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1.
Pan Afr Med J ; 38: 22, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33777290

RESUMEN

Introduction: all women, including those living with HIV, have the right to choose the timing, spacing, and number of their births and need access to family planning services. This study aimed at assessing the prevalence and factors associated with an unmet need for family planning among women receiving Antiretroviral Therapy (ART) services. Methods: a facility-based cross-sectional study was conducted from March to April 2018 in Gondar city, Ethiopia. A systematic random sampling technique was used to recruit 441 reproductive-age women on ART. The data were collected using a pretested structured questionnaire. The bivariate and backward multivariable logistic regression model was fitted to identify factors associated with the unmet need for family planning. Results: the prevalence of the unmet need for family planning among women living with HIV was 24.5%. Increase in women´s age (AOR: 0.90, 95% CI (0.85, 0.95)), having more than three children (AOR: 0.13, 95% CI (0.04, 0.38)), intention to have more children (AOR: 0.09, 95% CI (0.03, 0.23)), not disclosing sero-status to partner (AOR: 0.40, 95% CI (0.20, 0.82)) and having no experience of contraception use (AOR: 0.43, 95% CI (0.21, 0.90)) were protective factors against unmet need for family planning. Rural residence (AOR: 2.17, 95% CI (1.05, 4.46)) was associated with increased odds of unmet need for family planning. Conclusion: one in every four women living with HIV had an unmet need for family planning. So, continuous awareness-raising activities on family planning for women on ART should be given by emphasizing the rural and younger age women.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Servicios de Planificación Familiar/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Adulto , Factores de Edad , Anticoncepción/estadística & datos numéricos , Conducta Anticonceptiva/estadística & datos numéricos , Estudios Transversales , Etiopía , Femenino , Humanos , Población Rural/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
3.
Sex Reprod Health Matters ; 29(1): 1881210, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33599196

RESUMEN

The COVID-19 pandemic has substantially strained health systems across the globe. In particular, documented disruptions to voluntary family planning and reproductive health care due to competing health priorities, service disruptions, stockouts, and lockdowns are significantly impacting reproductive, maternal, newborn, and child health. As governments and family planning programmes grapple with how best to respond to the direct and indirect effects of the pandemic on family planning and reproductive health (FP/RH), the implementation and adaptation of evidence-based practices is crucial. In this commentary, we outline applications of the High Impact Practices in Family Planning (HIPs) towards COVID-19 response efforts. The HIPs are a set of evidence-based family planning practices which reflect global expert consensus on what works in family planning programming. Drawing upon preliminary COVID-19 data, documented experiences from prior health emergencies, and recommended programme adaptations from a variety of global health partners, we outline situations where specific HIPs may assist family planning programme managers in developing context-specific and evidence-based responses to COVID-19-related impacts on FP/RH, with the ultimate goal of ensuring the accessibility, availability, and continuity of voluntary family planning services across the world.


Asunto(s)
/epidemiología , Servicios de Planificación Familiar/tendencias , Servicios de Salud Materna/tendencias , Calidad de la Atención de Salud/tendencias , Salud Reproductiva/tendencias , Anticoncepción/tendencias , Femenino , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Pandemias/estadística & datos numéricos
4.
Reprod Health ; 18(1): 47, 2021 Feb 23.
Artículo en Inglés | MEDLINE | ID: mdl-33622376

RESUMEN

BACKGROUND: Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities. METHODS: This study utilizes cross-sectional health facility (N = 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N = 1479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Component Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). RESULTS: Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. CONCLUSION: Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that using more nuanced measures of integration may (a) more accurately reflect true variation in integration within and across health facilities, (b) enable more precise measurement of the determinants or effects of integration, and (c) provide more tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.


Asunto(s)
Prestación Integrada de Atención de Salud , Servicios de Planificación Familiar , Administración de Instituciones de Salud , Programas de Inmunización , Servicios de Salud Reproductiva , Adulto , Niño , Preescolar , Estudios Transversales , Prestación Integrada de Atención de Salud/organización & administración , Prestación Integrada de Atención de Salud/normas , Servicios de Planificación Familiar/organización & administración , Servicios de Planificación Familiar/normas , Servicios de Planificación Familiar/provisión & distribución , Femenino , Instituciones de Salud/normas , Administración de Instituciones de Salud/métodos , Administración de Instituciones de Salud/normas , Indicadores de Salud , Humanos , Programas de Inmunización/organización & administración , Programas de Inmunización/normas , Programas de Inmunización/provisión & distribución , Lactante , Recién Nacido , Masculino , Nigeria/epidemiología , Embarazo , Salud Reproductiva/normas , Servicios de Salud Reproductiva/organización & administración , Servicios de Salud Reproductiva/normas , Servicios de Salud Reproductiva/provisión & distribución , Encuestas y Cuestionarios , Población Urbana/estadística & datos numéricos , Vacunación/métodos , Vacunación/estadística & datos numéricos
6.
Adv Ther ; 38(2): 1011-1023, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33459975

RESUMEN

The rapid spread of novel coronavirus (COVID-19) has posed complex challenges to global public health. During this pandemic period, access to essential services including post-abortion care (PAC) has been disrupted. Along with the clinical management of the disease in women, protection of the healthcare workers and medical staff from nosocomial infection is important to ensure infection control. Thus, in order to implement the proper contraceptive measures and to reduce the rate of repeated abortion, the family planning group of minimally invasive gynecological branch of the Liaoning Medical Association organized a committee of experts to formulate guidance and suggestions to ensure the timely treatment and surgery of women opting for abortion, the implementation of PAC, implementation of safe contraceptive measures after surgery, and the protection of healthcare professionals and medical staff from infection. We believe these guidelines might be helpful for obstetrics and gynecology departments in China and globally, as well for women who wish to undergo abortion during these unprecedented times.


Asunto(s)
Aborto Inducido , Cuidados Posteriores/métodos , Anticoncepción/métodos , Servicios de Planificación Familiar/métodos , Control de Infecciones , Guías de Práctica Clínica como Asunto , Telemedicina , Abortivos/uso terapéutico , China , Consenso , Anticonceptivos , Femenino , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Pandemias , Equipo de Protección Personal , Embarazo , Automanejo , Triaje
7.
Niger J Clin Pract ; 23(12): 1648-1655, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33355816

RESUMEN

Background: Women may resume sexual intercourse anytime during the postpartum period with little consideration for contraceptive. Aim: To determine factors associated with resumption of sexual activity, explore FP practices and influence on sexual resumption among postpartum women. Subject and Methods: A cross-sectional study of postpartum women at the infant-welfare clinic of Adeoyo Maternity Teaching Hospital and University College Hospital, Ibadan between July and October, 2014. Data on socio-demographic characteristics, contraceptive use, and sexual behavior were collected using interviewer-administered semi-structured questionnaires. Associations were tested using Chi-square tests and Logistic regression analysis for crude and adjusted odds ratios. Level of significance was 5%. Results: There were 256 women with mean age of 29.1 years(SD = 5.2). Majority had tertiary education; were currently married in monogamous marriages and had 1-3 children. Ninety-one(38.7%) had started sexual intercourse at the time of interview. Among those who had not started having sex, about a quarter (24.2%) gave no reason and 20% felt it was too early. The fear of pain and child-spacing were reasons given by 5.7% and 5.1% respectively. Current use of contraceptive method was 20.7% among women and 36.4% among women who had resumed sexual activity. On multiple logistic regression, Family-planning users were about five times more-likely than non-users to resume sexual intercourse (Odd Ratio = 5.66, 95% Confidence interval = 2.61 - 12.28). Conclusion: Women commonly resume sexual intercourse during postpartum period without contraceptive use. Interventions during antenatal and early postnatal periods are needed to improve early adoption of Family planning by postpartum women.


Asunto(s)
Coito , Servicios de Planificación Familiar , Adulto , Niño , Estudios Transversales , Femenino , Humanos , Lactante , Bienestar del Lactante , Nigeria , Periodo Posparto , Embarazo
8.
Fortaleza; s.n; dez. 2020. 133 p.
Tesis en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1148350

RESUMEN

O estudo objetivou avaliar a qualidade do planejamento reprodutivo com Implanon®, com base nos seis elementos da qualidade propostos por Judith Bruce. Pesquisa avaliativa, com 110 usuárias do método, realizada de março a dezembro/2019, com roteiro semiestruturado de entrevista, em quatro instituições da Secretaria da Saúde do Estado do Ceará. Realizou-se análise pelos testes χ2 , Fisher-Freeman Halton e razão de verossimilhança, considerando p<0,05. As médias e anos de estudo foram 26,5 e 10,8 anos, respectivamente; 61,8% declararam união estável e 64,4% com renda familiar média de 1,5 salário mínimo. Os elementos da qualidade adequados foram: competência profissional (88,2%), rede apropriada de serviços (84,6%) e relação interpessoal (82,7%). Houve fragilidade no conhecimento geral acerca dos benefícios não contraceptivos. A maioria das mulheres estavam satisfeitas com o Implanon® (83,6%), tinham intenção de nova aquisição (78%) e recomendariam (87,3%). A percepção da qualidade da assistência apresentou quatro categorias: ambiente, serviço, método e profissional (51,8%). Os resultados evidenciaram que a prática dos profissionais atuantes no planejamento reprodutivo relacionado ao Implanon® contemplaram os seis elementos de qualidade propostos por Judith Bruce para avaliação do processo. (AU)


Asunto(s)
Evaluación en Salud , Enfermería , Poblaciones Vulnerables , Planificación Familiar , Servicios de Planificación Familiar
9.
PLoS One ; 15(12): e0243776, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33315904

RESUMEN

BACKGROUND: Contraceptive use is the best and most cost-effective strategy to reduce feto-maternal adverse effects of short birth intervals. More than two-thirds of women in developing countries who do not want to conceive are not using contraception methods. Although there were various primary studies in different parts of the country, there is no nationally representative evidence on postpartum modern contraception utilization and its determinants in Ethiopia. OBJECTIVE: This review was aimed to determine the best available pieces of evidence to pool the magnitude of postpartum modern contraception utilization and find out its determinants. METHODS: Published studies were extensively searched by using electronic databases and unpublished studies were identified from the digital library. All observational studies conducted on the magnitude of postpartum modern contraception utilization and its determinants in Ethiopia were included. Data were extracted on the Microsoft Excel spreadsheet and analyzed using STATA 14.1 version. A random-effects model was used to estimate the pooled magnitude of postpartum modern contraception utilization with a 95% confidence interval (CI). Inverse variance (I2) was used to identify the presence of heterogeneity and forest plot was used to estimate the pooled magnitude of postpartum contraception utilization. The presence of publication bias was assessed by funnel plots and Egger's statistical tests. Sub-group analysis was computed to minimize underlying heterogeneity. FINDINGS: In this review, 19 primary studies were included. The pooled magnitude of postpartum modern contraception utilization in Ethiopia was 45.79% (95%CI 36.45%, 55.13%). The review found that having more than four Antenatal care visits(ANC), having postnatal care visit (PNC), having a formal education, history of family planning use, history of counseling on family planning, and having greater than four alive children as significant determinants of postpartum modern contraception utilization. CONCLUSION: The magnitude of postpartum modern contraception utilization in Ethiopia was low. ANC visit, PNC visit, maternal educational status, history of previous family planning use, counseling on family planning, and number of alive children were found to be significant determinants of postpartum modern contraception utilization. Therefore, strengthening focused ANC and PNC services to encourage women in utilizing modern contraception during the postnatal period is needed.


Asunto(s)
Anticoncepción , Servicios de Planificación Familiar , Etiopía , Humanos , Atención Posnatal , Periodo Posparto , Atención Prenatal
10.
Taiwan J Obstet Gynecol ; 59(6): 808-811, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33218393

RESUMEN

Many routine and elective services have already been postponed or suspended by both Government and private setups in most parts of the world because of the unprecedented pandemic of COVID-19. Healthcare systems everywhere in the world are under pressure. Being a component of essential health services, family planning and abortion services should continue to cater the population in order to prevent the complications arising from unintended pregnancies and sudden rise in STIs. Due to airborne nature of transmission of the virus, it is advisable for all consultations relating to family planning services to be done remotely unless and until visit is absolutely necessary. Contraception initiation and continuation can be done by telemedicine in most individuals. Post partum contraception can be advised before discharge from hospital. In an individual planning for pregnancy, currently it is not advisable to discontinue contraceptive and plan for pregnancy as not much is known about the effect of the virus on foetal development. Also, pregnancy requires routine antenatal and peripartum care and complications arising from pregnancy may necessitate frequent hospital visits, exposing the individual to the risk of infection. Abortion services are time sensitive therefore should not be denied or delayed beyond legal limit. We need to change from real to virtual consultation to prevent the rise in unplanned pregnancies, sexually transmitted infections and unsafe abortions.


Asunto(s)
Aborto Inducido/métodos , Infecciones por Coronavirus/prevención & control , Servicios de Planificación Familiar/métodos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , Telemedicina/métodos , Betacoronavirus , Anticoncepción/métodos , Femenino , Humanos , Atención Preconceptiva/métodos , Embarazo , Complicaciones Infecciosas del Embarazo/virología
12.
BMJ Open ; 10(10): e043763, 2020 10 05.
Artículo en Inglés | MEDLINE | ID: mdl-33020109

RESUMEN

OBJECTIVES: We evaluated whether implementation of lockdown orders in South Africa affected ambulatory clinic visitation in rural Kwa-Zulu Natal (KZN). DESIGN: Observational cohort SETTING: Data were analysed from 11 primary healthcare clinics in northern KZN. PARTICIPANTS: A total of 46 523 individuals made 89 476 clinic visits during the observation period. EXPOSURE OF INTEREST: We conducted an interrupted time series analysis to estimate changes in clinic visitation with a focus on transitions from the prelockdown to the level 5, 4 and 3 lockdown periods. OUTCOME MEASURES: Daily clinic visitation at ambulatory clinics. In stratified analyses, we assessed visitation for the following subcategories: child health, perinatal care and family planning, HIV services, non-communicable diseases and by age and sex strata. RESULTS: We found no change in total clinic visits/clinic/day at the time of implementation of the level 5 lockdown (change from 90.3 to 84.6 mean visits/clinic/day, 95% CI -16.5 to 3.1), or at the transitions to less stringent level 4 and 3 lockdown levels. We did detect a >50% reduction in child healthcare visits at the start of the level 5 lockdown from 11.9 to 4.7 visits/day (-7.1 visits/clinic/day, 95% CI -8.9 to 5.3), both for children aged <1 year and 1-5 years, with a gradual return to prelockdown within 3 months after the first lockdown measure. In contrast, we found no drop in clinic visitation in adults at the start of the level 5 lockdown, or related to HIV care (from 37.5 to 45.6, 8.0 visits/clinic/day, 95% CI 2.1 to 13.8). CONCLUSIONS: In rural KZN, we identified a significant, although temporary, reduction in child healthcare visitation but general resilience of adult ambulatory care provision during the first 4 months of the lockdown. Future work should explore the impacts of the circulating epidemic on primary care provision and long-term impacts of reduced child visitation on outcomes in the region.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/tendencias , Neumonía Viral/epidemiología , Atención Primaria de Salud , Salud Pública , Adulto , Factores de Edad , Betacoronavirus , Servicios de Planificación Familiar/estadística & datos numéricos , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Pandemias , Pediatría/estadística & datos numéricos , Atención Primaria de Salud/métodos , Atención Primaria de Salud/estadística & datos numéricos , Salud Pública/métodos , Salud Pública/estadística & datos numéricos , Población Rural
16.
Obstet Gynecol ; 136(5): 1072-1073, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33093423

RESUMEN

Congenital heart conditions are the most common type of congenital anomaly, affecting nearly 1% of U.S. births, or approximately 40,000 neonates, each year. As more female patients with congenital heart disease enter adolescence and adulthood, there is a growing need to address reproductive health in this population. Addressing contraceptive needs is particularly important for adolescents and young women with congenital heart disease, many of whom may have limited knowledge about how their condition or medications may affect their long-term health, including reproductive health. Decisions regarding the most appropriate contraceptive method require discussion of future pregnancy desires and personal preferences, as well as critical assessment of the patient's underlying disease and the relative risks and benefits of the contraceptive option. Because of the morbidity associated with pregnancy in individuals with cardiac conditions, the initiation of contraception should not be delayed due to concerns about potential contraindication. For those patients with valvular heart disease, cardiomyopathy, or hypertension, it is reasonable to initiate a progestin-only method until clarification of the safety of an estrogen-containing method is determined in conjunction with the patient's cardiologist. Contraceptive counseling should be patient-centered, free of coercion, and should address the most common misperceptions about contraceptive methods in a way that is age-appropriate and compatible with the patient's health literacy. To optimize maternal and infant health outcomes, planning for future pregnancies in these patients should be done in collaboration with maternal-fetal medicine subspecialists and cardiology specialists. Patients who continue their pregnancy should be referred to a pregnancy heart team.


Asunto(s)
Anticoncepción/normas , Servicios de Planificación Familiar/normas , Cardiopatías Congénitas/complicaciones , Complicaciones Cardiovasculares del Embarazo/prevención & control , Adolescente , Adulto , Testimonio de Experto , Femenino , Ginecología/organización & administración , Ginecología/normas , Humanos , Obstetricia/organización & administración , Obstetricia/normas , Embarazo , Complicaciones Cardiovasculares del Embarazo/etiología , Sociedades Médicas , Adulto Joven
17.
Obstet Gynecol ; 136(5): e90-e99, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33093425

RESUMEN

Congenital heart conditions are the most common type of congenital anomaly, affecting nearly 1% of U.S. births, or approximately 40,000 neonates, each year. As more female patients with congenital heart disease enter adolescence and adulthood, there is a growing need to address reproductive health in this population. Addressing contraceptive needs is particularly important for adolescents and young women with congenital heart disease, many of whom may have limited knowledge about how their condition or medications may affect their long-term health, including reproductive health. Decisions regarding the most appropriate contraceptive method require discussion of future pregnancy desires and personal preferences, as well as critical assessment of the patient's underlying disease and the relative risks and benefits of the contraceptive option. Because of the morbidity associated with pregnancy in individuals with cardiac conditions, the initiation of contraception should not be delayed due to concerns about potential contraindication. For those patients with valvular heart disease, cardiomyopathy, or hypertension, it is reasonable to initiate a progestin-only method until clarification of the safety of an estrogen-containing method is determined in conjunction with the patient's cardiologist. Contraceptive counseling should be patient-centered, free of coercion, and should address the most common misperceptions about contraceptive methods in a way that is age-appropriate and compatible with the patient's health literacy. To optimize maternal and infant health outcomes, planning for future pregnancies in these patients should be done in collaboration with maternal-fetal medicine subspecialists and cardiology specialists. Patients who continue their pregnancy should be referred to a pregnancy heart team.


Asunto(s)
Anticoncepción/normas , Servicios de Planificación Familiar/normas , Cardiopatías Congénitas/complicaciones , Complicaciones Cardiovasculares del Embarazo/prevención & control , Adolescente , Adulto , Testimonio de Experto , Femenino , Ginecología/organización & administración , Ginecología/normas , Humanos , Obstetricia/organización & administración , Obstetricia/normas , Embarazo , Complicaciones Cardiovasculares del Embarazo/etiología , Sociedades Médicas , Adulto Joven
18.
Medicine (Baltimore) ; 99(44): e22978, 2020 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-33126370

RESUMEN

This cross-sectional study aimed to assess the impact of epilepsy, myasthenia gravis (MG), and multiple sclerosis (MS) on pregnancy and family planning decision-making in a cohort of Saudi women. Women with epilepsy, MG, and MS were recruited consecutively at the time of their follow-up visits at a neurology clinic. Data were collected using 3 standardized questionnaires, and presented using descriptive statistics. A logistic regression was performed to determine variables associated with decisions regarding abstaining from pregnancy and encouraging other women to conceive. A total of 272 (83 epilepsy, 69 MG, and 120 MS) women with a mean age of 29.9 ±â€Š8.0 years participated. The proportion of women who abstained from or postponed pregnancy was 41.2% and 31.4%, respectively. The concerns mentioned most often were disease worsening during pregnancy, peripartum and postpartum, side effects of medications on the unborn child, and inability to care for the child. Older age was independently associated with the decision to abstain from pregnancy (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.04 - 1.25). Higher knowledge levels were independently associated with encouraging other women to have children (OR 1.3, 95% CI 1.11-1.53). Over 50% of women reported that they were not counseled on issues related to pregnancy and childbirth. In conclusion, we identified a major influence of epilepsy, MG, and MS on pregnancy and family planning. Comprehensive counseling programs are needed to help women with these neurological diseases make informed family-planning decisions.


Asunto(s)
Epilepsia/psicología , Servicios de Planificación Familiar , Esclerosis Múltiple/psicología , Miastenia Gravis/psicología , Adulto , Estudios Transversales , Escolaridad , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Modelos Logísticos , Encuestas y Cuestionarios
19.
N Z Med J ; 133(1524): 11-19, 2020 10 30.
Artículo en Inglés | MEDLINE | ID: mdl-33119566

RESUMEN

AIM: Recent changes in funding have reduced the cost of the highly effective levonorgestrel-releasing intrauterine system (LIUS) contraceptives (Mirena and Jaydess). This paper explores equity of access to intrauterine contraceptives for Maori and the general population by locating and surveying all potential providers within the Southern District Health Board catchment area. METHODS: Using online survey, e-mail or phone, we asked if intrauterine contraceptive insertion was provided, what device was provided, cost and number of appointments required. ArcGIS 10.6.1 software was used to estimate population distribution, and to create service areas showing distance to nearest current providers for Maori and the general population. RESULTS: All 88 potential providers agreed to participate; two thirds (66.3%) provided some intrauterine contraceptive insertion. Approximately three quarters of the Maori and general population live within 5km of a primary provider. Costs ranged from $0 to $270, in addition to the cost of the required consultations. Number of consultations required varied from one to three. CONCLUSIONS: Cost and travel time likely remain barriers to accessing intrauterine contraceptives for a significant population within this catchment. Increasing the capacity for all primary providers to offer insertion, funding the insertion process, minimising the number of appointments required and providing mobile services would improve access.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Dispositivos Intrauterinos Medicados , Instituciones de Atención Ambulatoria , Servicios de Planificación Familiar , Femenino , Humanos , Dispositivos Intrauterinos Medicados/economía , Dispositivos Intrauterinos Medicados/estadística & datos numéricos , Levonorgestrel , Anticoncepción Reversible de Larga Duración , Nueva Zelanda , Viaje
20.
PLoS One ; 15(10): e0237319, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33119604

RESUMEN

BACKGROUND: Routine immunization coverage has stagnated over the past decade and fallen short of WHO targets in Ethiopia. Community engagement strategies that reach beyond traditional health systems may reduce dropout and increase coverage. This evaluation assesses changes in immunization, postpartum family planning, and antenatal care coverage after implementation of an enhanced community engagement and defaulter tracing strategy, entitled "Fifth Child" project, across two districts in Benishangul-Gumuz Regional State (BGRS), Ethiopia. METHODS AND FINDINGS: A formative evaluation was conducted to examine the contribution of the strategy on immunization, postpartum family planning and antenatal care utilization in Assosa and Bambasi districts of BGRS. The quantitative findings are presented here. Routine and project-specific data were analyzed to assess changes in uptake of childhood vaccinations, postpartum family planning and antenatal care. Between January 2013 and December 2016, pentavalent-3 coverage increased from 63% to 84% in Assosa, and from 78% to 93% in Bambasi. Similarly, measles vaccine coverage increased from 77% to 81% in Assosa, and from 59% to 86% in Bambasi. Approximately 54% of all eligible infants across both woredas defaulted on scheduled vaccinations at least once during the period. Among defaulting children, 84% were identified and subsequently caught up on the vaccinations missed. Secondary outcomes of postpartum family planning and antenatal care also increased in both woredas. CONCLUSION: The "Fifth Child" project likely contributed to enhanced immunization performance and increased utilization of immunization and select perinatal health services in two woredas of BGRS. Further research is required in order to determine the impact of this community engagement strategy.


Asunto(s)
Relaciones Comunidad-Institución , Programas de Inmunización , Atención Perinatal , Niño , Servicios de Salud Comunitaria , Participación de la Comunidad , Etiopía , Servicios de Planificación Familiar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Pacientes Desistentes del Tratamiento , Atención Posnatal , Embarazo
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