A Multi-Methods Qualitative Study of the Delivery Care Experiences of Congolese Refugees in Uganda.

INTRODUCTION: Uganda hosts over 1.4 million refugees and is regarded as one of the world's most hospitable places for displaced populations. However, reports suggest that comprehensive sexual and reproductive health (SRH) services remain inadequate. We aimed to explore the SRH experiences of Congolese refugees living in Uganda and ways that services could be improved. We focus this article on delivery care-related results. METHODS: In 2017, we assessed Congolese women's SRH, including pregnancy and delivery care, needs in the Nakivale Refugee Settlement and Kampala. We conducted a review of published literature and institutional records, 11 key informant interviews, four focus group discussions with married and unmarried Congolese women, and 21 in-person in-depth interviews with Congolese women refugees. We analyzed these data for content and themes using inductive and deductive techniques. In the final analytic phase, we integrated findings from each study component to identify concordant and discordant results. RESULTS: Our findings indicate that Congolese refugees experience significant challenges accessing delivery care in both camp and urban settings. The availability of trained healthcare staff is limited, health facilities and medication supplies are inadequate, and referral systems are deficient. Refugee women report that corruption, discrimination, language barriers, and lack of privacy characterize their delivery experiences. CONCLUSION: Efforts to increase trained healthcare staff, improve supply-chain management, and maintain infrastructure and equipment are imperative. Ensuring compliance with anti-bribery and anti-corruption policies and supporting respectful maternity care is also important. Creating approaches to overcome language barriers is crucial to minimizing miscommunication and building patient-provider trust.

Assessing the availability and accessibility of emergency contraceptive pills in Uganda: A multi-methods study with Congolese refugees.

OBJECTIVES: We aimed to document the availability and explore the accessibility of emergency contraceptive pills for Congolese refugees living in both camp and urban settings in Uganda. METHODS: In 2017, we conducted a multi-methods assessment in both the Nakivale Refugee Settlement and Uganda's capital of Kampala. Our study included a review of the published literature and institutional reports and statistics, 11 key informant interviews, 4 focus group discussions (FGDs) with married (N = 16) and unmarried (N = 20) Congolese women, and 21 in-person in-depth interviews with refugee women. We analyzed these data for content and themes using deductive and inductive techniques and triangulated our findings. RESULTS: Our findings show that the availability of emergency contraception in the Nakivale Refugee Settlement is inconsistent and theft of product by health center personnel is a significant problem. Congolese women living in Kampala reported that the cost of emergency contraceptive pills is prohibitive. Most of our refugee participants living in both settings lacked accurate knowledge about post-coital contraception and several reported using a range of other drugs to prevent pregnancy after sex. CONCLUSION: Emergency contraception has long been incorporated into the standards of care for sexual and reproductive health in humanitarian settings. However, results from our study indicate that Congolese women face a range of challenges accessing emergency contraception in Uganda. Strengthening supply chain management, examining and addressing the dynamics underlying product theft, and increasing awareness of effective post-coital methods are priorities for expanding reliable access. IMPLICATIONS: Inconsistent availability and lack of accessibility of emergency contraception has significant implications for refugee and displaced populations. Supporting efforts to ensure that humanitarian stakeholders in Uganda are adhering to global standards of care is critical.

Exploring Congolese refugees' experiences with abortion care in Uganda: a multi-methods qualitative study.

Uganda hosts 1.4 million refugees and conflict-affected people. Widely regarded as the best place in Africa to be a refugee, Uganda's policies encourage self-sufficiency and local integration. However, abortion is legally restricted and recent studies suggest that displaced women and girls have persistent unmet sexual and reproductive health needs. In 2017, we conducted a multi-methods study to assess the reproductive health needs of displaced Congolese women in camp- and urban-based settings in Uganda. Our project focused on maternal health and delivery care, contraception, and abortion/post-abortion services and the intersection of these issues with sexual and gender-based violence. We interviewed 11 key informants, facilitated 4 focus group discussions with refugee women, and conducted 21 in-depth interviews with Congolese women of reproductive age to understand better knowledge, attitudes, practices, and services. Using both inductive and deductive techniques, we employed a multi-phased analytic plan to identify content and themes and triangulate and interpret findings. Our results suggest that Congolese refugees in Uganda are unable to navigate the legal restrictions on abortion and are engaging in unsafe abortion practices. This appears to be the case for those living in both camps and urban areas. The legal restrictions on induced abortion pose a barrier to the provision of post-abortion care. Efforts to ensure access to comprehensive abortion care should be prioritised and providing information and support to women in need of post-abortion care is imperative.

Evaluation of the leishmanicide action of ethanol extracts of Crotalaria retusa L (Fabaceae) / Avaliação da ação leishmanicida do extrato etanólico da Crotalaria retusa L (Fabaceae)

The purpose of the present work is to conduct an evaluation of the cytotoxicity of ethanol extracts and the total alkaloid fraction (TAF) from Crotalaria retusa for procyclic promastigotes cells of Leishmania chagasi. The kinetic study of extraction assisted by ultrasound of the total alkaloids present in Crotalaria retusa made it possible the optimization of the extraction parameters. It was evaluated the leishmanicide action of the TAF which did not show toxic activity for cells of the parasite in high concentrations. It was observed a powerful leishmanicide action of the ethanol extracts (10 and 30 percent) after the concentration of 5.6 mg/mL of Crotalaria retusa, and the ethanol present in the extractive solution (10 and 30 percent) in the concentration from 70 and 210 x 10-4 percent, respectively. These results suggest that the cytotoxicity of the ethanol extract of Crotalaria retusa at 10 and 30 percent for cells of Leishmania chagasi, can be associated only to the concentration of the alcohol present in the extract.

O presente trabalho se propõe avaliar a atividade citotóxica do extrato etanólico bruto e da fração dos alcalóides totais (FAT) da planta Crotalaria retusa para células promastigotas metacíclicas de Leishmania chagasi. O estudo da cinética de extração por ultra-som para os alcalóides totais da Crotalaria retusa, tornou possível a otimização dos parâmetros de extração. Foi avaliada a ação leishmanicida da FAT da planta em estudo, a qual não mostrou atividade citotóxica em altas concentrações. Foi observado uma potente ação leishmanicida para os extratos etanólicos (10 e 30 por cento) após a concentração de 5,6 mg/mL de Crotalaria retusa e do etanol presente na solução extrativa (10 e 30 por cento) nas concentrações de 70 e 210 x 10-4 por cento, respectivamente. Estes resultados sugerem a citotoxicidade do extrato etanólico da Crotalaria retusa de 10 a 30 por cento para células de Leishmania chagasi, associada possivelmente à concentração do etanol presente no extrato.