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1.
Reprod Health ; 18(1): 47, 2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33622376

RESUMO

BACKGROUND: Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities. METHODS: This study utilizes cross-sectional health facility (N = 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N = 1479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Component Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). RESULTS: Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. CONCLUSION: Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that using more nuanced measures of integration may (a) more accurately reflect true variation in integration within and across health facilities, (b) enable more precise measurement of the determinants or effects of integration, and (c) provide more tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.


Assuntos
Prestação Integrada de Cuidados de Saúde , Serviços de Planejamento Familiar , Administração de Instituições de Saúde , Programas de Imunização , Serviços de Saúde Reprodutiva , Adulto , Criança , Pré-Escolar , Estudos Transversais , Prestação Integrada de Cuidados de Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/normas , Serviços de Planejamento Familiar/organização & administração , Serviços de Planejamento Familiar/normas , Serviços de Planejamento Familiar/provisão & distribução , Feminino , Instalações de Saúde/normas , Administração de Instituições de Saúde/métodos , Administração de Instituições de Saúde/normas , Indicadores Básicos de Saúde , Humanos , Programas de Imunização/organização & administração , Programas de Imunização/normas , Programas de Imunização/provisão & distribução , Lactente , Recém-Nascido , Masculino , Nigéria/epidemiologia , Gravidez , Saúde Reprodutiva/normas , Serviços de Saúde Reprodutiva/organização & administração , Serviços de Saúde Reprodutiva/normas , Serviços de Saúde Reprodutiva/provisão & distribução , Inquéritos e Questionários , População Urbana/estatística & dados numéricos , Vacinação/métodos , Vacinação/estatística & dados numéricos
3.
Rev. cuba. salud pública ; 46(4): e2224, oct.-dic. 2020. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1156630

RESUMO

Introducción: La deficiencia de cinc se considera un problema de salud global. Existe escasa información sobre el estado nutricional del cinc en mujeres cubanas en edad reproductiva. Objetivo: Identificar deficiencia de cinc y cobre sérico en mujeres en edad reproductiva, según factores relacionados, como la anemia, inflamación, exceso de peso y adiposidad abdominal. Métodos: Se estudiaron 104 mujeres de 18 a 40 años de edad, de La Habana, aparentemente sanas. Se realizó un estudio transversal descriptivo. Se realizó la determinación de cinc, cobre, hemoglobina, ferritina, proteína C reactiva, alfa 1 glicoproteína, peso, talla y circunferencia mínima de la cintura, se calculó el índice de masa corporal. Se utilizaron puntos de corte internacionales para la evaluación. Resultados: La prevalencia de deficiencia de hierro, estimada por ferritina sérica, cinc y cobre sérico fueron 66,3 por ciento (67/102), 36,2 por ciento (34/94) y 19,1 por ciento (18/94), respectivamente. De las mujeres 23,5 por ciento (24/102) tenían anemia e inflamación 8,8 por ciento (9/102) y 13 por ciento (13/102) estimada por CRP y AGP. Predominaron mujeres con exceso de peso 52,9 por ciento (54/102) y adiposidad abdominal 61,8 por ciento (60/97). Conclusiones: El riesgo de deficiencia de cinc en la muestra es elevado, la prevalencia del Zn sérico disminuido supera el 20 por ciento. No existe criterio para evaluar el riesgo de deficiencia de cobre como problema de salud pública. Las deficiencias de cinc y cobre no parecen estar asociadas a la anemia, la inflamación y el estado nutricional general. Se requiere realizar pesquisas adicionales para identificar la magnitud de las deficiencias de cinc y cobre y sus posibles causas(AU)


Introduction: Zinc deficiency is considered a global health problem. There is scarce information on zinc's nutritional state in Cuban childbearing-aged women. Objective: Identify zinc and serum copper deficiency in childbearing-aged women, based on related factors, such as anemia, inflammation, excess weight and abdominal adiposity. Methods: 104 seemingly healthy women from Havana, aged 18 to 40 were studied. A descriptive cross-sectional study was conducted. The determination of zinc, copper, hemoglobin, ferritin, C-reactive protein, alpha 1 glycoprotein, weight, size and minimum waist circumference was made, and the body mass index was calculated. International breakpoints were used for evaluation. Results: The prevalence of iron deficiency, estimated by serum ferritin, zinc and serum copper was 66.3 percent (67/101), 36.2 percent (34/94) and 19.1 percent (18/94), respectively. Of women, 23.5 percent (24/102) had anemia, and 8.8 percent had inflammation (9/102) and 13 percent (13/100) estimated by CRP and AGP. Women with overweight 52.9 percent (54/102) and abdominal adiposity 61.8% (60/97) predominated. Conclusions: The risk of zinc deficiency in the sample is high, the prevalence of decreased serum Zn exceeds 20 percent. There is no criterion for assessing the risk of copper deficiency as a public health problem. Zinc and copper deficiencies do not appear to be associated with anemia, inflammation and overall nutritional status. Additional tests are required to identify the magnitude of zinc and copper deficiencies and their possible causes(AU)


Assuntos
Humanos , Feminino , Gravidez , Mulheres , Cobre , Saúde Reprodutiva/normas , Epidemiologia Descritiva , Estudos Transversais , Cuba , Deficiência de Zinco
4.
Cochrane Database Syst Rev ; 8: CD013680, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32779730

RESUMO

BACKGROUND: The burden of poor sexual and reproductive health (SRH) worldwide is substantial, disproportionately affecting those living in low- and middle-income countries. Targeted client communication (TCC) delivered via mobile devices (MD) (TCCMD) may improve the health behaviours and service use important for sexual and reproductive health. OBJECTIVES: To assess the effects of TCC via MD on adolescents' knowledge, and on adolescents' and adults' sexual and reproductive health behaviour, health service use, and health and well-being. SEARCH METHODS: In July/August 2017, we searched five databases including The Cochrane Central Register of Controlled Trials, MEDLINE and Embase. We also searched two trial registries. A search update was carried out in July 2019 and potentially relevant studies are awaiting classification. SELECTION CRITERIA: We included randomised controlled trials of TCC via MD to improve sexual and reproductive health behaviour, health service use, and health and well-being. Eligible comparators were standard care or no intervention, non-digital TCC, and digital non-targeted communication. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane, although data extraction and risk of bias assessments were carried out by one person only and cross-checked by a second. We have presented results separately for adult and adolescent populations, and for each comparison. MAIN RESULTS: We included 40 trials (27 among adult populations and 13 among adolescent populations) with a total of 26,854 participants. All but one of the trials among adolescent populations were conducted in high-income countries. Trials among adult populations were conducted in a range of high- to low-income countries. Among adolescents, nine interventions were delivered solely through text messages; four interventions tested text messages in combination with another communication channel, such as emails, multimedia messaging, or voice calls; and one intervention used voice calls alone. Among adults, 20 interventions were delivered through text messages; two through a combination of text messages and voice calls; and the rest were delivered through other channels such as voice calls, multimedia messaging, interactive voice response, and instant messaging services. Adolescent populations TCCMD versus standard care TCCMD may increase sexual health knowledge (risk ratio (RR) 1.45, 95% confidence interval (CI) 1.23 to 1.71; low-certainty evidence). TCCMD may modestly increase contraception use (RR 1.19, 95% CI 1.05 to 1.35; low-certainty evidence). The effects on condom use, antiretroviral therapy (ART) adherence, and health service use are uncertain due to very low-certainty evidence. The effects on abortion and STI rates are unknown due to lack of studies. TCCMD versus non-digital TCC (e.g. pamphlets) The effects of TCCMD on behaviour (contraception use, condom use, ART adherence), service use, health and wellbeing (abortion and STI rates) are unknown due to lack of studies for this comparison. TCCMD versus digital non-targeted communication The effects on sexual health knowledge, condom and contraceptive use are uncertain due to very low-certainty evidence. Interventions may increase health service use (attendance for STI/HIV testing, RR 1.61, 95% CI 1.08 to 2.40; low-certainty evidence). The intervention may be beneficial for reducing STI rates (RR 0.61, 95% CI 0.28 to 1.33; low-certainty evidence), but the confidence interval encompasses both benefit and harm. The effects on abortion rates and on ART adherence are unknown due to lack of studies. We are uncertain whether TCCMD results in unintended consequences due to lack of evidence. Adult populations TCCMD versus standard care For health behaviours, TCCMD may modestly increase contraception use at 12 months (RR 1.17, 95% CI 0.92 to 1.48) and may reduce repeat abortion (RR 0.68 95% CI 0.28 to 1.66), though the confidence interval encompasses benefit and harm (low-certainty evidence). The effect on condom use is uncertain. No study measured the impact of this intervention on STI rates. TCCMD may modestly increase ART adherence (RR 1.13, 95% CI 0.97 to 1.32, low-certainty evidence, and standardised mean difference 0.44, 95% CI -0.14 to 1.02, low-certainty evidence). TCCMD may modestly increase health service utilisation (RR 1.17, 95% CI 1.04 to 1.31; low-certainty evidence), but there was substantial heterogeneity (I2 = 85%), with mixed results according to type of service utilisation (i.e. attendance for STI testing; HIV treatment; voluntary male medical circumcision (VMMC); VMMC post-operative visit; post-abortion care). For health and well-being outcomes, there may be little or no effect on CD4 count (mean difference 13.99, 95% CI -8.65 to 36.63; low-certainty evidence) and a slight reduction in virological failure (RR 0.86, 95% CI 0.73 to 1.01; low-certainty evidence). TCCMD versus non-digital TCC No studies reported STI rates, condom use, ART adherence, abortion rates, or contraceptive use as outcomes for this comparison. TCCMD may modestly increase in service attendance overall (RR: 1.12, 95% CI 0.92-1.35, low certainty evidence), however the confidence interval encompasses benefit and harm. TCCMD versus digital non-targeted communication No studies reported STI rates, condom use, ART adherence, abortion rates, or contraceptive use as outcomes for this comparison. TCCMD may increase service utilisation overall (RR: 1.71, 95% CI 0.67-4.38, low certainty evidence), however the confidence interval encompasses benefit and harm and there was considerable heterogeneity (I2 = 72%), with mixed results according to type of service utilisation (STI/HIV testing, and VMMC). Few studies reported on unintended consequences. One study reported that a participant withdrew from the intervention as they felt it compromised their undisclosed HIV status. AUTHORS' CONCLUSIONS: TCCMD may improve some outcomes but the evidence is of low certainty. The effect on most outcomes is uncertain/unknown due to very low certainty evidence or lack of evidence. High quality, adequately powered trials and cost effectiveness analyses are required to reliably ascertain the effects and relative benefits of TCC delivered by mobile devices. Given the sensitivity and stigma associated with sexual and reproductive health future studies should measure unintended consequences, such as partner violence or breaches of confidentiality.


Assuntos
Telefone Celular , Comunicação , Saúde Reprodutiva/normas , Saúde Sexual/normas , Aborto Legal/estatística & dados numéricos , Adolescente , Anticoncepção/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Melhoria de Qualidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Doenças Sexualmente Transmissíveis , Envio de Mensagens de Texto , Incerteza , Adulto Jovem
5.
Int J Equity Health ; 19(1): 111, 2020 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-32635915

RESUMO

This paper addresses a critical concern in realizing sexual and reproductive health and rights through policies and programs - the relationship between power and accountability. We examine accountability strategies for sexual and reproductive health and rights through the lens of power so that we might better understand and assess their actual working. Power often derives from deep structural inequalities, but also seeps into norms and beliefs, into what we 'know' as truth, and what we believe about the world and about ourselves within it. Power legitimizes hierarchy and authority, and manufactures consent. Its capillary action causes it to spread into every corner and social extremity, but also sets up the possibility of challenge and contestation.Using illustrative examples, we show that in some contexts accountability strategies may confront and transform adverse power relationships. In other contexts, power relations may be more resistant to change, giving rise to contestation, accommodation, negotiation or even subversion of the goals of accountability strategies. This raises an important question about measurement. How is one to assess the achievements of accountability strategies, given the shifting sands on which they are implemented?We argue that power-focused realist evaluations are needed that address four sets of questions about: i) the dimensions and sources of power that an accountability strategy confronts; ii) how power is built into the artefacts of the strategy - its objectives, rules, procedures, financing methods inter alia; iii) what incentives, disincentives and norms for behavior are set up by the interplay of the above; and iv) their consequences for the outcomes of the accountability strategy. We illustrate this approach through examples of performance, social and legal accountability strategies.


Assuntos
Equidade em Saúde/ética , Equidade em Saúde/normas , Saúde Reprodutiva/ética , Saúde Reprodutiva/normas , Saúde Sexual/ética , Saúde Sexual/normas , Responsabilidade Social , Adulto , Feminino , Equidade em Saúde/legislação & jurisprudência , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Reprodutiva/legislação & jurisprudência , Saúde Sexual/legislação & jurisprudência , Adulto Jovem
6.
Sex Reprod Health Matters ; 28(2): 1781583, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32543338

RESUMO

The COVID-19 pandemic is not just a health crisis - it is a full-blown economic and social crisis that is impacting the lives and livelihoods of billions of people. This commentary examines the mutually dependent relationship between health security and universal health coverage (UHC), and how the longstanding underinvestment in both renders us all vulnerable. It also discusses the vulnerability of services for sexual and reproductive health and rights (SRHR) in times of crisis, which is compounded when these services are not included and well integrated into national UHC packages. It concludes with a call for stronger political leadership for UHC and SRHR as the global community strives to "build back better" after COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Nível de Saúde , Pneumonia Viral/epidemiologia , Cobertura Universal do Seguro de Saúde/organização & administração , Betacoronavirus , Acesso aos Serviços de Saúde/normas , Humanos , Pandemias , Política , Saúde Reprodutiva/normas , Direitos Sexuais e Reprodutivos/normas , Saúde Sexual/normas
7.
Eur J Contracept Reprod Health Care ; 25(5): 402-404, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32436744

RESUMO

PURPOSE: Coronavirus Disease-2019 (COVID-19) is a rapidly evolving pandemic. It is well-known that pregnant women are more susceptible to viral infection due to immune and anatomic factors. Therefore, the viral pandemic might affect the reproductive health and maternity services especially in low-resource countries. MATERIALS AND METHODS: In this article, we tried to highlight the impact of COVID-19 on reproductive health and maternity health services in low resource countries with emphasis on adapting some of the published best practice recommendations to suit a struggling environment. CONCLUSION: Pregnant women residing in low resource countries represent a uniquely vulnerable group in epidemics due to several factors. Maternity services in low resource countries are adapting to provide antenatal and postnatal care amidst a rapidly shifting health system environment due to the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Serviços de Saúde Materna , Pandemias , Assistência Perinatal , Pneumonia Viral , Cuidado Pós-Natal , Complicações Infecciosas na Gravidez , Saúde Reprodutiva/normas , Betacoronavirus , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Países em Desenvolvimento , Egito/epidemiologia , Feminino , Humanos , Serviços de Saúde Materna/organização & administração , Serviços de Saúde Materna/normas , Serviços de Saúde Materna/provisão & distribução , Determinação de Necessidades de Cuidados de Saúde , Inovação Organizacional , Pandemias/prevenção & controle , Assistência Perinatal/métodos , Assistência Perinatal/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Cuidado Pós-Natal/métodos , Cuidado Pós-Natal/tendências , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle
10.
Obstet Gynecol ; 135(5): 1059-1068, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32282602

RESUMO

We aim to make evident that solely referencing cisgender women in the context of sexual and reproductive health-particularly pregnancy planning and care-excludes a diverse group of transgender and gender nonbinary people who have sexual and reproductive health needs and experiences that can be similar to but also unique from those of cisgender women. We call on clinicians and researchers to ensure that all points of sexual and reproductive health access, research, sources of information, and care delivery comprehensively include and are accessible to people of all genders. We describe barriers to sexual and reproductive health care and research participation unique to people of marginalized gender identities, provide examples of harm resulting from these barriers, and offer concrete suggestions for creating inclusive, accurate, and respectful care and research environments-which will lead to higher quality health care and science for people of all genders.


Assuntos
Assistência à Saúde/normas , Acesso aos Serviços de Saúde , Serviços de Saúde para Pessoas Transgênero/normas , Serviços de Saúde Reprodutiva/normas , Saúde da Mulher/normas , Assistência à Saúde/métodos , Feminino , Humanos , Masculino , Gravidez , Saúde Reprodutiva/normas , Pessoas Transgênero
11.
J Med Internet Res ; 22(3): e16336, 2020 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-32224484

RESUMO

BACKGROUND: Sexually transmitted infections (STIs) are on the rise in the United States, and adolescent girls (15-19 years old) are more susceptible to acquiring STIs than their male peers. The co-occurrence of alcohol use and sexual risk taking contribute significantly to STI acquisition. Mobile health (mHealth) interventions are ideally suited for our target population and have demonstrated increases in STI testing in young people, as well as reductions in alcohol use. OBJECTIVE: This pilot study used both qualitative and quantitative methods to explore the views of adolescent girls (age range 15-19 years old; 74.6%, 279/374 white) on the desired qualities and content of an mHealth app for sexual health. METHODS: We conducted nine 60-min in-depth interviews (IDIs) to gather information and identify themes of sexual health and alcohol use, and we tested the feasibility of using a two-week social media campaign to collect survey information regarding sexual health risk in adolescent girls. RESULTS: We iteratively coded IDIs and identified major themes around pressure of alcohol use, lack of STI knowledge, male pressure to not use condoms, and pregnancy as a worse outcome than STIs. Results from the web-based survey on risky health behaviors, which was completed by 367 participants, support the use of a sexual health app designed for girls. CONCLUSIONS: Future work will integrate these themes to inform the development of a culturally sensitive mHealth app to prevent STIs among adolescent girls.


Assuntos
Saúde Reprodutiva/normas , Comportamento Sexual/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/prevenção & controle , Adolescente , Adulto , Feminino , Humanos , Masculino , Projetos Piloto , Adulto Jovem
12.
Fertil Steril ; 113(3): 489-499, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32192588

RESUMO

Globally, male factor infertility accounts for 20%-70% of couples struggling to conceive. Certain male pediatric developmental conditions, such as cryptorchidism, hypospadias, testicular and other childhood cancers, infections, and pediatric varicocele have been associated with future infertility. Early fertility preservation, especially in those with pending chemotherapy or genetic conditions such as Klinefelter syndrome, should be strongly considered in patients expected to experience testicular loss. Although optimal treatment timing may be unknown owing to a paucity of long-term prospective studies, early diagnosis and targeted treatment may optimize fertility potential in adulthood.


Assuntos
Preservação da Fertilidade/normas , Infertilidade Masculina/prevenção & controle , Pediatria/métodos , Saúde Reprodutiva/normas , Calibragem , Criança , Fertilidade/fisiologia , Preservação da Fertilidade/métodos , Preservação da Fertilidade/tendências , Humanos , Masculino , Pediatria/tendências , Medicina Reprodutiva/normas , Terapêutica/métodos , Terapêutica/normas , Terapêutica/tendências , Resultado do Tratamento
13.
Int J Gynaecol Obstet ; 149(1): 113-119, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32012258

RESUMO

Ensuring universal access to sexual and reproductive healthcare services is Target 3.7 of the United Nations Sustainable Development Goals (SDG). Refugee and migrant women and children are at particular risk of being forgotten in the global momentum to achieve this target. In this article we discuss the violations of sexual and reproductive health and rights (SRHR) of particular relevance to the refugee and migrant reality. We give context-specific examples of denial of health services to vulnerable groups; lack of dignity as a barrier to care; the vulnerability of adolescents; child marriage; weaponized rape; gender-based violence; and sexual trafficking. We discuss rights frameworks and models that are being used in response to these situations, as well as what remains to be done. Specifically, we call for obstetricians and gynecologists to act as individual providers and through their FIGO member societies to protect women's health and rights in these exposed settings.


Assuntos
Refugiados , Saúde Reprodutiva/normas , Direitos Sexuais e Reprodutivos/normas , Migrantes , Adolescente , Adulto , Criança , Feminino , Saúde Global , Ginecologia/normas , Humanos , Cooperação Internacional , Obstetrícia/normas , Saúde Sexual/normas , Desenvolvimento Sustentável , Saúde da Mulher
15.
Am J Nurs ; 120(2): 22-33, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31977414

RESUMO

Contraception is widely used in the United States, and nurses in all settings may encounter patients who are using or want to use contraceptives. Nurses may be called on to anticipate how family planning intersects with other health care services and provide patients with information based on the most current evidence. This article describes key characteristics of nonpermanent contraceptive methods, including mechanism of action, correct use, failure rates with perfect and typical use, contraindications, benefits, side effects, discontinuation procedures, and innovations in the field. We also discuss how contraceptive care is related to nursing ethics and health inequities.


Assuntos
Anticoncepção/métodos , Saúde Reprodutiva/normas , Anticoncepção/enfermagem , Método de Barreira Anticoncepção/métodos , Contraceptivos Hormonais/administração & dosagem , Contraceptivos Hormonais/efeitos adversos , Contraceptivos Hormonais/farmacologia , Feminino , Genitália Feminina/anatomia & histologia , Disparidades em Assistência à Saúde , Humanos , Dispositivos Intrauterinos de Cobre/efeitos adversos , Masculino , Ovulação/fisiologia , Assistência Centrada no Paciente , Minorias Sexuais e de Gênero
16.
Reprod Health ; 17(1): 13, 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31973748

RESUMO

BACKGROUND: Reproductive health of vulnerable adolescent girls is a top priority in global programs. Alcohol consumption, drug abuse, high risk sexual behaviors, sexually transmitted diseases, sexual assault, escape from home, unrestrained sex in the family, history of robbery, imprisonment and living in drug hangouts expose adolescents to different sorts of damage and injury. These adolescent girls are at risk of AIDS and other STDs, unwanted pregnancies, illegal and unsafe abortions, unplanned pregnancy and childbirth, and unsafe motherhood. Therefore, assessing these girls' reproductive health needs and designing programs to improve their sexual and reproductive health seem to be essential. This study will be conducted to design a comprehensive program for improving the reproductive health of vulnerable adolescent girls. METHODS: The present study is an exploratory sequential mixed methods study (Qual-Quan) designed in three phases. In the first phase, a qualitative study will be used to describe the reproductive health needs of vulnerable adolescent girls, identify facilitating and inhibiting factors, and explain the strategies of reproductive health programs for these girls. Participants will be selected in this phase using purposive sampling method, and the data will be collected through semi-structured interviews. The obtained data will be analyzed using conventional qualitative content analysis. In the second phase, through a quantitative study, the strategies obtained from the qualitative study and review of the literature will be provided to reproductive health care providers, experts, policymakers, and planners to prioritize and select the best strategies. In the third phase, the initial draft of the program will be formulated based on prioritized strategies and will be proposed in a panel comprised of specialists in the areas of reproductive and sexual health, health promotion, social injuries and a psychiatrist. Finally, the final program will be developed and presented after obtaining the agreement and approval of the panel members. DISCUSSION: Designing a program based on a qualitative study, review of the existing evidence and programs, and using the opinions of experts in different areas can lead to different aspects of reproductive and sexual health of vulnerable adolescent girls. On the other hand, taking into account all cultural sensitivities and taboos as well as political, economic and social barriers, the development of such a program can provide the appropriate possibility of presenting comprehensive reproductive and sexual health services to vulnerable adolescent girls and achieve the goals agreed universally.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/normas , Serviços de Saúde Reprodutiva/organização & administração , Saúde Reprodutiva/normas , Comportamento Sexual/psicologia , Saúde Sexual/normas , Doenças Sexualmente Transmissíveis/prevenção & controle , Adolescente , Adulto , Criança , Feminino , Humanos , Gravidez , Gravidez não Desejada , Pesquisa Qualitativa , Adulto Jovem
17.
Reprod Health ; 17(1): 14, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992315

RESUMO

BACKGROUND: Maternal death remains a public health burden in the developing countries including Nigeria and the major causes are pregnancy related. Lack of male involvement in pregnancy related care is one of the contributing factors. Previous studies on male involvement focused on family planning services and were majorly targeted at women. This study, therefore, was carried out to assess the knowledge, perception and involvement of male partners in pregnancy related care among married men in Ibadan, Nigeria. METHODS: A cross sectional study was conducted using a four-stage sampling technique to select 367 married men in an urban community in Ibadan. A semi-structured, interviewer-administered questionnaire was used to obtain information on the knowledge, perception and involvement of respondents regarding pregnancy related care. Responses to questions on knowledge of pregnancy related care were converted to a 33-point scale. Scores greater than or equal to the mean knowledge score (26.2) were categorized as good knowledge of pregnancy related care. Similarly, responses to involvement in pregnancy related care questions were converted to a 24-point scale with scores greater than or equal to the mean (15.1) classified as good involvement in pregnancy related care. Data were analyzed using descriptive statistics and association between qualitative variables was established using Chi-square test at p < 0.05. RESULTS: Sixty-three percent had good knowledge of pregnancy related care. Majority believed that they had roles to play in their partners' care during pregnancy (89.9%), labor and delivery (92.9%), and in newborn care (97.5%). Overall, 56.9% had good involvement in pregnancy related care. About 20% followed their partners to antenatal care (19.6%) and postnatal (19.9%) clinics. A significantly higher proportion of respondents with good knowledge accompanied their partners for antenatal care (p = 0.008) and postnatal care clinic (p = 0.014); participated in birth preparedness (p < 0.001) and assisted with newborn care (p < 0.001). Job demands, social stigma and long waiting time at the health facilities were reasons highlighted for non-involvement in pregnancy related care. CONCLUSIONS: The study revealed gaps in knowledge and involvement in pregnancy related care. There is a need for reproductive health policy review to strongly emphasize the need for involvement of male partners in reproductive health issues including pregnancy related care.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Casamento/estatística & dados numéricos , Homens/psicologia , Cuidado Pré-Natal/psicologia , Cuidado Pré-Natal/normas , Saúde Reprodutiva/normas , Parceiros Sexuais/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Masculino , Nigéria , Gravidez , Pesquisa Qualitativa
18.
Int J Gynaecol Obstet ; 148(3): 344-354, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31785097

RESUMO

OBJECTIVE: To address the essential characteristics of a network and aspects related to network sustainability. METHOD: A descriptive study based on a two-round Delphi survey was conducted from 2016 to 2018. Researchers participating in maternal and perinatal health networks were identified by searching PubMed for network-based publications and invited to complete a two-round Delphi questionnaire by email. RESULTS: Among 529 eligible researchers identified, 54 (10.2%) and 46 (8.7%) responses were received in the first and second rounds, respectively. A consensus on 13 of 21 [OK] questions, and 5 of 10 questions was achieved in the first and second rounds, respectively. The results indicated that a responsible leader is required, and both coordinators and members have a role in decision-making within the network. Good communication and periodic face-to-face meetings are key factors in sustainability and motivation. Rules for secure access to the network database and definition of authorship of scientific papers are essential. Mentioning the name of the network in publications is important for strengthening its activities and the obtainment of funds. CONCLUSION: Although operational characteristics of the network may differ according to setting and collaborators, homogeneous and essential network characteristics were identified.


Assuntos
Saúde do Lactente/normas , Saúde Reprodutiva/normas , Consenso , Técnica Delfos , Feminino , Humanos , Gravidez , Desenvolvimento de Programas , Inquéritos e Questionários
19.
BMJ Sex Reprod Health ; 46(3): 161-171, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31722933

RESUMO

BACKGROUND: Youth involved in the juvenile justice system have high reproductive health needs and, on exiting detention, face the challenging transition of reentry. We conducted a systematic literature review to describe what is known about youths' reproductive health needs during community reentry after incarceration. METHODS: We searched PubMed, CINAHL, Cochrane Library, and Google Scholar for articles containing key words with the concepts 'child or adolescent', 'incarcerated' and 'reentry'. In the search, we defined the concept of 'reentry' as within 1 month prior to release (to include interventions involving pre-release planning) and up to 18 months after release from incarceration. RESULTS: Our search yielded 2187 articles. After applying all exclusion criteria, 14 articles on reproductive health remained for extraction. The articles provided data on the following aspects of youths' reproductive health: frequency of condom use (eight articles), sexual risk behaviours other than lack of condom use (seven articles), and prevalence of sexually transmitted infections (three articles). CONCLUSIONS: The literature on the reproductive health needs of youth undergoing reentry is extremely limited. Current intervention studies yield mixed but promising results and more intervention studies that address both pre-release reentry planning and the post-incarceration period are needed. Given incarcerated youths' well-documented reproductive health disparities compared with non-incarcerated adolescents, the identified gaps represent important opportunities for future research and programmatic emphasis.


Assuntos
Determinação de Necessidades de Cuidados de Saúde , Prisioneiros/educação , Prisioneiros/psicologia , Saúde Reprodutiva/educação , Adolescente , Criança , Feminino , Acesso aos Serviços de Saúde/normas , Humanos , Masculino , Saúde Reprodutiva/normas
20.
J Pediatr Adolesc Gynecol ; 33(1): 3-9, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31154017

RESUMO

Increasing numbers of transgender and gender diverse (TGD) youth are presenting for medical care, including seeking more information and access to services from gynecologic and reproductive health experts. Such experts are well positioned to provide affirming, comprehensive services, including education, hormonal interventions, menstrual management, contraception, and various gynecological procedures. Early medical guidance and support for the TGD community has been associated with long-term positive emotional and physical health outcomes. In this article medical interventions that reproductive health experts can offer to their TGD patients are discussed.


Assuntos
Ginecologia/normas , Saúde Reprodutiva/normas , Pessoas Transgênero , Adolescente , Assistência à Saúde/métodos , Feminino , Humanos , Masculino
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