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1.
Glob Health Sci Pract ; 7(2): 317-328, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31189699

RESUMO

BACKGROUND: Observational studies raise concern about a potential link between injectable progestin contraceptive use and HIV acquisition risk. This possible link is particularly relevant in sub-Saharan Africa where HIV risk is high and the method mix is skewed toward injectables. We developed the Planning for Outcomes (P4O) model (https://planning4outcomes.ctiexchange.org/) to predict changes in maternal and child health (MCH) and HIV outcomes that could occur if the proportion of injectables in the method mix is changed. METHODS: P4O incorporates evidence-based assumptions to predict yearly changes in unintended pregnancies, morbidity/mortality, HIV infections (women and infants), and anticipated health care costs associated with changing the proportions of injectable users in 22 selected countries. Users of this model designate all countries or a subset and adjust inputs including percentage of injectable users who discontinue, percentage of discontinuers who begin use of an alternative method, hazard ratio for HIV infection with injectable use, method mix used by injectable discontinuers, annual probabilities of method-specific pregnancy and mother-to-child transmission of HIV, condom effectiveness against HIV, risk of HIV during pregnancy, and HIV incidence among women of reproductive age. RESULTS: Illustrative results from all sub-Saharan African countries combined and from selected countries demonstrate the potential of P4O to inform program planning and procurement decisions. In countries with high use of long-acting reversible contraception, the removal of injectables from the method mix is associated with improvement in MCH and HIV indicators if most injectable users switch to more effective methods (e.g., implants). In countries with high use of short-acting methods (e.g., condoms), the model predicts mostly negative MCH outcomes. CONCLUSIONS: Policy makers and program planners may use P4O to inform programming and policy decisions. In all scenarios, programmatic preparation to accommodate changes to the contraceptive method mix, considerations of how the individual desires of women will be addressed, and potential burden of anticipated MCH-related costs warrant advanced consideration.


Assuntos
Anticoncepção/efeitos adversos , Anticoncepcionais Femininos , Infecções por HIV/etiologia , Planejamento em Saúde , Saúde do Lactente , Saúde Materna , Progestinas , Adolescente , Adulto , África ao Sul do Saara , Saúde da Criança , Preservativos , Anticoncepção/métodos , Comportamento Contraceptivo , Anticoncepcionais Femininos/administração & dosagem , Anticoncepcionais Femininos/efeitos adversos , Serviços de Planejamento Familiar/métodos , Feminino , Humanos , Lactente , Transmissão Vertical de Doença Infecciosa , Masculino , Pessoa de Meia-Idade , Políticas , Gravidez , Complicações Infecciosas na Gravidez/etiologia , Progestinas/administração & dosagem , Progestinas/efeitos adversos , Adulto Jovem
2.
Eur J Contracept Reprod Health Care ; 23(6): 415-420, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30474435

RESUMO

OBJECTIVES: The aims of this study were to assess the determinants of family planning misconceptions and modern contraceptive use, and the influence of misconceptions on the use of modern contraceptive methods. METHODS: We reviewed and analysed data collected between October 2010 and March 2011 among a representative household sample of 13,575 women of reproductive age (15-49 years) in six urban cities in Nigeria. Multiple linear and logistic regression models were used to examine the predictors of misconceptions and current use of contraception and the association between misconceptions and modern contraceptive use. RESULTS: Catholic women were significantly more likely to have misconceptions compared with Muslim women (ß = 1.09; 95% confidence interval [CI] 0.58, 1.60; p < .001); women with higher education were significantly less likely to have misconceptions about contraception compared with women with no formal education (ß= -0.06; 95% CI -0.96, -0.29; p < .001). Unmarried women living with a partner were not significantly different from those who were not cohabiting (single, separated or widowed) in their current contraceptive use (adjusted odds ratio [OR] 0.91; 95% CI 0.79, 1.04; p > .05). Women with lower misconception scores were significantly more likely to adopt and use modern contraception compared with those with high misconception scores (adjusted OR 0.93; 95% CI 0.92, 0.94; p < .001). CONCLUSION: These findings suggest that programmatic efforts should be geared towards dispelling misconceptions by providing simple factual information related to the benefits of contraception and family planning.


Assuntos
Comportamento Contraceptivo/psicologia , Anticoncepção/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Catolicismo/psicologia , Cidades , Anticoncepção/estatística & dados numéricos , Comportamento Contraceptivo/etnologia , Comportamento Contraceptivo/estatística & dados numéricos , Escolaridade , Serviços de Planejamento Familiar , Feminino , Humanos , Islamismo/psicologia , Modelos Logísticos , Pessoa de Meia-Idade , Nigéria , Adulto Jovem
4.
BMC Womens Health ; 17(1): 80, 2017 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-28893235

RESUMO

BACKGROUND: Fertility is high in Nigeria and contraceptive use is low. Little is known about how urban Nigerians perceive the risk of contraceptive use in relation to pregnancy and birth. This study examines and compares the risk perception of family planning methods and pregnancy related scenarios among urban Nigerians. METHODS: A total of 26 focus group discussions with 243 participants were conducted in September and October 2010 in Ibadan and Kaduna. The groups were stratified by sex, age, family planning use, and city. Study participants were asked to identify the risk associated with six different family planning methods and four pregnancy related risks. The data were coded in ATLAS.ti 6 and analyzed using the thematic content analysis approach. RESULTS: The ten family planning and pregnancy related items ranked as follows from most to least risky: sterilization, abortion, getting pregnant soon after having a baby (no birth spacing), pill, IUD, injectable, having a birth under 18 years of age (teenage motherhood), condom use, having six children, and fertility awareness methods. Risk of family planning methods was often categorized in terms of side effects and complications. Positive perceptions of teenage motherhood and having many children influenced the low ranking of these items. CONCLUSION: Inadequate birth spacing was rated as more risky than all contraceptive methods and pregnancy related events except for sterilization and abortion. Some of the participants' risk perceptions of contraceptives and pregnancy related scenarios does not correspond to actual risk of methods and practices. Instead, the items' perceived riskiness largely correspond with prevailing social norms. However, there was a high level of understanding of the risks of inadequate birth spacing. TRIAL REGISTRATION NUMBER: This study is not a randomized control trial so the study has not been registered as such.


Assuntos
Intervalo entre Nascimentos/psicologia , Comportamento Contraceptivo/psicologia , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/psicologia , Serviços de Planejamento Familiar/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Esterilização Reprodutiva/psicologia , Adulto , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Gravidez , Pesquisa Qualitativa , Fatores de Risco , População Urbana/estatística & dados numéricos
5.
Glob Health Sci Pract ; 4(3): 495-505, 2016 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-27688719

RESUMO

High-quality postabortion care (PAC) services that include family planning counseling and a full range of contraceptives at point of treatment for abortion complications have great potential to break the cycle of repeat unintended pregnancies and demand for abortions. We describe the first application of a systematic approach to quality improvement of PAC services in a West African country. This approach-IntraHealth International's Optimizing Performance and Quality (OPQ) approach-was applied at 5 health care facilities in Togo starting in November 2014. A baseline assessment identified the following needs: reorganizing services to ensure that contraceptives are provided at point of treatment for abortion complications, before PAC clients are discharged; improving provider competencies in family planning services, including in providing long-acting reversible contraceptive implants and intrauterine devices; ensuring that contraceptive methods are available to all PAC clients free of charge; standardizing PAC registers and enhancing data collection and reporting systems; enhancing internal supervision systems at facilities and teamwork among PAC providers; and engaging PAC providers in community talks. Solutions devised and applied at the facilities during OPQ resulted in significant increases in contraceptive counseling and uptake among PAC clients: During the 5-month baseline period, 31% of PAC clients were counseled, while during the 13-month intervention period, 91% were counseled. Of all PAC clients counseled during the baseline period, 37% accepted a contraceptive, compared with 60% of those counseled during the intervention period. Oral contraceptive pills remained the most popular method during both periods, yet uptake of implants increased significantly during the intervention period-from 4% to 27% of those accepting contraceptives. This result demonstrates that the solutions applied maintained method choice while expanding access to underused long-acting reversible contraceptives. OPQ shows great potential for sustainability and scale in Togo and for application in similar contexts where the health system struggles to offer safe, high-quality, accessible PAC services.


Assuntos
Aborto Induzido , Assistência ao Convalescente , Anticoncepção/estatística & dados numéricos , Serviços de Planejamento Familiar , Aceitação pelo Paciente de Cuidados de Saúde , Melhoria de Qualidade , Qualidade da Assistência à Saúde , Aborto Induzido/efeitos adversos , Anticoncepção/métodos , Comportamento Contraceptivo , Anticoncepcionais Orais , Aconselhamento , Feminino , Humanos , Dispositivos Intrauterinos , Contracepção Reversível de Longo Prazo , Gravidez , Gravidez não Planejada , Educação Sexual , Togo
6.
Patient Educ Couns ; 99(8): 1400-5, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27049877

RESUMO

OBJECTIVES: The medicalization and clinic-based distribution of contraceptive methods have been criticized as barriers to increasing levels of contraceptive use in Nigeria and other settings; however, our understanding of how clients themselves perceive the contraceptive method decision-making process is very limited. METHODS: Focus group discussions among men and women in Ibadan and Kaduna, Nigeria, were used to examine attitudes and norms surrounding contraceptive method decision-making in September and October of 2010. RESULTS: Choosing a family planning method was presented as a medical decision: best done by a doctor who conducts clinical tests on the client to determine the best, side effect free, contraceptive method for each client. An absolute trust in health professionals, hospitals, and governments to provide safe contraception was evident. CONCLUSION: The level of medicalization placed on contraceptive method choice by urban Nigerians is problematic, especially since a test that can determine what contraceptive methods will cause side effects in an individual does not exist, and side effects often do occur with contraceptive method use. PRACTICE IMPLICATIONS: Provider and client education approaches would help to improve client involvement in contraceptive decision-making and method choice.


Assuntos
Comportamento de Escolha , Comportamento Contraceptivo/psicologia , Anticoncepção/métodos , Tomada de Decisões , Serviços de Planejamento Familiar/métodos , Conhecimentos, Atitudes e Prática em Saúde , Medicalização , Adolescente , Adulto , Comportamento Contraceptivo/etnologia , Feminino , Grupos Focais , Pessoal de Saúde , Acesso aos Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Nigéria , Percepção , Pesquisa Qualitativa , Adulto Jovem
7.
Afr J Reprod Health ; 19(4): 31-40, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27337851

RESUMO

Research shows that side effects are often the most common reason for contraceptive non-use in Nigeria; however, research to date has not explored the underlying factors that influence risk and benefit perceptions associated with specific contraceptive methods in Nigeria. A qualitative study design using focus group discussions was used to explore social attitudes and beliefs about family planning methods in Ibadan and Kaduna, Nigeria. A total of 26 focus group discussions were held in 2010 with men and women of reproductive age, disaggregated by city, sex, age, marital status, neighborhood socioeconomic status, and--for women only--family planning experience. A discussion guide was used that included specific questions about the perceived risks and benefits associated with the use of six different family planning methods. A thematic content analytic approach guided the analysis. Participants identified a spectrum of risks encompassing perceived threats to health (both real and fictitious) and social concerns, as well as benefits associated with each method. By exploring Nigerian perspectives on the risks and benefits associated with specific family planning methods, programs aiming to increase contraceptive use in Nigeria can be better equipped to highlight recognized benefits, address specific concerns, and work to dispel misperceptions associated with each family planning method.


Assuntos
Anticoncepção/métodos , Anticoncepção/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Percepção , Adulto , Anticoncepção/estatística & dados numéricos , Comportamento Contraceptivo/psicologia , Comportamento Contraceptivo/estatística & dados numéricos , Serviços de Planejamento Familiar , Feminino , Grupos Focais , Humanos , Masculino , Nigéria/epidemiologia , Gravidez , Fatores de Risco , Fatores Socioeconômicos
8.
Matern Child Health J ; 18(1): 307-315, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23576403

RESUMO

To date, limited evidence is available for urban populations in sub-Saharan Africa, specifically research into the association between urban women's empowerment and reproductive health outcomes. The objective of this study is to investigate whether women's empowerment in urban Nigerian settings is associated with family planning use and maternal health behaviors. Moreover, we examine whether different effects of empowerment exist by region of residence. This study uses baseline household survey data from the Measurement, Learning and Evaluation Project for the Nigerian Urban Reproductive Health Initiative being implemented in six major cities. We examine four dimensions of empowerment: economic freedom, attitudes towards domestic violence, partner prohibitions and decision-making. We determine if the empowerment dimensions have different effects on reproductive health outcomes by region of residence using multivariate analyses. Results indicate that more empowered women are more likely to use modern contraception, deliver in a health facility and have a skilled attendant at birth. These trends vary by empowerment dimension and by city/region in Nigeria. We conclude by discussing the implications of these findings on future programs seeking to improve reproductive health outcomes in urban Nigeria and beyond.


Assuntos
Serviços de Planejamento Familiar/estatística & dados numéricos , Saúde Reprodutiva , Classe Social , Direitos da Mulher , Adolescente , Adulto , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Nigéria , Paridade , Gravidez , Saúde da População Urbana , Adulto Jovem
9.
J Adolesc Health ; 53(5): 609-16, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23871802

RESUMO

PURPOSE: To examine the timing and circumstances of first sex among urban female and male youth in Kenya, Nigeria, and Senegal. METHODS: Recently collected data are used to examine youth sexual behaviors in Kenya, Nigeria, and Senegal. In each country, a large, representative sample of women (ages 15-49) and men (ages 15-59) was collected from multiple cities. Data from youth (ages 15-24) are used for the analyses of age at sexual initiation, whether first sex was premarital, and modern family planning use at first sex. Cox proportional hazard models and logistic regression analyses are performed to determine factors associated with these outcomes. RESULTS: Across all three countries, a greater percentage of male youth than female youth report initiating sex with a nonmarital partner. More educated youth are less likely to have initiated sex at each age. In Nigeria and Senegal, poor female youth report earlier first sex than wealthier female youth. In Kenya, richer female youth are more likely to have premarital first sex and to use contraception/condom at first sex than their poorer counterparts. Older age at first sex and youth who report that first sex was premarital are significantly more likely to use a method of contraception (including condom) at first sex. City-specific distinctions are found and discussed for each outcome. CONCLUSIONS: Programs seeking to reduce HIV and unintended pregnancy risk among urban youth need to undertake needs assessments to understand the local context that influences the timing and circumstances of first sex in each city/country-specific context.


Assuntos
Coito , Comparação Transcultural , Países em Desenvolvimento , População Urbana/estatística & dados numéricos , Adolescente , Fatores Etários , Coito/psicologia , Comportamento Contraceptivo , Escolaridade , Feminino , Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Humanos , Quênia , Modelos Logísticos , Masculino , Nigéria , Pobreza/psicologia , Pobreza/estatística & dados numéricos , Gravidez , Gravidez na Adolescência/etnologia , Gravidez na Adolescência/prevenção & controle , Modelos de Riscos Proporcionais , Senegal , Fatores Sexuais , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Adulto Jovem
10.
Int Health ; 4(4): 277-82, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24029673

RESUMO

This study aimed to develop and implement a customized training program related to the delivery of an integrated human immunodeficiency virus - sexually transmitted infections (HIV-STI) risk reduction intervention for peer-facilitators and to evaluate its immediate outcome including changes in trainee knowledge, attitudes, and self-reported competence and confidence. We developed and delivered a structured training program and materials about HIV and STI prevention in a university setting. The training was offered to candidate facilitators who were planned to be involved in a larger project, known as Integrated HIV-STI Risk Reduction Program. Ten candidate facilitators participated in the training program and completed both the pretest and posttest survey questionnaire. The data were analyzed using SPSS version 17.0 software package and Wilcoxon signed rank test was applied to assess the impact of the training program. Overall, the trainees' performance in HIV-related and STI knowledge, attitude and stigma scores had significantly increased compared to the baseline. The median scores for HIV and STI knowledge after the training significantly increased from 22.0 to 30.5 (p=0.007) and 8.0 to 9.5 (p=0.005), respectively, whereas the median score on the positive attitude towards HIV and STI prevention rose from 39.0 to 57.0 (p=0.011). Upon completion of the program, 80-100% of the trainees believed that they were competent and confident in performing most of the designed sexual health intervention activities. This preliminary study suggests that a customized on-site training program on sexual health intervention could significantly improve their knowledge, attitude and practice related to HIV-STI prevention.

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