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1.
Rev. Hosp. Ital. B. Aires (2004) ; 40(4): 227-232, dic. 2020. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1145596

RESUMO

La enfermedad producida por el nuevo coronavirus SARS-CoV-2 se identificó por primera vez en diciembre de 2019 en la ciudad de Wuhan, en la República Popular China, y en pocos meses se convirtió en una pandemia. Desde el comienzo ha sido un desafío mundial, que amenazó la salud pública y obligó a tomar medidas estrictas de aislamiento social. Como consecuencia de la emergencia sanitaria se ha producido una reducción importante de la actividad asistencial, que puso en riesgo el acceso y la continuidad de los métodos anticonceptivos, exponiendo a mujeres a embarazos no intencionales. Los derechos sexuales y reproductivos resultan esenciales y deben garantizarse siempre. (AU)


The disease caused by the new coronavirus SARS-CoV-2 was identified for the first time in December 2019 in the city of Wuhan, in the People's Republic of China, and within a few months it became a pandemic. From the beginning, it has been a global challenge, threatening public health, having to take strict measures of social isolation. As a consequence of the health emergency, there has been a significant reduction in healthcare activity, putting access and continuity of contraceptive methods at risk, exposing women to unintended pregnancies. Sexual and reproductive rights are essential and must always be guaranteed. (AU)


Assuntos
Humanos , Feminino , Pneumonia Viral/complicações , Infecções por Coronavirus/complicações , Contracepção Hormonal/métodos , Pneumonia Viral/patologia , Gravidez não Desejada , Infecções por Coronavirus/patologia , Anticoncepcionais/administração & dosagem , Anticoncepcionais/classificação , Anticoncepcionais/provisão & distribução , Direitos Sexuais e Reprodutivos , Coagulação Intravascular Disseminada/etiologia , Tromboembolia Venosa/etiologia , Pandemias , Betacoronavirus , Acesso aos Serviços de Saúde
2.
PLoS One ; 15(8): e0236659, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745110

RESUMO

BACKGROUND: Until 2011, stockouts of family planning commodities were common in Senegalese public health facilities. Recognizing the importance of addressing this problem, the Government of Senegal implemented the Informed Push Model (IPM) supply system, which involves logisticians to collect facility-level stock turnover data once a month and provide contraceptive supplies accordingly. The aims of this paper were to evaluate the impact of IPM on contraceptive availability and on stockout duration. METHODS AND FINDINGS: To estimate the impact of the IPM on contraceptive availability, stock card data were obtained from health facilities selected through multistage sampling. A total number of 103 health facilities pertaining to 27 districts and nine regions across the country participated in this project. We compared the odds of contraceptive stockouts within the health facilities on the 23 months after the intervention with the 18 months before. The analysis was performed with a logistic model of the monthly time-series. The odds of stockout for any of the five contraceptive products decreased during the 23 months post-intervention compared to the 18 months pre-intervention (odds ratio, 95%CI: 0.34, 0.22-0.51). To evaluate the impact of the IPM on duration of stockouts, a mixed negative binomial zero-truncated regression analysis was performed. The IPM was not effective in reducing the duration of contraceptive stockouts (incidence rate ratio, 95%CI: 0.81, 0.24-2.7), except for the two long-acting contraceptives (intrauterine devices and implants). Our model predicted a decrease in stockout median duration from 23 pre- to 4 days post-intervention for intrauterine devices; and from 19 to 14 days for implants. CONCLUSIONS: We conclude that the IPM has resulted in greater efficiency in contraceptive stock management, increasing the availability of contraceptive methods in health facilities in Senegal. The IPM also resulted in decreased duration of stockouts for intrauterine devices and implants, but not for any of the short-acting contraception (pills and injectables).


Assuntos
Anticoncepção/instrumentação , Anticoncepcionais/provisão & distribução , Serviços de Planejamento Familiar/provisão & distribução , Acesso aos Serviços de Saúde/estatística & dados numéricos , Dispositivos Intrauterinos/provisão & distribução , Senegal
3.
PLoS One ; 15(8): e0236352, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760153

RESUMO

INTRODUCTION: Despite the desire of adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) to use contraceptives, the majority of them have challenges with access to contraceptive services. This is more evident in high fertility countries in SSA. The purpose of this study was to examine the predictors of unmet need for contraception among AGYW in selected high fertility countries in SSA. MATERIALS AND METHODS: Data from current Demographic and Health Surveys (DHS) carried out between 2010 and 2018 in 10 countries in SSA were analysed. A sample size of 24,898 AGYW who were either married or cohabiting was used. Unmet need for contraception was the outcome variable in this study. The explanatory variables were age, marital status, occupation, educational level, frequency of reading newspaper/magazine, frequency of listening to radio, frequency of watching television and parity (individual level variables) and wealth quintile, sex of household head, place of residence and decision-maker in healthcare (household/community level variables). Descriptive and multilevel logistic regression analyses were carried out. The results of the multilevel logistic regression analyses were reported using adjusted odds ratios at 95% confidence interval. RESULTS: The prevalence of unmet need for contraception in all the countries considered in this study was 24.9%, with Angola, recording the highest prevalence of 42.6% while Niger had the lowest prevalence of 17.8%. In terms of the individual level predictors, the likelihood of unmet need for contraception was low among AGYW aged 20-24 [aOR = 0.82; 95% CI = 0.76-0.88], those with primary [aOR = 1.22; 95% CI = 1.13-1.31] and secondary/higher levels of formal education [aOR = 1.18; 95% CI = 1.08-1.28, p < 0.001], cohabiting AGYW [aOR = 1.52; 95% CI = 1.42-1.63] and AGYW with three or more births [aOR = 3.41; 95% CI = 3.02-3.85]. At the household/community level, the odds of unmet need for contraception was highest among poorer AGYW [aOR = 1.36; 95% CI = 1.21-1.53], AGYW in female-headed households [aOR = 1.22; 95% CI = 1.13-1.33], urban AGYW [aOR = 1.21; 95% CI = 1.11-1.32] and AGYW who took healthcare decisions alone [aOR = 1.10; 95% CI = 1.01-1.21]. CONCLUSION: This study has identified disparities in unmet need for contraception among AGYW in high fertility countries in SSA, with AGYW in Angola having the highest prevalence. Both individual and household/community level factors predicted unmet need for contraception among AGYW in this study. However, based on the ICC values, household/community level factors prevailed the individual level factors. Enhancing access to contraception among poorer AGYW, those in female-headed households, those in urban areas and those who take healthcare decisions alone by both governmental and non-governmental organisations in high fertility countries is recommended.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Anticoncepcionais/provisão & distribução , Dispositivos Anticoncepcionais/provisão & distribução , Serviços de Planejamento Familiar/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Adolescente , África ao Sul do Saara , Feminino , Inquéritos Epidemiológicos , Humanos , Estado Civil/estatística & dados numéricos , Análise Multinível/métodos , Fatores Socioeconômicos , Adulto Jovem
5.
Best Pract Res Clin Obstet Gynaecol ; 66: 107-118, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32527659

RESUMO

This article sets out the progress that has been made in reducing levels of adolescent childbearing and in meeting adolescent contraceptive needs, over the last 25 years, and also makes the public health, economic, and human rights rationale for continued attention to and investment in these areas. Using an analytic framework that covers the perspectives of both the use and the provision of contraception, it examines the factors that make it difficult for adolescents to obtain and use contraceptives to avoid unintended pregnancies, and outlines what could be done to address these factors, drawing from research evidence and programmatic experience. In doing this, the article provides concrete examples from low- and middle-countries that have made tangible progress in these areas.


Assuntos
Comportamento Contraceptivo , Anticoncepção/estatística & dados numéricos , Serviços de Planejamento Familiar/organização & administração , Acesso aos Serviços de Saúde , Gravidez na Adolescência/prevenção & controle , Adolescente , Serviços de Saúde do Adolescente , Anticoncepcionais/administração & dosagem , Anticoncepcionais/provisão & distribução , Dispositivos Anticoncepcionais , Feminino , Direitos Humanos , Humanos , Gravidez
6.
Womens Health Issues ; 30(4): 268-276, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32376188

RESUMO

BACKGROUND: The Zika Contraception Access Network (Z-CAN) was designed to provide women in Puerto Rico who chose to delay or avoid pregnancy during the 2016-2017 Zika virus outbreak access to high-quality client-centered contraceptive counseling and the full range of reversible contractive methods on the same day and at no cost through a network of trained providers. We evaluated the implementation of Z-CAN from the patient perspective. METHODS: An online survey, administered to a subset of women served by the Z-CAN program approximately 2 weeks after their initial Z-CAN visit, assessed patient satisfaction and receipt of services consistent with select program strategies: receipt of high-quality client-centered contraceptive counseling, same-day access to the contraceptive method they were most interested in after counseling, and no-cost contraception. RESULTS: Of 3,503 respondents, 85.2% reported receiving high-quality client-centered contraceptive counseling. Among women interested in a contraceptive method after counseling (n = 3,470), most reported same-day access to that method (86.8%) and most reported receiving some method of contraception at no cost (87.4%). Women who reported receiving services according to Z-CAN program strategies were more likely than those who did not to be very satisfied with services. Women who received high-quality client-centered contraceptive counseling and same-day access to the method they were most interested in after counseling were also more likely to be very satisfied with the contraceptive method received. CONCLUSIONS: A contraception access program can be rapidly implemented with high fidelity to program strategies in a fast-moving and complex public health emergency setting.


Assuntos
Anticoncepcionais/provisão & distribução , Aconselhamento/métodos , Acesso aos Serviços de Saúde/organização & administração , Satisfação do Paciente , Assistência Centrada no Paciente , Infecção por Zika virus/prevenção & controle , Zika virus , Adulto , Anticoncepção/métodos , Comportamento Contraceptivo , Surtos de Doenças/prevenção & controle , Serviços de Planejamento Familiar/organização & administração , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Gravidez , Porto Rico/epidemiologia , Infecção por Zika virus/epidemiologia
7.
Reprod Health ; 16(1): 161, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703700

RESUMO

BACKGROUND: Despite improved health facility access relative to rural areas, distance and transportation remain barriers in some urban areas. Using household and facility data linked to residential and transportation geographic information we describe availability of health facilities offering long-acting reversible contraceptive (LARC) methods and measure access via matatus (privately owned mid-size vehicles providing public transport) in urban Kenya. METHODS: Study data were collected by the Measurement, Learning and Evaluation (MLE) Project. Location information for clusters (2010) representative of city-level population were used to identify formal and informal settlement residents. We measured straight-line distances between clusters and facilities that participated in facility audits (2014) and offered LARCs. In Kisumu, we created a geographic database of matatu routes using Google Earth. In Nairobi, matatu route data were publicly available via the Digital Matatus Project. We measured straight-line distance between clusters and matatu stops on 'direct' routes (matatu routes with stop(s) ≤1 km from health facility offering LARCs). Facility and matatu access were compared by settlement status using descriptive statistics. We then used client exit interview data from a subset of facilities in Nairobi (N = 56) and Kisumu (N = 37) Kenya (2014) to examine the frequency of matatu use for facility visits. RESULTS: There were 141 (Informal = 71; Formal = 70) study clusters in Nairoibi and 73 (Informal = 37; Formal = 36) in Kisumu. On average, residential clusters in both cities were located ≤1 km from a facility offering LARCs and ≤ 1 km from approximately three or more matatu stops on direct routes regardless of settlement status. Client exit interview data in Nairobi (N = 1602) and Kisumu (N = 1158) suggest that about 25% of women use matatus to visit health facilities. On average, women who utilized matatus travelled 30 min to the facility, with 5% travelling more than 1 hour. Matatu use increased with greater household wealth. CONCLUSIONS: Overall, formal and informal settlement clusters were within walking distance of a facility offering LARCs, and multiple matatu stops were accessible to get to further away facilities. This level of access will be beneficial as efforts to increase LARC use expand, but the role of wealth and transportation costs on access should be considered, especially among urban poor.


Assuntos
Anticoncepcionais/provisão & distribução , Serviços de Planejamento Familiar/estatística & dados numéricos , Instalações de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde , Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Adolescente , Adulto , Cidades , Feminino , Humanos , Quênia , Pessoa de Meia-Idade , População Rural , Adulto Jovem
8.
Glob Health Sci Pract ; 7(2): 240-257, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31249021

RESUMO

Donors and others are concerned that implants procured under the Family Planning 2020 Initiative exceed the number sought by clients, resulting in accumulating stocks. To explore this issue, we examined 3 questions across 9 countries: (1) How accurate were procurement quantities given requirements for filling supply chains for the rapidly growing implant programs? (2) Is there a standard factor that can be applied to consumption data to predict procurement volumes required? (3) How accurately do demographic estimates mirror dispensed-to-client data? We created a model incorporating public-sector supply chain system parameters to calculate system "imputed" inventory and the system "filled-to-max" inventory. Comparing results determined the adequacy of the procurement quantities. The proportion of consumption that the filled-to-max inventory represented through time suggests whether a standard factor can be applied to consumption to predict necessary procurement volumes. We compared demographic estimates to consumption data to determine the usability of the former in predicting demand. According to model results, 3 of the 9 countries came close to procuring accurate quantities over the study period between 2010 and 2017, 4 had procurement volumes lower than what was required to fill the supply chain to maximum inventory requirement levels, and 2 had volumes that exceeded the need. We found no standard factor for relating inventory quantities to consumption rates across countries, given that inventory needs can vary based on system design parameters and the rates of growth or decline in consumption. Finally, we observed that our demographic estimates were on average lower than the dispensed-to-client data in the 6 countries for which these data were available. Study results show that the significant investments in procurement quantities for the rapidly growing implant programs were justified based on consumption and system design. This research should assure observers that rapid increases in implant procurement quantities (where data are available) have generally not resulted in overstocks of the system to date. It suggests that the relationship between procurement quantities and consumption levels cannot be accurately assessed without understanding the country supply chain, inventory control parameters, and current and future demand.


Assuntos
Comportamento Contraceptivo , Anticoncepção , Anticoncepcionais/provisão & distribução , Implantes de Medicamento/provisão & distribução , Serviços de Planejamento Familiar/métodos , Acesso aos Serviços de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , África , Anticoncepcionais/administração & dosagem , Tomada de Decisões Gerenciais , Demografia , Países em Desenvolvimento , Características da Família , Feminino , Humanos , Cooperação Internacional , Paquistão , Setor Público
9.
Sex Reprod Healthc ; 19: 50-55, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30928135

RESUMO

OBJECTIVE: This longitudinal study examined access to, and factors associated with, receipt of sexual and reproductive health services deemed essential by the World Health Organization among pregnant adolescents in New York City. METHODS: Participants included 649 pregnant adolescents, ages 14-21 who were enrolled in a clustered randomized controlled trial from 2008 to 2012. Data were collected via medical record abstraction and structured surveys during the second and third trimesters of pregnancy and 12-months postpartum. We used multivariable logistic regression to test associations between measures of social and economic vulnerability (age, race/ethnicity, immigration status, food and housing security, relationship status, perceived discrimination) and access to core sexual and reproductive health services (perinatal care, contraception, HIV testing, sexual health knowledge). RESULTS: Only 4% of participants received all four core aspects of sexual and reproductive health assessed. Adolescents <18 years old had lower odds of contraception use (OR = 0.46, CI 0.27-0.78), having had an HIV test (OR = 0.35, CI 0.16-0.78), and high sexual health knowledge (OR = 0. 59, CI 0.37-0.95), compared to those ≥18 years. Black women were significantly more likely to have high sexual health knowledge compared to other women (OR = 1.84, CI 1.05, 3.22). Immigrants had higher odds of adequate perinatal care (OR = 1.60, CI 1.09-2.36) and contraception use (OR = 1.64, CI 1.07-2.53), but lower likelihood of high sexual health knowledge (OR = 0.52, CI 0.34-0.81), compared to US-born counterparts. Food insecurity was associated with lower likelihood of comprehensive perinatal care (OR = 0.63, CI 0.45-0.90). CONCLUSIONS: Access to sexual and reproductive health services in New York City is poor among vulnerable adolescents. Health practice and policy should assure access to fundamental sexual and reproductive health services among vulnerable populations in the United States.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Infecções por HIV/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Assistência Perinatal , Serviços de Saúde Reprodutiva/provisão & distribução , Adolescente , Fatores Etários , Anticoncepcionais/provisão & distribução , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Abastecimento de Alimentos , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Estudos Longitudinais , Cidade de Nova Iorque , Gravidez , Gravidez na Adolescência , Saúde Sexual , Inquéritos e Questionários , Adulto Jovem
10.
Int Perspect Sex Reprod Health ; 45: 87-98, 2019 12 30.
Artigo em Inglês | MEDLINE | ID: mdl-31895041

RESUMO

CONTEXT: Bangladesh's pluralistic health system has diversified opportunities for clients to obtain family planning, but public-private partnerships could improve access to services, particularly in urban areas. METHOD: Sixteen providers, clients and program managers were interviewed to assess perspectives on a family planning orientation and demand-side financing referral program tested in Mirpur, Bangladesh. The 15-month program, conducted in 2015-2016, was designed to encourage private providers to identify non-family planning clients with unmet contraceptive needs, promote choice of a broader contraceptive mix and refer clients to one of three public or nonprofit clinics for provision of their preferred method. Use of the system was assessed by tracking referral slips. RESULTS: Most stakeholders reported that it was acceptable and feasible to discuss fertility intentions with clients presenting for non-family planning matters. Providers were able to alleviate clients' misconceptions and fears concerning long-acting contraceptive methods, but were unable to address patriarchal and religious barriers. The majority of referrals were done by private providers who had a pre-existing relationship with one of the family planning clinics and referred clients to that clinic; overall, documented referrals accounted for 13% of provision of reversible and permanent methods at that clinic during the study period. CONCLUSIONS: Providing private practitioners with appropriate training on contraceptives and referral could improve Bangladeshi women's access to long-acting and other contraceptive methods in urban areas, and may be useful for other types of health workers. Further study of suitable referral systems is warranted.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais/provisão & distribução , Serviços de Planejamento Familiar/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Serviços Urbanos de Saúde/organização & administração , Adulto , Atitude do Pessoal de Saúde , Bangladesh , Estudos de Viabilidade , Feminino , Acesso aos Serviços de Saúde/organização & administração , Humanos , População Urbana/estatística & dados numéricos
11.
Afr J Reprod Health ; 23(4): 63-74, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32227741

RESUMO

In spite of the improvements in knowledge about family planning (FP), the contraceptive prevalence rate and unmet need for FP remain poor in most parts of Northern Nigeria. This study sought to explore specific factors that influence contraceptive uptake and demand in North-West Nigeria. Key Informant and In-depth Interviews were conducted using guides among stakeholders in two selected states in North-West Nigeria, Kebbi and Sokoto States. Interviewees were selected purposively to include Reproductive Health Focal Persons at the local government level, service providers, Women of Reproductive Age (WRA) and FP coordinators. Factors inhibiting contraceptive uptake included lack of health education, religion, fear of spousal rejection and side effects. Poor government funding and inadequate number of health workers were also identified as systemic factors. Suggested methods of overcoming identified challenges include; task-shifting, increased stakeholder participation and political will.


Assuntos
Comportamento Contraceptivo/psicologia , Anticoncepção/psicologia , Anticoncepcionais/provisão & distribução , Serviços de Planejamento Familiar/organização & administração , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Adolescente , Adulto , Anticoncepção/estatística & dados numéricos , Comportamento Contraceptivo/etnologia , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais/administração & dosagem , Estudos Transversais , Características Culturais , Serviços de Planejamento Familiar/métodos , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Entrevistas como Assunto , Islamismo , Pessoa de Meia-Idade , Nigéria , Pesquisa Qualitativa , Saúde Reprodutiva , Parceiros Sexuais , Adulto Jovem
12.
BMC Public Health ; 19(1): 1752, 2019 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-31888577

RESUMO

BACKGROUND: Ambitious global goals have been established to provide universal access to affordable modern contraceptive methods. To measure progress toward such goals in populous countries like Nigeria, it's essential to characterize the current levels and trends of family planning (FP) indicators such as unmet need and modern contraceptive prevalence rates (mCPR). Moreover, the substantial heterogeneity across Nigeria and scale of programmatic implementation requires a sub-national resolution of these FP indicators. The aim of this study is to estimate the levels and trends of FP indicators at a subnational scale in Nigeria utilizing all available data and accounting for survey design and uncertainty. METHODS: We utilized all available cross-sectional survey data from Nigeria including the Demographic and Health Surveys, Multiple Indicator Cluster Surveys, National Nutrition and Health Surveys, and Performance, Monitoring, and Accountability 2020. We developed a hierarchical Bayesian model that incorporates all of the individual level data from each survey instrument, accounts for survey uncertainty, leverages spatio-temporal smoothing, and produces probabilistic estimates with uncertainty intervals. RESULTS: We estimate that overall rates and trends of mCPR and unmet need have remained low in Nigeria: the average annual rate of change for mCPR by state is 0.5% (0.4%,0.6%) from 2012-2017. Unmet need by age-parity demographic groups varied significantly across Nigeria; parous women express much higher rates of unmet need than nulliparous women. CONCLUSIONS: Understanding the estimates and trends of FP indicators at a subnational resolution in Nigeria is integral to inform programmatic decision-making. We identify age-parity-state subgroups with large rates of unmet need. We also find conflicting trends by survey instrument across a number of states. Our model-based estimates highlight these inconsistencies, attempt to reconcile the direct survey estimates, and provide uncertainty intervals to enable interpretation of model and survey estimates for decision-making.


Assuntos
Anticoncepcionais/provisão & distribução , Serviços de Planejamento Familiar , Necessidades e Demandas de Serviços de Saúde , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Nigéria , Gravidez , Inquéritos e Questionários , Incerteza , Adulto Jovem
13.
Glob Health Sci Pract ; 6(4): 657-667, 2018 12 27.
Artigo em Inglês | MEDLINE | ID: mdl-30591574

RESUMO

In a context where distance, user fees, and health staff shortages constitute significant barriers to accessing facility-based family planning services, the use of community-based distributors (CBDs) as counseling and contraceptive providers has been tested in several resource-constrained environments to increase family planning uptake. In the capital city of the Democratic Republic of the Congo (DRC), Kinshasa, a massive CBD program (AcQual) has been implemented since 2014, with lackluster results measured in terms of the low volume of contraceptives provided. A process evaluation conducted in 2017 assessed the fidelity of implementation of the program compared with the original AcQual design and analyzed gaps in provider training and motivation, contraceptive supplies, and reporting and monitoring processes. Its objective was to identify both theory and implementation failures in order to propose midcourse corrections for the program. The mixed-method data collection focused on the CBDs as a pivotal component of the AcQual program with 700 active CBDs interviewed. In addition, 10 in-depth interviews were conducted with clinical personnel, local health program managers, and project partners to identify gaps in the AcQual implementation environment. Issues with CBDs' performance, knowledge retention, and commitment to program activities, as well as gaps in contraceptive supply chains and insufficient monitoring and supervision processes, were the main implementation failures identified. Inappropriate method mix offered by the CBDs (condoms, pills, and CycleBeads only) and chronic overburdening of health care staff at the local level compounded these issues and explained the low volume of contraceptives provided through AcQual. Midcourse corrections included a more structured schedule of activities, stronger integration of CBDs with clinical providers and health zone managers, expansion of the mix of contraceptives offered to include subcutaneous injectables and emergency contraceptive pills, and clarifying reporting and monitoring responsibilities among all partners. Findings from this process evaluation contribute to the limited knowledge base regarding "unwelcome results" by examining all the intervention components and their relationships to highlight areas of potential failures, both in design and implementation, for similar CBD programs.


Assuntos
Redes Comunitárias/organização & administração , Anticoncepcionais/provisão & distribução , Congo , Serviços de Planejamento Familiar , Necessidades e Demandas de Serviços de Saúde , Humanos , Entrevistas como Assunto , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa
14.
BMC Res Notes ; 11(1): 851, 2018 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-30509324

RESUMO

OBJECTIVE: Millions of women want to delay or avoid pregnancy, but they are not using contraception, especially in refugee settings. Due to lack of contraception, one fifth of reproductive age group women suffered from unwanted pregnancy and unsafe abortion, which accounted for 78% of maternal mortality in refugee camps. Therefore, the aim of this study was to assess the prevalence of unmet need for modern contraception and its associated factors among reproductive age group women in Eritrean refugee camps, Tigray, Northern Ethiopia, 2016. RESULTS: 400 women of reproductive age group interviewed. Prevalence of unmet need for modern contraception in this study was found to be 41.8% (95% CI 36.99%, 46.63%).Respondents' unfavorable attitude towards modern contraceptive methods [AOR = 0.372, 95% CI 0.170, 0.818] and the availability of modern contraceptive methods [AOR = 3.501, 95% CI 1.328, 9.231] were factors significantly associated with unmet need for modern contraception. Respondents' attitude towards modern contraceptive methods and availability of modern contraceptives were independent predictors of unmet need. Governmental and non-governmental organizations should design programs to create behavioral change in women's attitude towards contraceptive use and to secure the availability of contraceptive methods in refugee camp settings.


Assuntos
Anticoncepção/psicologia , Anticoncepcionais/provisão & distribução , Necessidades e Demandas de Serviços de Saúde/organização & administração , Gravidez não Desejada/psicologia , Refugiados/psicologia , Adolescente , Adulto , Anticoncepção/estatística & dados numéricos , Estudos Transversais , Etiópia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Gravidez , Campos de Refugiados
15.
BMC Health Serv Res ; 18(1): 390, 2018 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-29855292

RESUMO

BACKGROUND: Unmet need for contraception results in several health challenges such as unintended pregnancies, unwanted births and unsafe abortions. Most interventions have been unable to successfully address this unmet need due to various community and health system level factors. Identifying these inhibiting and enabling factors prior to implementation of interventions forms the basis for planning efforts to increase met needs. This qualitative study was part of the formative phase of a larger research project that aimed to develop an intervention to increase met needs for contraception through community and health system participation. The specific study component reported here explores barriers and enablers to family planning and contraceptive services provision and utilisation at community and health systems levels. METHODS: Twelve focus group discussions were conducted with community members (n = 114) and two with healthcare providers (n = 19). Ten in-depth interviews were held with key stakeholders. The study was conducted in Kabwe district, Zambia. Interviews/discussions were translated and transcribed verbatim. Data were coded and organised using NVivo 10 (QSR international), and were analysed using thematic analysis. RESULTS: Health systems barriers include long distances to healthcare facilities, stock-outs of preferred methods, lack of policies facilitating contraceptive provision in schools, and undesirable provider attitudes. Community level barriers comprise women's experience with contraceptive side effects, myths, rumours and misconceptions, societal stigma, and negative traditional and religious beliefs. On the other hand, health systems enablers consist of political will from government to expand contraceptive services access, integration of contraceptive services, provision of couples counselling, and availability of personnel to offer basic methods mix. Functional community health system structures, community desire to delay pregnancy, and knowledge of contraceptive services are enablers at a community level. CONCLUSIONS: These study findings highlight key community and health systems factors that should be considered by policy, program planners and implementers in the design and implementation of family planning and contraceptive services programmes, to ensure sustained uptake and increased met needs for contraceptive methods and services.


Assuntos
Serviços de Saúde Comunitária/provisão & distribução , Serviços de Planejamento Familiar/provisão & distribução , Aborto Induzido/estatística & dados numéricos , Adulto , Serviços de Saúde Comunitária/estatística & dados numéricos , Anticoncepção/métodos , Anticoncepcionais/provisão & distribução , Aconselhamento , Assistência à Saúde/estatística & dados numéricos , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Grupos Focais , Programas Governamentais/provisão & distribução , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Assistência Médica , Gravidez , Pesquisa Qualitativa , Zâmbia
16.
PLoS One ; 13(2): e0192522, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29444140

RESUMO

BACKGROUND: An estimated 214 million women have unmet need for family planning in developing regions. Improved utilization of the private sector is key to achieving universal access to a range of safe and effective modern contraceptive methods stipulated by FP2020 and SDG commitments. Until now, a lack of market data has limited understanding of the private sector's role in increasing contraceptive coverage and choice. METHODS: In 2015, the FPwatch Project conducted representative outlet surveys in Ethiopia, Nigeria, and DRC using a full census approach in selected administrative areas. Every public and private sector outlet with the potential to sell or distribute modern contraceptives was approached. In outlets with modern contraceptives, product audits and provider interviews assessed contraceptive market composition, availability, and price. FINDINGS: Excluding general retailers, 96% of potential outlets in Ethiopia, 55% in Nigeria, and 41% in DRC had modern contraceptive methods available. In Ethiopia, 41% of modern contraceptive stocking outlets were in the private sector compared with approximately 80% in Nigeria and DRC where drug shops were dominant. Ninety-five percent of private sector outlets in Ethiopia had modern contraceptive methods available; 37% had three or more methods. In Nigeria and DRC, only 54% and 42% of private sector outlets stocked modern contraceptives with 5% and 4% stocking three or more methods, respectively. High prices in Nigeria and DRC create barriers to consumer access and choice. DISCUSSION: There is a missed opportunity to provide modern contraception through the private sector, particularly drug shops. Subsidies and interventions, like social marketing and social franchising, could leverage the private sector's role in increasing access to a range of contraceptives. Achieving global FP2020 commitments depends on the expansion of national contraceptive policies that promote greater partnership and cooperation with the private sector and improvement of decisions around funding streams of countries with large populations and high unmet need like Ethiopia, Nigeria, and DRC.


Assuntos
Comportamento de Escolha , Anticoncepcionais/provisão & distribução , Dispositivos Anticoncepcionais/provisão & distribução , Setor Privado , República Democrática do Congo , Etiópia , Feminino , Humanos , Nigéria
17.
J Am Coll Health ; 66(4): 259-268, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29405874

RESUMO

OBJECTIVE: To describe the array of sexual health care services provided at US colleges and universities. PARTICIPANTS: During 2014-2015, 885 colleges were surveyed about their provision of sexual health services. METHODS: 55% of colleges responded. Data were weighted and stratified by minority-serving institutions (MSIs), 2-year and 4-year institutions. RESULTS: 70.6% of colleges reported having a health center (HC), of which 73.0% offered STI diagnosis/treatment (4 years vs. 2 years; 77.9% vs. 53.1%) and contraceptive services (70.1% vs. 46.4%), all p < .001. HCs less frequently offered LARC (19.7%), express STI testing (24.4%) and self-collection (31.4%). Condoms were available on 66.8% of campuses. HPV vaccination was available at more 4-year colleges (73.7% vs. 48.5%, p < .003) and non-MSIs (74.4% vs. 58.5, p = .019). Regarding MSM-targeted services, 54.6% offered pharyngeal and 51.8% rectal STI testing. CONCLUSIONS: 2-year colleges may require additional support with providing sexual health care. Improvements could entail increasing express testing, extra-genital STI testing, and LARC.


Assuntos
Serviços de Saúde Reprodutiva/estatística & dados numéricos , Serviços de Saúde para Estudantes/estatística & dados numéricos , Universidades/estatística & dados numéricos , Anticoncepcionais/provisão & distribução , Feminino , Homossexualidade Masculina , Humanos , Masculino , Grupos Minoritários , Vacinas contra Papillomavirus/administração & dosagem , Serviços de Saúde Reprodutiva/normas , Saúde Sexual , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/terapia , Serviços de Saúde para Estudantes/normas , Inquéritos e Questionários , Universidades/normas
18.
Lancet Public Health ; 3(2): e91-e99, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29371100

RESUMO

BACKGROUND: Prevention of unintended pregnancy is a primary strategy to reduce adverse pregnancy and birth outcomes related to Zika virus infection. The Zika Contraception Access Network (Z-CAN) aimed to build a network of health-care providers offering client-centred contraceptive counselling and the full range of reversible contraception at no cost to women in Puerto Rico who chose to prevent pregnancy during the 2016-17 Zika virus outbreak. Here, we describe the Z-CAN programme design, implementation activities, and baseline characteristics of the first 21 124 participants. METHODS: Z-CAN was developed by establishing partnerships between federal agencies, territorial health agencies, private corporations, and domestic philanthropic and non-profit organisations in the continental USA and Puerto Rico. Private donations to the National Foundation for the Centers for Disease Control and Prevention (CDCF) secured a supply of reversible contraceptive methods (including long-acting reversible contraception), made available to non-sterilised women of reproductive age at no cost through provider reimbursements and infrastructure supported by the CDCF. To build capacity in contraception service provision, doctors and clinic staff from all public health regions and nearly all municipalities in Puerto Rico were recruited into the programme. All providers completed 1 day of comprehensive training in contraception knowledge, counselling, and initiation and management, including the insertion and removal of long-acting reversible contraceptives (LARCs). Z-CAN was announced through health-care providers, word of mouth, and a health education campaign. Descriptive characteristics of programme providers and participants were recorded, and we estimated the factors associated with choosing and receiving a LARC method. As part of a Z-CAN programme monitoring plan, participants were invited to complete a patient satisfaction survey about whether they had obtained free, same-day access to their chosen contraceptive method after receiving comprehensive counselling, their perception of the quality of care they had received, and their satisfaction with their chosen method and services. FINDINGS: Between May 4, 2016, and Aug 15, 2017, 153 providers in the Z-CAN programme provided services to 21 124 women. 20 110 (95%) women received same-day provision of a reversible contraceptive method. Whereas only 767 (4%) women had used a LARC method before Z-CAN, 14 259 (68%) chose and received a LARC method at their initial visit. Of the women who received a LARC method, 10 808 (76%) women had used no method or a least effective method of contraception (ie, condoms or withdrawal) before their Z-CAN visit. Of the 3489 women who participated in a patient satisfaction survey, 3068 (93%) of 3294 women were very satisfied with the services received, and 3216 (93%) of 3478 women reported receiving the method that they were most interested in after receiving counselling. 2382 (78%) of 3040 women rated their care as excellent or very good. INTERPRETATION: Z-CAN was designed as a short-term response for rapid implementation of reversible contraceptive services in a complex emergency setting in Puerto Rico and has served more than 21 000 women. This model could be replicated or adapted as part of future emergency preparedness and response efforts. FUNDING: National Foundation for the Centers for Disease Control and Prevention.


Assuntos
Anticoncepcionais/provisão & distribução , Surtos de Doenças , Serviços de Planejamento Familiar/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Infecção por Zika virus/epidemiologia , Adulto , Estudos de Viabilidade , Feminino , Humanos , Gravidez , Gravidez não Planejada , Avaliação de Programas e Projetos de Saúde , Porto Rico/epidemiologia , Adulto Jovem
19.
J Adolesc Health ; 62(3): 265-272, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29055646

RESUMO

PURPOSE: We aimed to evaluate adolescent access to contraceptive information and quality of care in a sample of primary care clinics and pharmacies in Mexico and their association with health facility and adolescent characteristics. METHODS: We selected a random sample of pharmacies (n = 434) and public-sector, primary care clinics (n = 327) in Mexico City to be visited by young women posing as "mystery clients" looking for contraception or emergency contraception. Access to contraception information was measured as the percent of times that women received the information they requested. To assess quality of care, we built an "adolescent-friendly services" (AFS) score based on the World Health Organization framework. Regression models were fitted to evaluate the associations between outcomes and health facility and client characteristics. RESULTS: Twenty percent of women did not receive the information they requested. Clients seeking emergency contraception information had higher odds of obtaining it than clients seeking information on contraception (odds ratio 3.08 95% confidence interval 2.03, 4.67). AFS scores were low, although higher in clinics than in pharmacies (5/9 in clinics vs. 3/9 in pharmacies). Younger age and indigenous appearance were associated with lower quality as measured by the AFS score. CONCLUSIONS: Access to information about contraception in pharmacies and clinics is high, but efforts must be made to provide 100% coverage to adolescents. The quality of contraception services in pharmacies and clinics is poor and nonequitable, favoring older and nonindigenous adolescents. Clinics and pharmacies must strive to comply with international AFS guidelines.


Assuntos
Acesso à Informação , Anticoncepcionais/provisão & distribução , Instalações de Saúde , Farmácias , Adolescente , Anticoncepção/métodos , Anticoncepção Pós-Coito , Feminino , Acesso aos Serviços de Saúde , Humanos , México , Atenção Primária à Saúde
20.
Eur J Contracept Reprod Health Care ; 22(5): 384-390, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29087737

RESUMO

PURPOSE: To identify and assess factors determining the functioning of supply chain systems for modern contraception in low- and middle-income countries (LMICs), and to identify challenges contributing to contraception stockouts that may lead to unmet need. MATERIALS AND METHODS: Scientific databases and grey literature were searched including Database of Abstracts of Reviews of Effectiveness (DARE), PubMed, MEDLINE, POPLINE, CINAHL, Academic Search Complete, Science Direct, Web of Science, Cochrane Central, Google Scholar, WHO databases and websites of key international organisations. RESULTS: Studies indicated that supply chain system inefficiencies significantly affect availability of modern FP and contraception commodities in LMICs, especially in rural public facilities where distribution barriers may be acute. Supply chain failures or bottlenecks may be attributed to: weak and poorly institutionalized logistic management information systems (LMIS), poor physical infrastructures in LMICs, lack of trained and dedicated staff for supply chain management, inadequate funding, and rigid government policies on task sharing. However, there is evidence that implementing effective LMISs and involving public and private providers will distribution channels resulted in reduction in medical commodities' stockout rates. CONCLUSIONS: Supply chain bottlenecks contribute significantly to persistent high stockout rates for modern contraceptives in LMICs. Interventions aimed at enhancing uptake of contraceptives to reduce the problem of unmet need in LMICs should make strong commitments towards strengthening these countries' health commodities supply chain management systems. Current evidence is limited and additional, and well-designed implementation research on contraception supply chain systems is warranted to gain further understanding and insights on the determinants of supply chain bottlenecks and their impact on stockouts of contraception commodities.


Assuntos
Anticoncepcionais/provisão & distribução , Países em Desenvolvimento/economia , Indústria Farmacêutica/organização & administração , Preparações Farmacêuticas/provisão & distribução , Feminino , Humanos , Masculino , Pobreza
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