículo en Francés | MEDLINE | ID: mdl-33912291

RESUMEN

Introduction: the purpose of this study was to assess adolescents and teachers´ knowledge, attitude and practices towards family planning (FP). Methods: in 2018, a qualitative study was conducted among seven teachers and 62 teenagers aged 15-19 years based on the Theory of Reasoned Action published by Fishbein and Ajzen in 2011. Data were collected from six focus group (FG) with adolescents and seven semi-structured interviews of teachers. They were analyzed using Atlas Ti software on the basis of a deductive approach. Results: periodic abstinence, male condoms and pills were the only contraceptive methods reported. Adolescents and teachers were apprehensive about using artificial contraceptive methods other than irregularly used male condom. Girls prefer natural methods fearing side effects. The majority of adolescents wanted to be informed about FP in school; however, they felt that the content of the Life Education Course (EVIE) was insufficient and that teachers lacked of openness. Peers, brothers, sisters and internet were the main sources of information. Mothers were an important source of information especially for girls, unlike fathers who were generally less appreciated. Conclusion: knowledge about FP is weak. Misconceptions about contraception lead to the use of ineffective practices to prevent unintended pregnancies. Training programs to improve teachers´ knowledge should be developed and the content of the EVIE course should be formalized and regulated.


Asunto(s)
Anticoncepción/psicología , Anticonceptivos/uso terapéutico , Conocimientos, Actitudes y Práctica en Salud , Maestros/estadística & datos numéricos , Adolescente , República Democrática del Congo , Servicios de Planificación Familiar , Femenino , Grupos Focales , Humanos , Entrevistas como Asunto , Masculino , Embarazo , Embarazo en Adolescencia/prevención & control , Educación Sexual/métodos , Adulto Joven
14.
Pan Afr Med J ; 38: 124, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33912294

RESUMEN

Introduction: the phenomenon of unintended adolescent pregnancy continues to be a reproductive and public health concern in sub-Saharan Africa. Healthcare providers play an important role in influencing the use of contraceptives among adolescent girls. This study assessed knowledge and perceptions of healthcare providers regarding the use of modern contraceptives among adolescent girls in Umlazi township, KwaZulu-Natal province, South Africa. Methods: this was a descriptive study involving 35 healthcare providers covering all 10 primary healthcare clinics in Umlazi township. Data collected through a structured questionnaire were coded, entered into Epi data manager (version 4.6) and exported to STATA (version 15.0) for analysis. Results: of the thirty-five healthcare providers that participated in this study, professional nurses (54.3%) and enrolled nurses (17.1%) constituted the majority. The mean age of the participants was 42.11 years, with 88.6% being females. More than a third (37.1%) of healthcare providers did not know whether or not modern contraceptives make users promiscuous, while more than half (57%) had negative attitudes towards adolescents exploring contraceptive methods. Healthcare providers viewed health systems challenges, such as poor working conditions, long queues, and contraceptives stock-outs, as deterrents towards the provision of quality sexual behaviour counselling and modern contraceptive education to users. Conclusion: poor health systems and negative behaviours by healthcare providers influences the delivery of family planning services in primary healthcare clinics and serve as barriers to quality family planning services provided to younger women.


Asunto(s)
Anticoncepción/estadística & datos numéricos , Servicios de Planificación Familiar , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/estadística & datos numéricos , Adolescente , Adulto , Conducta Anticonceptiva/estadística & datos numéricos , Anticonceptivos/uso terapéutico , Consejo/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/métodos , Conducta Sexual , Sudáfrica , Encuestas y Cuestionarios
15.
J Med Syst ; 45(5): 58, 2021 Apr 06.
Artículo en Inglés | MEDLINE | ID: mdl-33825075

RESUMEN

To evaluate an academic institution's implementation of a gynecologic electronic consultation (eConsult) service, including the most common queries, turnaround time, need for conversion to in-person visits, and to demonstrate how eConsults can improve access and convenience for patients and providers. This is a descriptive and retrospective electronic chart review. We obtained data from the UCSF eConsult and Smart Referral program manager. The medical system provided institution-wide statistics. Three authors reviewed and categorized gynecologic eConsults for the last fiscal year. The senior author resolved conflicts in coding. The eConsult program manager provided billing information and provider reimbursement. A total of 548 eConsults were submitted to the gynecology service between July 2017 and June 2020 (4.5% of institutional eConsult volume). Ninety-five percent of the eConsults were completed by a senior specialist within our department. Abnormal pap smear management, abnormal uterine bleeding, and contraception questions were the most common queries. Over half (59.3%) of all inquiries were answered on the same day as they were received, with an average of 9% declined. Gynecology was the 10th largest eConsult provider at our institution in 2020. The present investigation describes one large university-based experience with eConsults in gynecology. Results demonstrate that eConsults permit appropriate, efficient triaging of time-sensitive conditions affecting patients especially in the time of the COVID-19 pandemic. eConsult services provide the potential to improve access, interdisciplinary communication, and patient and provider satisfaction.


Asunto(s)
/epidemiología , Ginecología/estadística & datos numéricos , Consulta Remota/estadística & datos numéricos , Centros Médicos Académicos , Anticoncepción , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Reembolso de Seguro de Salud , Pandemias , Prueba de Papanicolaou , Derivación y Consulta , Estudios Retrospectivos , Factores de Tiempo , Hemorragia Uterina
16.
Artículo en Inglés | MEDLINE | ID: mdl-33800580

RESUMEN

The decision to use oral contraception varies and is based on several considerations: Personal reasons, the evaluation of the benefit/ risk ratio, and religious beliefs. In this research, a questionnaire was distributed to 422 female students from the George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mures, Romania (UMPhST Târgu Mureș, Romania), aged between 19 and 24 years old. The first endpoint of the study was to evaluate the use of hormonal contraception by the sexually active female population. The second endpoint was to assess the degree of awareness of the benefit/risk ratio of oral contraceptive use. The third endpoint was to evaluate the influence of religious beliefs regarding the decision to use this type of pharmaceutical product. Our results show that only a small percentage of students chose to use oral contraceptive pills (OCP). Fortunately, most of the respondents were well-informed and used a particular contraceptive drug based on a healthcare professional's recommendation. Another aspect that emphasizes the choice of contraceptive method is the religious affiliation, which could influence the decision to use OCP. For the students with medical knowledge, the advice of a healthcare professional seems to be quite important, because they are aware of the risks of improper use of OCP. Although religious doctrines affect the decision to use oral contraception, this is not always taken into account, as the use of OCP is a personal decision.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Autonomía Personal , Adulto , Anticoncepción , Femenino , Humanos , Religión , Rumanía , Estudiantes , Encuestas y Cuestionarios , Adulto Joven
17.
BMC Health Serv Res ; 21(1): 293, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33794871

RESUMEN

BACKGROUND: Rwanda has markedly increased the nation's contraceptive use in a short period of time, tripling contraceptive prevalence in just 5 years between 2005 and 2010. An integral aspect of family planning programs is the interactions between family planning providers and clients. This study aims to understand the client-provider relationship in the Rwandan family planning program and to also examine barriers to those relationships. METHODS: This qualitative study in Rwanda utilized convenience sampling to include eight focus group discussions with family planning providers, both family planning nurses and community health workers, as well as in-depth interviews with 32 experienced modern contraceptive users. Study participants were drawn from the two districts in Rwanda with the highest and lowest modern contraceptive rates, Musanze and Nyamasheke, respectively Data analysis was guided by the thematic content approach, Atlas.ti 8 was utilized for coding the transcripts and collating the coding results, and Microsoft Excel for analyzing the data within code. RESULTS: Data analysis revealed that, despite workplace related challenges - including inadequate staffing, training, and resources, relationships between providers and clients are strong. Family planning providers work hard to understand, learn from, and support clients in their initiation and sustained use of contraceptives. CONCLUSION: Given the existing context of purposeful efforts on the part of family planning providers to build relationships with their clients, if the current level of government support for family planning service provision is enhanced, Rwanda will likely sustain many current users of contraception and engage even more Rwandans in contraceptive services in the future.


Asunto(s)
Servicios de Planificación Familiar , Amor , Anticoncepción , Humanos , Rwanda , Lugar de Trabajo
18.
BMJ Open ; 11(4): e043532, 2021 04 24.
Artículo en Inglés | MEDLINE | ID: mdl-33895714

RESUMEN

OBJECTIVES: This study aimed to investigate whether child marriage had causal effects on unmet needs for modern contraception, and unintended pregnancy, by estimating the marginal (population-averaged) treatment effect of child marriage. DESIGN: This study used secondary data from the Nepal Demographic and Health Survey 2016. Applying one-to-one nearest-neighbour matching with replacement within a calliper range of ±0.01, 15-49 years old women married before the age of 18 were matched with similar women who were married at 18 or above to reduce selection bias. SETTING: Nationally representative population survey data. PARTICIPANTS: The sample consisted of 7833 women aged 15-49 years who were married for more than 5 years. OUTCOME MEASURES: Unmet needs for modern contraception and unintended pregnancy. RESULTS: The matching method achieved adequate overlap in the propensity score distributions and balance in measured covariates between treatment and control groups with the same propensity score. Propensity score matching analysis showed that the risk of unmet needs for modern contraception, and unintended pregnancy among women married as children were a 14.3 percentage point (95 % CI 10.3 to 18.2) and a 10.1 percentage point (95 % CI 3.7 to 16.4) higher, respectively, than among women married as adults. Sensitivity analysis indicated that the estimated effects were robust to unmeasured covariates. CONCLUSIONS: Child marriage appears to increase the risk of unmet needs for modern contraception and unintended pregnancy. These findings call for social development and public health programmes that promote delayed entry into marriage and childbearing to improve reproductive health and rights.


Asunto(s)
Matrimonio , Embarazo no Planeado , Adolescente , Adulto , Niño , Anticoncepción , Conducta Anticonceptiva , Estudios Transversales , Servicios de Planificación Familiar , Femenino , Humanos , Persona de Mediana Edad , Nepal , Embarazo , Puntaje de Propensión , Adulto Joven
19.
BMJ Open ; 11(4): e043786, 2021 04 26.
Artículo en Inglés | MEDLINE | ID: mdl-33903142

RESUMEN

INTRODUCTION: Birth spacing is a critical pathway to improving reproductive health. WHO recommends a minimum of 33-month interval between two consecutive births to reduce maternal, perinatal, infant morbidity and mortality. Our study evaluated factors associated with short birth intervals (SBIs) of less than 33 months between two consecutive births, in Karachi, Pakistan. METHODS: We used data from a cross-sectional study among married women of reproductive age (MWRA) who had at least one live birth in the 6 years preceding the survey (N=2394). Information regarding their sociodemographic characteristics, reproductive history, fertility preferences, family planning history and a 6-year reproductive calendar were collected. To identify factors associated with SBIs, we fitted simple and multiple Cox proportional hazards models and computed HRs with their 95% CIs. RESULTS: The median birth interval was 25 months (IQR: 14-39 months), with 22.9% (833) of births occurring within 33 months of the index birth. Women's increasing age (25-30 years (aHR 0.63 (0.53 to 0.75), 30+ years (aHR 0.29, 95% CI 0.22 to 0.39) compared with 20-24 years; secondary education (aHR 0.75, 95% CI 0.63 to 0.88), intermediate education (aHR 0.62, 95% CI 0.48 to 0.80), higher education (aHR 0.69, 95% CI 0.51 to 0.92) compared with no education, and a male child of the index birth (aHR 0.81, 95% CI 0.70 to 0.94) reduced the likelihood of SBIs. Women's younger age <20 years (aHR 1.24, 95% CI 1.05 to 1.24) compared with 20-24 years, and those who did not use contraception within 9 months of the index birth had a higher likelihood for SBIs for succeeding birth compared with those who used contraception (aHR 2.23, 95% CI 1.93 to 2.58). CONCLUSION: Study shows that birth intervals in the study population are lower than the national average. To optimise birth intervals, programmes should target child spacing strategies and counsel MWRA on the benefits of optimal birth spacing, family planning services and contraceptive utilisation.


Asunto(s)
Intervalo entre Nacimientos , Servicios de Planificación Familiar , Adulto , Niño , Anticoncepción , Estudios Transversales , Países en Desarrollo , Femenino , Humanos , Lactante , Masculino , Pakistán , Embarazo , Adulto Joven
20.
Artículo en Inglés | MEDLINE | ID: mdl-33924290

RESUMEN

Malawi is a low-income country with a high maternal mortality rate. This study aimed to investigate the use of contraception and factors associated with unmet need of family planning among fertile women in selected health facilities in southern Malawi. A cross-sectional study design was employed using a validated questionnaire to investigate the unmet need. A total of 419 pregnant women, who attended antenatal clinics at a central hospital and two district hospitals, voluntarily participated in the study. Logistic regression analysis was used to identify possible factors associated with unmet needs. Amongst the participants, 15.1% reported unmet need, 27.0% had never used a contraceptive method, and 27.2% had an unwanted pregnancy. Being married, 20-24 years of age, living in a rural area, and high parity were protective factors against having unmet need regarding family planning. Malawi, a country with a young population and a high fertility rate, has a high level of unmet family planning need. Barriers and facilitators need to be identified and addressed at different levels by the health care system, society, and the government of Malawi.


Asunto(s)
Conducta Anticonceptiva , Servicios de Planificación Familiar , Anticoncepción , Estudios Transversales , Femenino , Necesidades y Demandas de Servicios de Salud , Humanos , Malaui , Embarazo
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