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1.
BMC Womens Health ; 21(1): 346, 2021 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-34600521

RESUMO

BACKGROUND: Fertility decline characterised by inter-birth intervals remains rather slow or stall in many countries of sub-Saharan African (SSA). Non-adherence to optimal inter-birth intervals often occasioned by low prevalence of contraceptive use and high fertility desires often lead to poor maternal and child health outcomes. Additionally, information on the influence of contraception and fertility desire on interval between first and second births (SBI) is rarely available. This study therefore aimed to examine the influence of fertility desire and contraception on SBI among women in four SSA countries. METHODS: We analysed cross-sectional data on women aged 15-49 years who participated in the recent Demographic and Health Surveys in DR Congo, Ethiopia, Nigeria and South Africa. Semi-parametric Cox proportional hazards regression was employed for the analysis at 5% significance level. RESULTS: The median time to second birth was 34 months in DR Congo; 35 months, Nigeria; 42 months, Ethiopia; and 71 months, South Africa. About 70% of the women desired additional child(ren) and two-thirds have never used contraceptive in both Nigeria and DR Congo. The hazard of second birth was significantly lower among women who desired additional child(ren) compared to desired for no more child in DR Congo (aHR = 0.93; CI: 0.89-0.97), Ethiopia (aHR = 0.64; CI: 0.61-0.67) and South Africa (aHR = 0.51; CI: 0.47-0.55). Women who had never used contraceptive were 12%, 20% and 24% more likely to lengthen SBI than those who were current users in DR Congo, Nigeria and South Africa respectively. DR Congo and Nigerian women were about two times more likely to shorten SBI compared with their South African counterparts. Other significant determinants of SBI include ethnicity, rural residential, age and marital status at first birth, wealth and employment status. CONCLUSION: Findings showed differentials in the linkage between second birth interval and the desired fertility and contraception by country, demonstrating the importance of context. The contribution of these factors to second birth interval requires country context-specific attention if further decline in fertility and poor health outcomes associated with sub-optimal inter-birth interval is to be attained in SSA.


Assuntos
Intervalo entre Nascimentos , Anticoncepcionais , Criança , Estudos Transversais , Feminino , Fertilidade , Humanos , Fatores Socioeconômicos , África do Sul
2.
Pan Afr Med J ; 39: 216, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34630828

RESUMO

Introduction: in Burkina Faso, despite the strategies implemented to increase the use of contraceptives, the prevalence rate of modern contraceptives remains low. Religion is an important part of the socio-cultural fabric of many communities. Besides, religious leaders play an essential role in adopting and using contraceptive methods to support family health. The study objective was to explore the knowledge, beliefs and perceptions of religious leaders about modern contraceptives among women of childbearing age. Methods: data were collected in September 2018 from twenty-one religious' leaders of the urban municipality of Dori. Study participants were selected based on reasoned sampling with maximum variation (sex, religion, age, residence and level of education). We conducted semi-structured individual interviews, non-participant observations and documentary review. Results: religious leaders have a good knowledge of modern contraceptive methods, but they prefer traditional contraceptive methods and abstinence. They consider modern contraception as abortion and female sterilization and emphasize birth spacing. Furthermore, religious leaders lack training on contraception and have no real links and exchanges with sexual and reproductive health services. As a result, their assessment of the quality of these services is very mixed. Conclusion: religious leaders play a crucial role in improving modern contraceptive methods in Burkina Faso. Close collaboration with family planning services should, at all times, be maintained. The implementation of training and educational activities for religious leaders could help raise modern contraceptive use in Burkina Faso.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/métodos , Conhecimentos, Atitudes e Prática em Saúde , Religião , Adulto , Idoso , Burkina Faso , Anticoncepcionais/administração & dosagem , Feminino , Humanos , Entrevistas como Assunto , Liderança , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
3.
Einstein (Sao Paulo) ; 19: eAO6376, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34644746

RESUMO

OBJECTIVE: To evaluate willingness to pay for short- and long-acting reversible contraceptive methods among female Brazilian adolescents and their parents, as well as their perspective on using such methods. METHODS: This is a cross-sectional study of female adolescents aged 13 to 19 years and their parents. We surveyed to estimate their willingness to pay for contraceptive methods. The values are expressed as mean±standard deviation in Brazilian reals (R$). Spearman correlation was employed for socioeconomic status of parents, age of adolescents and their standpoints. The methods types and adolescent and parent perspectives were analyzed by the test χ2. To determine an agreement between pairs and their willingness to pay, we used the Bland-Altman plot. RESULTS: A total of 165 surveys were collected. Short-acting method was significantly more acceptable to pay than the long-action method, by both parents and their daughters. Parents and their daughters are willing to pay out-of-pocket R$ 52,25±22,48 and R$ 51,63±21,24 for short-acting reversible contraception method, and R$ 176,83±130,34 and R$ 174,83±143,64, for long-acting method, respectively. Bland-Altman analysis indicated an agreement on both perspectives and the price they are willing to pay for each contraceptive method. CONCLUSION: Parents and adolescent daughters are more willing to pay for short-acting methods. We showed an agreement between the parent and the daughter for the values paid for each method.


Assuntos
Anticoncepcionais , Pais , Adolescente , Brasil , Estudos Transversais , Feminino , Humanos , Projetos Piloto
4.
Reprod Health ; 18(1): 209, 2021 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-34663362

RESUMO

BACKGROUND: The prevalence of teenage pregnancies in Malawi is 29%. About 25% of those are married while 30% are unmarried adolescents (15-19 years old) who use contraceptives. Data on contraceptive use has focused on older adolescents (15-19 years old) leaving out the young adolescents (10-14 years old). This study assessed factors that influence contraceptive decision-making and use among young adolescents aged 10-14 years. METHODS: This was a qualitative study that used the Theory of Reasoned Action (TRA) model to understand the processes that influence contraceptive decision-making among young adolescents (10-14 years old) in urban Lilongwe. The study was conducted in six youth health-friendly service centers and 12 youth clubs. Two focus group discussions and 26 in-depth interviews were conducted among sexually active in and out of school young adolescents and key informants. The results are organized into themes identified during the analysis. RESULTS: Results showed that contraceptive decision-making is influenced by social factors (individual, interpersonal, society) and adolescents' perceptions regarding hormonal contraceptives. There is also a disconnect between Education and Adolescent Sexual and Reproductive Health policies. CONCLUSION: The findings suggest that interventions that scale up contraceptive use need male and female involvement in decision making. Addressing myths around contraceptives, and harmonization of Education and Sexual and Reproductive Health policies in the country would motivate adolescents to use contraceptives.


Assuntos
Anticoncepcionais , Dispositivos Anticoncepcionais , Adolescente , Adulto , Criança , Tomada de Decisões , Feminino , Humanos , Malaui , Masculino , Gravidez , Comportamento Sexual , Adulto Jovem
5.
Ethiop J Health Sci ; 31(3): 457-466, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34483602

RESUMO

Background: Ethiopia is the second most populous nations in Africa. Family planning is a viable solution to control such fast-growing population. This study aimed to assess the prevalence of contraceptive use and its predictors in Ethiopia. Methods: About 4,563 women were drawn randomly by Central Statistics Agency from its master sampling frame. The survey was conducted from January, 2014 to March, 2016 within six months' interval for the study period. The study was conducted using secondary data collected by PMA2020/Ethiopia project. Negative Binomial regression model was employed for data analysis. The model was selected using information criterion. Results: Predictors like easy access of health service, residence area, level of health institutions, regions, availability of community health volunteers, experience sharing, support from husbands, level of education and employment status of women as well as residence area significantly affected the performance of contraceptive use in Ethiopia. From the interaction effects of health centers with region and health post with number of opening days per a week were significant predictors of the contraceptive use. Conclusion: The performance of contraceptive use was different from one individual to another because of their experience sharing, support from their husbands, employment status and education level. A woman who got encouragement to use birth control from her husband had good performance to be effective for her contraceptive use. There should be an experience sharing/orientation, about use of birth control to protect women from unwanted pregnancy. Hence, rural women should get experience from urban women.


Assuntos
Comportamento Contraceptivo , Anticoncepcionais , Anticoncepção , Estudos Transversais , Etiópia , Serviços de Planejamento Familiar , Feminino , Humanos , Gravidez
6.
JNMA J Nepal Med Assoc ; 59(239): 640-644, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508514

RESUMO

INTRODUCTION: Contraception plays a key role in preventing unwanted births. It also decreases pregnancy and childbirth-related morbidities and mortalities, but many women don't use contraception particularly in the postpartum period. The main objective of this study was to find out the prevalence of contraception use among postpartum women in a municipality. METHODS: A descriptive cross-sectional study was conducted among married women of reproductive age in Dhulikhel municipality of Kavrepalanchok from January to September 2019. Ethical approval was obtained from Institutional Review Committee and permission was taken from Dhulikhel Municipality before the study. The sample size was 332. A convenience sampling method was used. A semi-structured questionnaire pre-tested in Panauti municipality was used. Data entry and analysis were done using Statistical Package for Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated for descriptive analysis. RESULTS: Out of total 332 women, 146 (40%) (34.73-45.26 at 95% Confidence Interval) used postpartum contraception. Injectable/Depot was used by 61 (42%) women. Total 97 (52%) of the non-users intended to use contraception in the future. The most common reason for contraception use was women not wanting the next child soon 91 (62%) and reason for non-use was feeling contraception as unnecessary 73 (39%). CONCLUSIONS: The use of postpartum contraception was poor, and only half of the non-users intended to use contraception in the future. Thus, contraception use should be encouraged during all possible contact times, and counselling should be made universal to improve postpartum contraception services' uptake.


Assuntos
Anticoncepção , Anticoncepcionais , Criança , Comportamento Contraceptivo , Estudos Transversais , Atenção à Saúde , Serviços de Planejamento Familiar , Feminino , Humanos , Período Pós-Parto , Gravidez
8.
Int J Mol Sci ; 22(18)2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34576131

RESUMO

The cyclical proliferation of the wild fossorial rodent Arvicola terrestris scherman (ATS) is critical in mid-mountain ecosystems of several European countries. Our goal is to develop an immunocontraceptive vaccine to control their fertility, as a sustainable alternative to chemical poisons currently used. Indeed, these chemicals cause the death of ATS predators and animals sharing their ecosystem, and current laws progressively limit their use, making the development of a targeted vaccination strategy an interesting and efficient alternative. In order to identify species-specific sperm antigens, male and female ATS received subcutaneous injections of whole ATS spermatozoa to elicit an immune response. The analysis of the immune sera led to the identification of 120 immunogenic proteins of sperm cells. Of these, 15 were strictly sperm-specific and located in different regions of the male gamete. Some of these antigens are proteins involved in molecular events essential to the reproductive process, such as sperm-egg interaction, acrosomal reaction, or sperm motility. This approach not only identified a panel of immunogenic proteins from ATS sperm cells, but also demonstrated that some of these proteins trigger an immune response in both male and female ATS. These spermatic antigens are good candidates for the development of a contraceptive vaccine.


Assuntos
Antígenos/metabolismo , Arvicolinae/imunologia , Anticoncepcionais , Espermatozoides/imunologia , Animais , Anticorpos/sangue , Feminino , Ontologia Genética , Imunidade , Imunização , Masculino , Proteínas de Membrana/metabolismo , Peptídeos/metabolismo , Proteômica , Especificidade da Espécie
9.
Rev. ecuat. pediatr ; 22(2): 1-7, 31 de agosto del 2021.
Artigo em Espanhol | LILACS | ID: biblio-1284505

RESUMO

Introducción: El embarazo en adolescentes es un grave problema social con consecuencias perjudiciales para la madre y el niño. Es importante comprender los factores relacionados con este problema para poder desarrollar políticas sociales adecuadas. El presente trabajo identifica los factores predictores del embarazo en adolescentes en el Ecuador. Métodos: Se analiza la Encuesta Nacional de Salud y Nutrición 2018 (ENSANUT) del Instituto Nacional de Estadísticas y Censos del Ecuador. La muestra fue probabilística, se selecciona-ron registros mujeres de 10 a 24 años. Se utilizó estadística descriptiva y una análisis de regresión logística múltiple: la variable embarazo adolescente es la variable dependiente, las variables predictoras: educación, uso de anticonceptivos, situación socioeconómica, área, estado civil, edad en la primera relación sexual. Se reporta Odds ratio. Resultados: Fueron 38 casos/7587 (0.5%) casos de embarazo en mujeres de 10 a 14 años, 714/6053 (11.8%) de mujeres embarazadas de 15 a 18 años, y 1978/8599 (23%) casos de mu-jeres de 19 a 24 años que tuvieron una historia de embarazo adolescente. El embarazo adolescente fue de 2730 casos/22239 (12.28%). La variable estado civil "casada o de Unión libre" OR=2.53 (IC95% 2.50-2.56) P<0.001, relaciones sexuales antes de los 14 años OR 5.72 (IC95% 5.63-5.81) P<0.001, necesidades básicas insatisfechas OR = 1.57 (IC95% 1.55-1.59), Escolaridad OR=0.87 (IC95% 0.866-0.87) P<0.001 y el uso de anticonceptivos OR=0.53 (IC95% 0.525-0.537) P<0.001. La ecuación de predicción tiene una exactitud de 76.1%. Conclusiones: Es posible predecir el embarazo adolescente por lo que se debe trabajar en estas variables.


Introduction: Pregnancy in adolescents is a serious social problem with harmful consequences for the mother and the child. It is important to understand the factors related to this problem in order to develop adequate social policies. The present work identifies the predictive factors of adolescent pregnancy in Ecuador. Methods: The 2018 National Health and Nutrition Survey (ENSANUT) of the National Institute of Sta-tistics and Censuses of Ecuador is analyzed. The sample was probabilistic, female records between 10 and 24 years old were selected. Descriptive statistics and a multiple logistic regression analysis were used: the adolescent pregnancy variable is the dependent variable, the predictor variables: educa-tion, contraceptive use, socioeconomic status, area, marital status, age at first sexual intercourse. Odds ratio is reported. Results: There were 38 cases / 7587 (0.5%) cases of pregnancy in women aged 10 to 14 years, 714/6053 (11.8%) in pregnant women aged 15 to 18 years, and 1978/8599 (23%) cases of women. Women ages 19 to 24 who had a history of teenage pregnancy. Adolescent pregnancy was 2730 cases / 22239 (12.28%). The variable marital status "married or in a free union" OR = 2.53 (95% CI 2.50-2.56) P<0.001, sexual relations before the age of 14 OR 5.72 (95% CI 5.63-5.81) P<0.001, unsatisfied basic needs OR = 1.57 (95% CI 1.55-1.59), Schooling OR = 0.87 (95% CI 0.866-0.87) P<0.001 and contracep-tive use OR = 0.53 (95% CI 0.525-0.537) P<0.001. The prediction equation has an accuracy of 76.1%. Conclusions: It is possible to predict adolescent pregnancy, so it is necessary to work on these variables.


Assuntos
Humanos , Gravidez , Pré-Escolar , Criança , Adolescente , Gravidez na Adolescência , Análise de Regressão , Anticoncepcionais , Saúde Sexual , Saúde Sexual e Reprodutiva
10.
Womens Health Issues ; 31 Suppl 1: S66-S80, 2021 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-34454705

RESUMO

INTRODUCTION: The purpose of this scoping review was to apply the Social Ecological Model for Military Women's Health to literature on unintended pregnancy (UIP) to answer the question: In United States active duty military women (population) with the potential for UIP (context), what is known about risk factors, prevention, and pregnancy outcomes (concepts)? METHODS: We conducted this review based on a PRISMA-ScR protocol registered a priori in Open Science Framework. Following a literature search of six databases and the grey literature, we used DistillerSR to manage data screening and data charting. The Social Ecological Model for Military Women's Health served as the theoretical framework to chart findings regarding UIP at the individual, microsystem, mesosystem, exosystem, and macrosystem levels. RESULTS: A total of 74 research, review, and grey literature articles met the inclusion criteria. Risk factors included specific demographics, military service, and recent deployment. Prevention included contraceptive practices, access, and education that should take place early in servicewomen's careers and before deployment. Outcomes included early return from deployment, personal career challenges, and seeking alternative health services outside the military health system. CONCLUSIONS: Research and policy initiatives should focus on decreasing risk factors in the military working environment, with particular attention to the deployed environment. These initiatives should include input from military leaders, health care providers, servicewomen, and servicemen with the goal of decreasing the incidence of unintended pregnancies. Pregnancy intentionality among military women should be considered as a concept to shape intervention research to reduce unintended pregnancies.


Assuntos
Militares , Gravidez não Planejada , Anticoncepcionais , Feminino , Pessoal de Saúde , Humanos , Gravidez , Estados Unidos , Local de Trabalho
11.
Reprod Health ; 18(1): 178, 2021 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-34461925

RESUMO

BACKGROUND: South Africa faces a high burden of unmet contraceptive need, particularly among adolescent girls and young women. Providing contraception in community-based venues may overcome barriers to contraceptive access. Our objective was to explore the potential impact of the social environment and stylist-client interactions on perceived accessibility of contraceptives within hair salons. METHODS: We conducted 42 semi-structured, in-depth interviews with salon clients (100% identified as female, 100% identified as Black, median age 27.1 years) and 6 focus groups with 43 stylists (95% identified as female, 98% identified as Black, median age 29.6 years) in and around Umlazi Township, Durban, KwaZulu-Natal to explore perspectives on offering contraceptive services in hair salons. We used an inductive and deductive approach to generate the codebook, identified themes in the data, and then organized findings according to Rogers' Individual Adoption Model as applied to community-based health prevention programs. Twenty-five percent of transcripts were coded by two independent coders to ensure reliability. RESULTS: We identified elements of the salon environment and stylist-client relationships as facilitators of and barriers to acceptability of salon-based contraceptive care. Factors that may facilitate perceived contraceptive accessibility in salons include: the anonymous, young, female-centered nature of salons; high trust and kinship within stylist-client interactions; and mutual investment of time. Stylists may further help clients build comprehension about contraceptives through training. Stylists and clients believe salon-based contraceptive delivery may be more accessible due to contraceptive need facilitating client buy-in for the program, as well as a salon environment in which clients may encourage other clients by voluntarily sharing their own contraceptive decisions. The non-judgmental nature of stylist-client relationships can empower clients to make contraceptive decisions, and stylists seek to support clients' continued use of contraceptives through various adherence and support strategies. Some stylists and clients identified existing social barriers (e.g. confidentiality concerns) and made recommendations to strengthen potential contraceptive delivery in salons. CONCLUSION: Stylists and clients were highly receptive to contraceptive delivery in salons and identified several social facilitators as well as barriers within this setting. Hair salons are community venues with a social environment that may uniquely mitigate barriers to contraceptive access in South Africa.


Assuntos
Anticoncepção , Anticoncepcionais , Adolescente , Adulto , Feminino , Humanos , Relações Interpessoais , Pesquisa Qualitativa , Reprodutibilidade dos Testes , África do Sul
12.
BMC Womens Health ; 21(1): 305, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34407805

RESUMO

BACKGROUND: Afar region is one of the pastoralist dominated regions in Ethiopia. The region is characterized by a low contraceptive prevalence rate (CPR) of 5.4%. Lack of awareness of contraceptive use, husband objection and religious barriers are attributed to low CPR in the region. This study assessed the effect of community-based interventions for promoting family planning (FP) use among pastoralist communities in Ethiopia. METHODS: The study design was a three-arm, parallel, clustered randomized controlled trial (CRT). The three study arms were: (1) male involvement in family planning (FP) education; (2) women's education on FP; and (3) control. A total of 33 clusters were randomized and allocated with a one-to-one ratio. Intervention components included (1) health education on FP to married women and men by faema leaders (a traditional community-based structure that serves as a social support group); (2) video-assisted message on FP; and (3) assisting the faema leader using health workers and health extension workers (HEWs). The intervention was given for a total of nine months. FP use and intentions were measured as outcome variables. In addition, a cluster-level summary considering a cluster effect analysis was performed. The result was presented with t.test, adjusted risks and its 95% confidence interval (CI). RESULTS: The proportion of FP use among the arms was 34% in the male involvement in FP education, 17.5% in women's education on FP and 4.3% in the control. There was a positive change in the proportion of FP use in the male involvement in FP education and women's education on FP arms with absolute risk (AR) of 0.29 (95% CI, 0.23,0.34) and 0.13 (95% CI,0.08,0.17), respectively, as compared to the control arm. Similarly, married women in the male involvement in FP education and women's education on FP arms had 3.4 (2.48, 4.91) and 2.1 (1.50, 2.95) higher intention to use FP, respectively, as compared with the control arm. CONCLUSION: The present study suggests that in such male-dominated pastoralist communities with more considerable religious barriers, the community-based health education mainly targeting males appears to be a promising strategy for improving FP use and intention to use FP. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03450564, March, 2018.


Assuntos
Serviços de Planejamento Familiar , Educação Sexual , Comportamento Contraceptivo , Anticoncepcionais , Etiópia , Feminino , Humanos , Masculino , Casamento
14.
Int J Equity Health ; 20(1): 186, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34412647

RESUMO

BACKGROUND: Although evidence suggest that many slum dwellers in low- and middle-income countries have the most difficulty accessing family planning (FP) services, there are limited workable interventions/models for reaching slum communities with FP services. This review aimed to identify existing interventions and service delivery models for providing FP services in slums, and as well examine potential impact of such interventions and service delivery models in low- and middle-income settings. METHODS: We searched and retrieved relevant published studies on the topic from 2000 to 2020 from e-journals, health sources and six electronic databases (MEDLINE, Global Health, EMBASE, CINAHL, PsycINFO and Web of Science). Grey and relevant unpublished literature (e.g., technical reports) were also included. For inclusion, studies should have been published in a low- and middle-income country between 2000 and 2020. All study designs were included. Review articles, protocols or opinion pieces were excluded. Search results were screened for eligible articles and reports using a pre-defined criterion. Descriptive statistics and narrative syntheses were produced to summarize and report findings. RESULTS: The search of the e-journals, health sources and six electronic databases including grey literature and other unpublished materials produced 1,260 results. Following screening for title relevance, abstract and full text, nine eligible studies/reports remained. Six different types of FP service delivery models were identified: voucher schemes; married adolescent girls' club interventions; Willows home-based counselling and referral programme; static clinic and satellite clinics; franchised family planning clinics; and urban reproductive health initiatives. The urban reproductive health initiatives were the most dominant FP service delivery model targeting urban slums. As regards the impact of the service delivery models identified, the review showed that the identified interventions led to improved targeting of poor urban populations, improved efficiency in delivery of family planning service, high uptake or utilization of services, and improved quality of family planning services. CONCLUSIONS: This review provides important insights into existing family planning service delivery models and their potential impact in improving access to FP services in poor urban slums. Further studies exploring the quality of care and associated sexual and reproductive health outcomes as a result of the uptake of these service delivery models are essential. Given that the studies were reported from only 9 countries, further studies are needed to advance knowledge on this topic in other low-middle income countries where slum populations continue to rise.


Assuntos
Serviços de Planejamento Familiar/organização & administração , Acesso aos Serviços de Saúde , Áreas de Pobreza , Saúde Reprodutiva , Adolescente , Adulto , Criança , Anticoncepção , Anticoncepcionais , Atenção à Saúde , Feminino , Humanos , Masculino , Gravidez , Adulto Jovem
15.
BMC Med ; 19(1): 178, 2021 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-34384443

RESUMO

BACKGROUND: Preventing unintended pregnancies is paramount for women living with HIV (WLHIV). Previous studies have suggested that efavirenz-containing antiretroviral therapy (ART) reduces contraceptive effectiveness of implants, but there are uncertainties regarding the quality of the electronic medical record (EMR) data used in these prior studies. METHODS: We conducted a retrospective, cohort study of EMR data from 2011 to 2015 among WLHIV of reproductive age accessing HIV care in public facilities in western Kenya. We validated a large subsample of records with manual chart review and telephone interviews. We estimated adjusted incidence rate ratios (aIRRs) with Poisson regression accounting for the validation sampling using inverse probability weighting and generalized raking. RESULTS: A total of 85,324 women contributed a total of 170,845 women-years (w-y) of observation time; a subset of 5080 women had their charts reviewed, and 1285 underwent interviews. Among implant users, the aIRR of pregnancy for efavirenz- vs. nevirapine-containing ART was 1.9 (95% CI 1.6, 2.4) using EMR data only and 3.2 (95% CI 1.8, 5.7) when additionally using both chart review and interview validated data. Among efavirenz users, the aIRR of pregnancy for depomedroxyprogesterone acetate (DMPA) vs. implant use was 1.8 (95% CI 1.5, 2.1) in EMR only and 2.4 (95% CI 1.0, 6.1) using validated data. CONCLUSION: Pregnancy rates are higher when contraceptive implants are concomitantly used with efavirenz-containing ART, though rates were similar to leading alternative contraceptive methods such as DMPA. Our data provides policymakers, program staff, and WLHIV greater confidence in guiding their decision-making around contraceptive and ART options. Our novel, 3-phase validation sampling provides an innovative tool for using routine EMR data to improve the robustness of data quality.


Assuntos
Anticoncepcionais , Infecções por HIV , Estudos de Coortes , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Quênia/epidemiologia , Gravidez , Estudos Retrospectivos
16.
Pan Afr Med J ; 39: 39, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34422162

RESUMO

Introduction: contraceptives in family planning are used to control the timings between pregnancies. Although the number of those using family planning has increased, determinants of contraceptive use among women in Indonesia remain insufficient. This research aimed to identify the factors associated with contraceptive use among reproductive aged women in Bangka Belitung Province. Methods: this study employed data from the Indonesian demographic and health survey (IDHS) 2017. The selected respondents were 768 women aged 15-49 years. Then, the determinants of contraceptive use among women were examined by multinomial logistic regression. Results: women's aged 15-49 years (adjusted Odds Ratio (aOR) =8.955; 95% CI=3.573-22.439), level of education (aOR=2.017; 95% CI=1.053-3.862), the number of children (aOR=1.207; 95% CI=0.498-2.926), residential location (aOR=0.877; 95% CI=0.601-1.282), wealth index (aOR=2.23; 95% CI=0.953-5.218), visited health facilities (aOR=1.683; 95% CI=1.174-2.412), knowledge of contraceptive method (aOR=2.043; 95% CI=2.043-2.043) were significantly associated with contraceptive use among reproductive age women. Conclusion: factors such as women's age, education, number of living children, area of residence, wealth index, knowledge, and visits to health facilities were still considered significant issues in determining contraceptive use among reproductive-age women in Bangka Belitung Province.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/métodos , Anticoncepcionais/administração & dosagem , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Fatores Etários , Anticoncepção/estatística & dados numéricos , Escolaridade , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Indonésia , Pessoa de Meia-Idade , Adulto Jovem
17.
BMC Med Educ ; 21(1): 430, 2021 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-34399761

RESUMO

BACKGROUND: Pharmacists are often the first healthcare professionals that patients contact with their illnesses and requests for medical information, which is enhanced following the recent COVID-19 pandemic. Community pharmacists are expected and required to possess a broad spectrum of knowledge and skills. Self-assessment of these competencies is needed for their self-improvement. PURPOSE OF THE STUDY: To assess pharmacists' clinical knowledge and practice in the safe use of contraceptives, and to compare the scores obtained by external observation with pharmacists' self-assessment of their knowledge as well as investigate the significance of preceptorship experiences. Contraceptives was chosen as the subject area in view of high rates of abortions as a means of contraception in Bosnia and Herzegovina. METHODS: A questionnaire approach was used. The questionnaire included the following: the first domain contained two case scenarios (safe use of contraceptives), which evaluated clinical knowledge, a second domain in which pharmacists self-assessed their knowledge to resolve cases from the first domain and a third domain that measured the demographics of pharmacists (including experience in preceptorship). Dispensing practice was evaluated in the second domain. The questionnaires were distributed to a convenient sample of 100 pharmacists at the Annual Meeting of Bosnia and Herzegovina Pharmacists. The results were presented as counts (%). The groups (preceptors and non-preceptors) were compared using Mann-Whitney U test, paired assessments were analyzed by Wilcoxon signed-rank test and Spearman's correlation was used to assess the correlation between variables. RESULTS: Of the 100 pharmacists invited to participate, 84 completed the questionnaire (84 % response rate). There was no agreement between pharmacists' real knowledge (average score - case 1: 2.71, case 2: 3.3) and their self-assessment (average score - case 1: 3.77, case 2: 3.91). There was no statistically significant difference in the actual knowledge of pharmacists (experienced/non-experienced in precepting), while the difference in the self-assessment was significant between these two groups. CONCLUSION: Pharmacists appear to overrate themselves, which leads to self-enhancement bias, in which the experience in precepting has some influence. Pharmacists' capability in performing an objective self-assessment of their clinical knowledge needs to be carefully studied in the future to fully benefit patients.


Assuntos
COVID-19 , Farmacêuticos , Anticoncepcionais , Feminino , Humanos , Pandemias , Gravidez , SARS-CoV-2 , Autoimagem
18.
BMC Health Serv Res ; 21(1): 784, 2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372830

RESUMO

BACKGROUND: Clients must recall information from contraceptive counseling sessions to properly use their chosen method. Client recall in community-based settings is challenging given the public nature of these events and the presence of many potential distractions. Understanding the factors that influence client recall during community-based distribution events can guide future training of providers to improve proper use of contraceptive methods and client satisfaction. METHODS: This cross-sectional study employed a convenience sample of 957 women ages 15-49 old who sought contraceptive services from community-based contraceptive distribution events in Kinshasa, Democratic Republic of the Congo, known as Lelo PF. Recall scores were developed by matching direct observations with client exit interviews. The association between recall and client characteristics, provider characteristics and an index for the quality of the provider-client interaction were tested using multivariate linear regression. RESULTS: The average recall score was 67.6%. Recall scores were higher among clients who accepted methods with simpler administration procedures, such as CycleBeads (81.3%), compared to methods requiring more medically advanced administration procedures, such as DMPA-SC (56.6%) and Implanon-NXT (62.1%). This relationship held even after controlling for amount of information each client received. Status as a first-time user was associated with a 5.8 percentage point decrease in recall score (p = 0.002). Time since the provider's initial family planning training and clients' perception of the provider-client interaction were associated with higher client recall scores. CONCLUSION: Results of this study suggest that to improve client recall at Lelo PF events, future provider training should focus on how to deliver clear, specific information to clients, making sure clients feel at ease during the counseling session, and treating clients with respect. First-time family planning users and clients who select methods with more medically advanced administration procedures may require extra attention during the consultation to ensure they are able understand and remember the information. Results suggest that providers who have been offering services longer may be more effective in conveying information in a way that clients can remember. Program managers should consider requesting input from experienced providers to improve training sessions.


Assuntos
Aconselhamento , Serviços de Planejamento Familiar , Adolescente , Adulto , Anticoncepcionais , Estudos Transversais , República Democrática do Congo , Feminino , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Adulto Jovem
19.
BMJ Open ; 11(8): e046536, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34408034

RESUMO

OBJECTIVE: To examine the effects of a positive deviance intervention on dual-method contraceptive use among married or in-union women. DESIGN: Open-label cluster randomised controlled trial. SETTING: 20 health facilities in Mbarara District, Uganda. PARTICIPANTS: 960 married or in-union women aged 18-49 years using a non-barrier modern contraceptive method. INTERVENTIONS: A combination of clinic-based and telephone-based counselling and a 1-day participatory workshop, which were developed based on a preliminary qualitative study of women practising dual-method contraception. PRIMARY OUTCOME MEASURE: Dual-method contraceptive use at the last sexual intercourse and its consistent use in the 2 months prior to each follow-up. These outcomes were measured based on participants' self-reports, and the effect of intervention was assessed using a mixed-effects logistic regression model. RESULTS: More women in the intervention group used dual-method contraception at the last sexual intercourse at 2 months (adjusted OR (AOR)=4.12; 95% CI 2.02 to 8.39) and 8 months (AOR=2.16; 95% CI 1.06 to 4.41) than in the control group. At 4 and 6 months, however, the proportion of dual-method contraceptive users was not significantly different between the two groups. Its consistent use was more prevalent in the intervention group than in the control group at 2 months (AOR=14.53; 95% CI 3.63 to 58.13), and this intervention effect lasted throughout the follow-up period. CONCLUSIONS: The positive deviance intervention increased dual-method contraceptive use among women, and could be effective at reducing the dual risk of unintended pregnancies and HIV infections. This study demonstrated that the intervention targeting only women can change behaviours of couples to practise dual-method contraception. Because women using non-barrier modern contraceptives may be more reachable than men, interventions targeting such women should be recommended. TRIAL REGISTRATION NUMBER: UMIN000037065.


Assuntos
Anticoncepcionais , Infecções por HIV , Anticoncepção , Comportamento Contraceptivo , Feminino , Humanos , Masculino , Gravidez , Uganda
20.
Reprod Health ; 18(1): 173, 2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34419083

RESUMO

OBJECTIVE: To evaluate the type of contraceptives used by women in need of family planning in India and the inequalities associated with that use according to women's age, education, wealth, subnational region of residence and empowerment level. METHODS: Using data from the Indian National Family and Health Survey-4 (2015-2016), we evaluated the proportion of partnered women aged 15-49 years with demand for family planning satisfied (DFPS) with modern contraceptive methods. We also explored the share of each type of contraception [short- (e.g., condom, pill) and long-acting (i.e., IUD) reversible contraceptives and permanent methods] and related inequalities. RESULTS: The majority (71.8%; 95% CI 71.4-72.2) of women in need of contraception were using a modern method, most (76.1%) in the form of female sterilization. Condom and contraceptive pill were the second and third most frequently used methods (11.8% and 8.5%, respectively); only 3.2% reported IUD. There was a nearly linear exchange from short-acting to permanent contraceptive methods as women aged. Women in the poorest wealth quintile had DFPS with modern methods at least 10 percentage points lower than other women. We observed wide geographic variation in DFPS with modern contraceptives, ranging from 23.6% (95% CI 22.1-25.2) in Manipur to 93.6% (95% CI 92.8-94.3) in Andhra Pradesh. Women with more accepting attitudes towards domestic violence and lower levels of social independence had higher DFPS with modern methods but also had higher reliance on permanent methods. Among sterilized women, 43.2% (95% CI 42.7-43.7) were sterilized before age 25, 61.5% (95% CI 61.0-62.1) received monetary compensation for sterilization, and 20.8% (95% CI 20.3-21.3) were not informed that sterilization prevented future pregnancies. CONCLUSION: Indian family planning policy should prioritize women-centered care, making reversible contraceptive methods widely available and promoted.


Assuntos
Anticoncepcionais , Serviços de Planejamento Familiar , Adulto , Anticoncepção , Comportamento Contraceptivo , Feminino , Humanos , Índia , Gravidez
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