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1.
Sex Reprod Health Matters ; 28(1): 1723321, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32178594

RESUMO

In Africa, high discontinuation of contraceptive use is thwarting goals for healthy birth spacing or limiting childbearing. This paper investigates how well the contraception program is addressing the needs of women and couples in the Arusha region, Tanzania by studying contraceptive use continuation. We measured the overall and method-specific discontinuation rate, reasons for discontinuation, post-discontinuation reproductive behaviours/outcomes, and examined the determinants of contraceptive discontinuation. We used data from a household survey conducted in Arusha from January to May 2018. Information on contraceptive use during the 31 months preceding the survey was recorded in a monthly calendar. Using the single- and multiple-decrement life-table approach, we calculated the overall and cause-specific discontinuation of contraceptive methods. Logistic regression was used to evaluate the determinants of discontinuation. The 12-month overall discontinuation of contraceptive use was 44.6%. Discontinuation was lowest for implants (12.3%) and highest for male condoms (60.1%), the most common reason being side effects (11.7%). 59.8% of women who discontinued did not switch to another method within 3 months following discontinuation and 20.9% experienced pregnancy. Longer distance to a health facility is associated with higher discontinuation of hormonal methods such as injectables, but lower discontinuation of non-hormonal methods such as condoms. Discontinuation due to side effects is not explained by most of the women's background characteristics other than the method they used. Discontinuation of contraception is high among Arusha women. Effective contraception programs, especially improved counselling, need to address the reasons for the discontinuation of contraceptive use.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/métodos , Anticoncepção/estatística & dados numéricos , Anticoncepcionais Femininos/administração & dosagem , Serviços de Planejamento Familiar/organização & administração , Acesso aos Serviços de Saúde , Cooperação do Paciente/estatística & dados numéricos , Adolescente , Adulto , Preservativos , Anticoncepção/psicologia , Comportamento Contraceptivo/etnologia , Comportamento Contraceptivo/psicologia , Feminino , Humanos , Cooperação do Paciente/etnologia , Cooperação do Paciente/psicologia , Gravidez , Gravidez não Planejada , Gravidez não Desejada , Inquéritos e Questionários , Adulto Jovem
3.
PLoS One ; 15(2): e0228714, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32040485

RESUMO

BACKGROUND: Family planning counseling is critical for women to make informed reproductive and sexual health decisions. Despite Ethiopia's success in expanding access to family planning services, information on the quality of family planning counseling is limited. The objectives of this study were to assess whether the quality of counseling from the female client´s perspective has changed over time (2014 to 2018) and to investigate determinants associated with the quality of counseling to provide a more nuanced understanding of disparities in sexual and reproductive health outcomes in Ethiopia. METHODS: Data were obtained from five rounds of the Ethiopian Performance Monitoring and Accountability 2020 female survey questionnaire. Quality of counseling was categorized into four levels based on the responses of the questions that compose the Method Information Index, a core Family Planning 2020 indicator that serves as a proxy for quality of counseling and reflects the extent to which women are informed about side effects and alternate methods. The proportion of female contraceptive users that received good counseling were examined over time by each region, demographic characteristics, and contraception method type and source. Ordinal logistic regression was applied to the last survey round (2018) to investigate determinants associated with counseling quality. RESULTS: The proportion of female contraception users that reported receiving information on all three questions did not significantly change over the period 2014 to 2018. Overall quality of counseling on family planning was low, with only 30% of women reporting receiving sufficient information during counseling. The likelihood of good quality counseling was the least among those who had no formal schooling when compared to those who had higher educational attainment (OR = 0.70, 95% CI: 0.50, 0.97). Women from the wealthiest quintile were 1.72 times more likely (95% CI: 1.10, 2.69) to receive good quality counseling when compared to women in the lower wealth quintile. Women from rural areas were 1.51 times more likely to have received good counseling when compared to those in urban areas (95% CI: 1.04, 2.18). Amhara residents were less likely to receive good counseling when compared to the SNNPR (OR: 0.51, 95% CI: 0.32, 0.81). Women who acquired their method from the private sector had worse counseling (OR: 0.31, 95% CI: 0.23, 0.41) when compared to the public sector. Those using short-acting methods were more at risk of receiving lesser quality counseling when compared to users of long-acting methods (OR: 0.58, 95% CI: 0.46, 0.72). CONCLUSION: The results of this analysis indicated that Ethiopia's overall progress in modern contraceptive use has not been accompanied by a corresponding increase in the quality of family planning counseling. Improving the quality of contraception counseling for women across all demographics, including wealth quintiles and education, is a crucial strategy to support positive reproductive health outcomes with a rights-based focus. Based on the findings of this study, it is essential to emphasize the need to do proper counseling for all methods including short-acting methods especially for those working the private sector and some of the regions which have lower prevalence of good counseling. Further community-based participatory and qualitative research should focus on understanding the root causes and barriers to the delivery of high-quality counseling in Ethiopia.


Assuntos
Anticoncepcionais Femininos/uso terapêutico , Aconselhamento/estatística & dados numéricos , Serviços de Planejamento Familiar/estatística & dados numéricos , Inquéritos Epidemiológicos , Qualidade da Assistência à Saúde/tendências , Adolescente , Adulto , Escolaridade , Etiópia , Feminino , Humanos , Renda , Estado Civil/estatística & dados numéricos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Parto , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto Jovem
4.
Eur J Pharm Sci ; 141: 105114, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31655211

RESUMO

A mathematical construct is proposed to analyze drug released from matrix-type vaginal rings. This work is intended to support experimental studies and promote the fabrication of these devices. The transport of a dissolved drug through a toroidal membrane was predicted using diffusion equations and their solutions. This dynamic framework led to the estimation of the time elapsed before releasing 98% of the ethynodiol diacetate from the polymer. Closed-form expressions, easily adaptable to spreadsheet implementation, were developed to simulate the controlled delivery of levonorgestrel initially dispersed in a silicone vaginal ring. As the loading increased, a greater amount of medication was delivered. However, the fractional release decreased from 32.6% to 23.1% when the dosage changed from 4.137 g/cm3 to 8.274 mg/cm3. The expressions were further simplified for thin rings.


Assuntos
Dispositivos Anticoncepcionais Femininos , Sistemas de Liberação de Medicamentos , Modelos Teóricos , Anticoncepcionais Femininos/química , Anticoncepcionais Orais Hormonais/química , Liberação Controlada de Fármacos , Diacetato de Etinodiol/química , Levanogestrel/química , Membranas Artificiais , Silicones/química
7.
J Pediatr Adolesc Gynecol ; 32(5S): S2-S6, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31585615

RESUMO

Although adolescent pregnancy and birth rates have been declining since the early 1990s, the rate of intrauterine device (IUD) use in adolescents remain low. IUDs are a highly effective contraceptive method with a failure rate of less than 1%. There are currently 5 IUDs available and marketed in the United States: the nonhormonal copper-containing IUD (Paragard Copper T380A; Ortho-McNeil) and 4 hormonal levonorgestrel-releasing intrauterine systems (LNG-IUDs). IUDs can be used in adolescents, and the LNG-IUD has many noncontraceptive benefits including the treatment of heavy menstrual bleeding, dysmenorrhea, pelvic pain/endometriosis, and endometrial hyperplasia/endometrial cancer. In addition, the LNG-IUD is an effective tool for suppression of menses.


Assuntos
Anticoncepção/estatística & dados numéricos , Anticoncepcionais Femininos/uso terapêutico , Dispositivos Intrauterinos/classificação , Adolescente , Dismenorreia/tratamento farmacológico , Endometriose/tratamento farmacológico , Feminino , Humanos , Menorragia/tratamento farmacológico , Menstruação/efeitos dos fármacos , Gravidez , Gravidez na Adolescência/prevenção & controle
8.
S Afr Med J ; 109(10): 750-755, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31635572

RESUMO

BACKGROUND: The contraceptive implant, Implanon NXT, was introduced in South Africa (SA) in 2014 and, although it offers multiple advantages, users may request to have it removed early for several reasons. The number of insertions of Implanon NXT has declined in SA and there have been concerns about early removals. OBJECTIVES: To gain an understanding of patterns of Implanon NXT use, reasons for requesting removal and duration of use at the time of requesting removal. METHODS: This was a cross-sectional study conducted at an urban public-sector reproductive health clinic in the eThekwini District of KwaZulu-Natal, SA. A total of 120 women ≥18 years of age requesting removal of Implanon NXT completed an interviewer-administered questionnaire that probed experiences of use and reasons for removal. Data were collected electronically on Wits REDCap (Research Electronic Data Capture) and analysed using Stata 14 (StataCorp, USA). The study was conducted from 2017 to 2018. RESULTS: A total of 120 women were interviewed. Their mean age was 28 (range 19 - 44) years and most women (n=103; 85.8%) had completed secondary school. The majority were black (n=115; 95.8%) and unmarried (n=102; 85%). Implants had been inserted primarily by nurses (n=110; 91.7%) at public-sector clinics (n=91; 75.8%). Three-quarters of the women (n=91; 75.8%) requested removal of Implanon NXT because it had reached the intended 3-year duration. Reasons for early removal were mainly due to side-effects, e.g. bleeding problems (n=19; 15.8%), weight gain (n=7; 5.8%), loss of libido (n=2; 1.7%), headaches (n=5; 4.2%), dizziness (n=4; 3.3%) and pain/numbness in the arm (n=2; 1.7%). Just more than half (57.1%) of the women who had received the implant for the intended 3-year duration had requested reinsertion of Implanon NXT. CONCLUSIONS: The main reason for requesting removal was that Implanon NXT had reached its intended 3-year duration, and more than half of the women requested reinsertion of the device following removal. Implanon NXT is a highly effective, safe, acceptable, long-acting contraceptive and important in the SA contraceptive method mix.


Assuntos
Anticoncepcionais Femininos/administração & dosagem , Desogestrel/administração & dosagem , Remoção de Dispositivo/estatística & dados numéricos , Implantes de Medicamento , Adulto , Anticoncepcionais Femininos/efeitos adversos , Estudos Transversais , Desogestrel/efeitos adversos , Feminino , Humanos , Satisfação do Paciente/estatística & dados numéricos , África do Sul , Fatores de Tempo , População Urbana , Adulto Jovem
9.
BMC Public Health ; 19(1): 1362, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651273

RESUMO

BACKGROUND: To increase access to voluntary family planning (FP) services, Nigerian policymakers are debating how to task share injectable contraceptive services to drug shop owners known as Patent and Proprietary Medicine Vendors (PPMVs). Task sharing FP services to drug shops is a promising practice, but information is needed on how to ensure high quality FP services. This analysis assesses the effects of job aids on PPMVs' knowledge of injectable contraceptives 9 months after receiving a standardized training. METHODS: One hundred ninety-four PPMVs were trained on FP counseling and administration of injectable contraceptives in Bauchi, Cross River, Ebonyi and Kaduna states. PPMVs were interviewed before, after, and 9 months after the training. Three variables were used to assess injectable contraceptive knowledge: 1) intramuscular depot-medroxyprogesterone acetate (DMPA-IM) knowledge: a combination of three questions related to device type, injection location, and reinjection frequency; 2) subcutaneous DMPA (DMPA-SC) knowledge: a combination of the same three questions but for DMPA-SC; and 3) knowledge of at least 4 of the 7 common injectable side effects. Three separate adjusted logistic regression models were conducted to determine the factors that influence PPMV knowledge of injectable contraceptives 9 months after the training. RESULTS: Over half of PPMVs (56%) reported using at least two job aids at 9 months. PPMVs' knowledge of DMPA-IM, DMPA-SC and side effects were low before the training but increased immediately after. Nine months later, knowledge remained higher than pre-test levels but generally reduced compared to posttest levels. PPMVs who reported using at least two FP job aids were 2.6 (95% CI: 1.4-5.1) times more likely to have DMPA-IM knowledge 9 months after the training compared to those who used one or no job aids, while adjusting for PPMV characteristics. Similar results were observed for knowledge of DMPA-SC (AOR: 2.5; 95% CI: 1.2-4.6) and side effects (AOR: 2.5; 95% CI: 1.3-4.8). CONCLUSION: PPMVs who used at least two FP job aids were more likely to correctly answer key injectable contraceptive questions 9 months after training. Incorporating proven job aids into routine trainings is a low-cost strategy that can reinforce knowledge and help PPMVs to retain information.


Assuntos
Comércio/educação , Anticoncepcionais Femininos/administração & dosagem , Conhecimentos, Atitudes e Prática em Saúde , Acetato de Medroxiprogesterona/administração & dosagem , Adolescente , Adulto , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde , Humanos , Ciência da Implementação , Injeções Intramusculares , Injeções Subcutâneas , Estudos Longitudinais , Nigéria , Adulto Jovem
10.
Metas enferm ; 22(8): 21-27, oct. 2019. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-184995

RESUMO

La adopción de la Convención de los Derechos de las Personas con Discapacidad oficializó un cambio de paradigma de un modelo biomédico a uno social en la comprensión de la discapacidad, permitiendo establecer el foco en su entorno y la importancia de adaptarlo a sus necesidades específicas. Sin embargo, este colectivo sigue haciendo frente a barreras a la hora de ejercer sus derechos. Uno de los mayores obstáculos a los que se enfrentan se produce en el ámbito de la salud, especialmente en la salud sexual y reproductiva, donde las mujeres con discapacidad intelectual conforman el grupo más vulnerable. Este trabajo tiene como propósito presentar el estado de la cuestión en lo que respecta a las desigualdades sociales en salud en materia de salud sexual y reproductiva en mujeres con discapacidad intelectual. Para ello se parte de un planteamiento de la discapacidad intelectual desde el modelo social, posteriormente se hace un análisis de los determinantes sociales en salud en la discapacidad intelectual, para llegar a exponer cuestiones concretas de la salud sexual y reproductiva en mujeres con discapacidad intelectual y que ponen de manifiesto las desigualdades sociales en salud. Ello evidencia la necesidad de generar datos sólidos acerca de su salud y de adaptar la atención sanitaria en el ámbito sexual y reproductivo de esta población


Adopting the Convention on the Rights of Persons with Disabilities formalized a change in paradigm from a biomedical to a social model in terms of understanding disability, allowing to place the focus on their setting and the importance of adapting it to their specific needs. However, this group still faces barriers at the time of exercising their rights. One of the major obstacles faced occurs in the health setting, particularly regarding sexual and reproductive health, where women with intellectual disability are the most vulnerable group. The objective of this article is to present the state of the matter regarding social inequalities in health, in the area of sexual and reproductive health in women with intellectual disability. To this aim, we have approached intellectual disability from the social model, with a subsequent analysis of the social determinants in health regarding intellectual disability, in order to finally present specific issues regarding sexual and reproductive health in women with intellectual disability, which show the social inequalities in health. This shows the need to generate solid data about their health, and adapt healthcare in the sexual and reproductive setting for this population


Assuntos
Humanos , Feminino , Iniquidade Social , Saúde Sexual , Saúde Reprodutiva , Deficiência Intelectual , Disparidades nos Níveis de Saúde , Atenção à Saúde , Anticoncepcionais/uso terapêutico , Anticoncepcionais Femininos , Delitos Sexuais , Doenças Sexualmente Transmissíveis/epidemiologia
11.
Sex Reprod Health Matters ; 27(1): 1628593, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31533578

RESUMO

Historically, women living with HIV (WLWH) have been vulnerable to biased advice from healthcare workers regarding contraception and childbearing. However, antiretroviral therapy (ART) has made motherhood safer, prompting a re-examination of whether contraceptive services enable the realisation of WLWH's reproductive intentions. We use longitudinal quantitative data on contraceptive choice and use, and childbearing intentions collected in (up to) six interviews between entry into antenatal care (ANC) and 18 months post-partum from a cohort of 471 ART-initiated WLWH in Cape Town, South Africa. Thirty-nine of these women were randomly selected for in-depth interview where they described experiences of contraception services and use. We find high prevalence of injectable contraceptive (IC) use after birth (74%). With increasing post-partum duration, greater proportions of women discontinue this method (at 18 months 21% were not using contraception), while desires for another child remain stable. We find little consistency between method choice and use: many women who elected to use the intrauterine device, sterilisation or oral contraceptives at first ANC visit are using IC after birth. Women commonly report receiving an IC shortly after birth, including those who had previously chosen to use another method or no method. Among WLWH, injectables dominated the contraceptive method mix. Despite a human rights-grounded policy and attempts to introduce new methods, contraceptive services in South Africa remain largely unchanged over time. Women are frequently unable to make autonomous contraceptive choices. Despite low desires for future pregnancy, we observed high rates of contraceptive discontinuation, resulting in heightened risk of unintended pregnancy.


Assuntos
Anticoncepção/métodos , Anticoncepção/psicologia , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Anticoncepcionais Femininos/administração & dosagem , Tomada de Decisões , Serviços de Planejamento Familiar , Feminino , Humanos , Injeções/psicologia , Entrevistas como Assunto , Período Pós-Parto , Gravidez , Cuidado Pré-Natal , África do Sul , Adulto Jovem
12.
Int J Gynaecol Obstet ; 147(3): 326-331, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31489621

RESUMO

OBJECTIVE: To determine whether users of the non-fundal levonorgestrel-releasing intrauterine system (LNG-IUS) present with unfavorable bleeding patterns more frequently than fundal LNG-IUS users. METHODS: A prospective cohort was conducted from June, 2016 to January, 2018 involving women aged 18-45 years who wished to use the LNG-IUS as contraception and had no contraindications, endometrial polyps, submucosal myomas, irregular menstrual cycle, or anticoagulant use. Two study groups comprised women using fundal insertion and non-fundal insertion LNG-IUS. Bleeding was evaluated using a diary and pictogram chart. RESULTS: Of the 92 women who participated in the study, those with non-fundal LNG-IUS insertion sustained bleeding at rates greater than 83% (31) in the first 3 months of use, and 58% (14) at 6 months, versus 51% (22) at 3 months and 33% (19) at 6 months in those with fundal insertion (P=0.002 at 3 months; P=0.037 at 6 months). Blood loss in the non-fundal LNG-IUS group was higher than in the fundal LNG-IUS group according to pictograms drawn by participants. CONCLUSION: Women with non-fundal LNG-IUS placement had a higher frequency of sustained bleeding and blood loss volume according to self-reported charts than those with fundal LNG-IUS placement.


Assuntos
Anticoncepcionais Femininos/farmacologia , Dispositivos Intrauterinos Medicados/efeitos adversos , Levanogestrel/farmacologia , Distúrbios Menstruais/induzido quimicamente , Adulto , Estudos de Casos e Controles , Anticoncepcionais Femininos/efeitos adversos , Feminino , Humanos , Levanogestrel/efeitos adversos , Estudos Prospectivos , Adulto Jovem
13.
Int J Gynaecol Obstet ; 147(3): 319-325, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479152

RESUMO

OBJECTIVE: To evaluate calcium metabolism and bone mineral density (BMD) in new users of depot medroxyprogesterone acetate (DMPA) in the first year of use. METHODS: This prospective, non-randomized study, conducted at the University of Campinas, São Paulo, Brazil, was carried out between February 2011 and February 2013. Women aged from 18 to 40 with a body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) <30 and with no known history of disease or medication use who chose to use DMPA were paired by age (±1 year) and BMI (±1) with women commencing the use of a copper intrauterine device (IUD). The primary outcomes were BMD measured by dual-energy X-ray absorptiometry and calcium metabolism markers; other variables were body composition and lifestyle habits. Repeated measures analysis of variance (ANOVA) and multiple regression analyses were used to evaluate associations. RESULTS: Twenty-seven women using DMPA and 24 using IUD were evaluated, with a mean age of 29.7 years and 28.6 years, respectively. The DMPA group presented with a 3.6% (P<0.001) loss of lumbar spine BMD, a 2.1% (P=0.100) loss of femoral neck BMD and higher phosphorus (P=0.014) concentrations at 12 months compared to the IUD group. The decreases in BMD were associated with the use of DMPA, while total mass and coffee intake were found to be protective factors. CONCLUSION: Changes in calcium metabolism and a decrease in BMD were found in the DMPA group at 12 months.


Assuntos
Densidade Óssea/efeitos dos fármacos , Cálcio/metabolismo , Anticoncepcionais Femininos/farmacologia , Acetato de Medroxiprogesterona/farmacologia , Absorciometria de Fóton , Adulto , Índice de Massa Corporal , Brasil , Estudos de Casos e Controles , Anticoncepcionais Femininos/administração & dosagem , Feminino , Humanos , Acetato de Medroxiprogesterona/administração & dosagem , Estudos Prospectivos , Adulto Jovem
14.
BMC Res Notes ; 12(1): 512, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416486

RESUMO

OBJECTIVES: Depo-Provera is an injectable contraceptive method containing medroxyprogesterone acetate. It has some adverse effects like changes in menstrual pattern, loss in bone mineral density and risk of weight gain. Therefore, this study is aimed at to investigate the effects of Depo-Provera on body weight and blood pressure among Ethiopian women. Institution based cross-sectional study design was conducted from January 2017 to April 2017. Data were analyzed using SPSS version 21 software. Paired t test, independent t-test and ANOVA were used to evaluate the presence of mean difference and relationship between changes in variables and duration of use of Depo-Provera. P-value ≤ 0.05 were considered as statistically significant. RESULTS: The mean weight and body mass index (BMI) of Depo-Provera users were increased significantly (p = 0.02 for mean body weight and p = 0.019, for body mass index). There was no significant difference in mean arterial blood pressure (MAP) of Depo-Provera users compared to controls or their respective pretreatment value (p-value = 0.85 for Depo-Provera users and 0.67 for non-users). The finding of this study revealed that there is an increased weight gain and BMI among Depo-Provera users compared to non-users, which really requires attention of health professionals and other stake holders.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Acetato de Medroxiprogesterona/administração & dosagem , Ganho de Peso/efeitos dos fármacos , Adulto , Índice de Massa Corporal , Densidade Óssea/efeitos dos fármacos , Anticoncepcionais Femininos/administração & dosagem , Estudos Transversais , Feminino , Humanos , Injeções , Menstruação/efeitos dos fármacos , Adulto Jovem
15.
Afr J Reprod Health ; 23(2): 101-109, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31433598

RESUMO

Attention to the sexual reproductive health needs of persons with disabilities is important to ensure the protection and promotion of their human rights, to move forward the international development agenda, and to build a truly inclusive society. The objective of this study was to assess modern contraceptive use and associated factors among women with disabilities in Gondar city, Ethiopia. A community-based cross- sectional study was employed, from 25 June to 05 August 2013. All 280 reproductive age women with disabilities who were found in the town during study period were included. Data were coded, entered and cleaned using EPI INFO statistical software version 3.5.2, and analysed by Software Statistical Packages for Social Sciences version 16. About 18% of participants had ever used modern contraceptive and the contraceptive prevalence rate among study participants and currently married women were 13.1% and 20.2% respectively. One fourth of respondents believed that existing family planning service delivery points were not accessible. The proportion of modern contraceptive use among participants was low. Age, marital status, education, income, and type of disability were significant predictors of modern contraceptive use. Therefore, social behavioural change communication interventions should be designed to improve the awareness of people living with disabilities on modern contraceptives based on the needs and type of disabilities.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/estatística & dados numéricos , Serviços de Planejamento Familiar/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Comportamento Sexual/etnologia , Adolescente , Adulto , Atitude do Pessoal de Saúde , Anticoncepcionais Femininos/uso terapêutico , Dispositivos Anticoncepcionais , Etiópia/epidemiologia , Feminino , Educação em Saúde/estatística & dados numéricos , Humanos , Saúde Reprodutiva , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
16.
S Afr Med J ; 109(8): 559-561, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31456548

RESUMO

The first difficult contraceptive implant removals clinic in sub-Saharan Africa was started 2 years ago at New Somerset Hospital in Cape Town, South Africa, and has seen two cases of implant migration. We report these cases here. The first was a case of fascial migration and the second one of migration via the cephalic vein, both to a site just anterior to the glenohumeral joint. Both implants were removed without complications. Even with correct insertion technique, migrations can occur. Healthcare providers need to know how to manage difficult removals, and how to access and refer to difficult removals services when necessary. These services must therefore be available in all settings where implants are offered, to ensure access to rights-based family planning services for all women in southern Africa.


Assuntos
Anticoncepcionais Femininos , Desogestrel , Remoção de Dispositivo , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Adulto , Feminino , Humanos , Radiografia , Articulação do Ombro/diagnóstico por imagem
17.
Glob Health Sci Pract ; 7(Suppl 2): S258-S270, 2019 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-31455623

RESUMO

BACKGROUND: In Tanzania, limited access to postabortion care (PAC) contributes to high rates of maternal mortality. To address the issue, Pathfinder International and the Tanzania Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC) introduced and expanded coverage of PAC in 64 public health facilities in Dar es Salaam, Tanzania. METHODS: During a 30-month period, we implemented a multifaceted approach to introduce and expand PAC, including clinical training and mentorship for health care providers; service reorganization, equipment provision, and an expanded method mix offering; standardization of PAC reporting tools; and community engagement and referral. We assessed outcomes using PAC service statistics from 64 public health facilities in 4 districts of Dar es Salaam and health care provider mentorship data from 385 observed PAC visits. RESULTS: From January 2016 to June 2018, voluntary postabortion contraceptive uptake increased steadily. A total of 6,636 PAC clients, including 2,731 young people (ages 10-24), adopted a method post-procedure. Average semesterly client volume per facility increased from 27 to 52.4 manual vacuum aspiration clients and 17.6 to 43.9 postabortion contraceptors between the first and last periods. Overall postabortion contraceptive uptake was 80.6% (6,636/8,230), with a method mix of 58.3% implant, 18.9% intrauterine device, 13.7% pills, 8.6% injectables, and 0.5% permanent methods. Adults and young people had comparable method mix. Mentored providers showed improvements in service quality indicators. During the last period, 92% counseled the client on contraception, 93% considered the client's sexual and reproductive health intentions, 94% provided correct method information and supply, and 96% documented services on the client's family planning card. Different provider types (mid- and senior-level) performed comparably. CONCLUSIONS: Expanding PAC coverage to primary- and secondary-level facilities led to high uptake of voluntary contraception among postabortion clients. Key interventions included PAC clinical training and mentorship; service reorganization, equipment provision, and an expanded method mix offering; use of standardized PAC registers; and community engagement for awareness building and linkage to PAC.


Assuntos
Aborto Induzido , Assistência ao Convalescente/organização & administração , Anticoncepção/estatística & dados numéricos , Anticoncepcionais Femininos/administração & dosagem , Assistência à Saúde , Dispositivos Intrauterinos/estatística & dados numéricos , Adolescente , Adulto , Criança , Implantes de Medicamento , Serviços de Planejamento Familiar , Feminino , Pessoal de Saúde/educação , Humanos , Mentores , Gravidez , Tanzânia , Adulto Jovem
18.
Reprod Health ; 16(1): 131, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464640

RESUMO

BACKGROUND: In Brazil, high contraceptive prevalence rates coexist with high rates of unintended pregnancies. Contraceptive discontinuation may explain this context, but few studies have focused on highly educated young women in countries with low unmet need for modern contraception. This paper explores frequency and associated factors of contraceptive discontinuation among undergraduate students in Brazil within 12-months. METHODS: This retrospective cohort study was conducted among a probability sample of 1679 undergraduates of São Paulo University. Data were collected online using a contraceptive calendar. We examined factors related to monthly discontinuation of oral pills and male condoms using Generalized Estimating Equation models. RESULTS: Altogether, 19% of oral pill users and 48% of male condom users discontinued their method for method-related reasons within 12-months, and 18% of oral pill users and 15% of male condom users abandoned/or switched to less effective methods. Women in casual relationships were at increased odds of oral pill (OR = 1.4 [1.1-1.8]) and male condom discontinuation (OR = 1.3 [1.0-1.7]), and at increased odds of switching from oral pill to less effective or no method (OR = 1.4 [1.1-1.7]). Other associated factors were method specific. Women from lower socioeconomic status or who had multiple lifetime partners were more likely to discontinue or abandon the oral pill, while more sexually experienced women were less likely to discontinue the male condom. CONCLUSION: Frequent method discontinuation in Brazil calls for greater attention to the difficulties women face when using short acting methods. Discontinuation was associated with type of partner and sexual experience highlighting the changing contraceptive needs of women at the early stages of their professional careers.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Anticoncepcionais Femininos/administração & dosagem , Gravidez não Planejada , Comportamento Sexual , Estudantes/psicologia , Adolescente , Adulto , Brasil , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Sexo Seguro , Adulto Jovem
19.
J Obstet Gynaecol Res ; 45(9): 1892-1898, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31286635

RESUMO

AIM: To evaluate the pregnancy rate in Japanese women treated with levonorgestrel for emergency contraception. METHODS: This retrospective record-based medical study included 1000 women who visited our clinic for emergency contraceptive treatment with 1.5 mg single-dose oral levonorgestrel, followed by 50 µg hormonal oral contraceptive from May 2011 to December 2017. The outcomes of the emergency contraceptive treatment were recorded at a follow-up visit, and descriptive statistics were obtained. RESULTS: The number of women treated with levonorgestrel at the clinic increased from 2011 to 2015, but there was no subsequent increase thereafter. Most women were in their 20s (57.4%), followed by their 30s (19.3%) and teens (18.3%). Of the 1000 women treated with levonorgestrel, 659 were followed up. Among the 659 women with follow-up data, 16 were pregnant (2.4%), of whom 11 underwent abortions, three had miscarriages, and two delivered at term. The timing of unprotected sexual intercourse relative to the estimated ovulation date among the pregnant women ranged from -3 to 23 days. The most commonly used contraceptive method before the emergency contraceptive visit was condoms (89.3%, 887/993). No new safety concerns were identified throughout the study period. CONCLUSION: The pregnancy rate after levonorgestrel treatment in Japanese women was low, and similar to that reported in previous studies. Information on contraceptive methods and emergency contraception with levonorgestrel needs to be better disseminated among women of childbearing age.


Assuntos
Anticoncepção Pós-Coito , Anticoncepcionais Femininos/administração & dosagem , Levanogestrel/administração & dosagem , Taxa de Gravidez , Adolescente , Adulto , Feminino , Humanos , Japão/epidemiologia , Gravidez , Adulto Jovem
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