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1.
Drug Deliv ; 29(1): 2549-2560, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35912869

RESUMO

It was found that propranolol hydrochloride (PNL), which is a beta-blocker used for hypertension treatment, has a potent spermicidal activity through local anesthetic activity or beta-blocking effect on sperm cells subsequently it could be used as a contraceptive remedy. This study aimed to entrap PNL into invasomes (INVs) and then formulate it as a locally acting contraceptive gel. PNL-loaded mucoadhesive INVs were prepared via the thin-film hydration technique. The D-optimal design was utilized to fabricate INVs employing lipid concentration (X1), terpenes concentration (X2), terpenes type (X3), and chitosan concentration (X4) as independent variables, while their impact was observed for entrapment efficiency percent (Y1; EE%), particle size (Y2; PS), zeta potential (Y3; ZP), and amount of drug released after 6 h (Y4; Q6h). Design Expert® was bestowed to nominate the desired formula. The selected INV was subjected to further studies and formulated into a mucoadhesive gel for ex-vivo and in-vivo investigations. The optimum INV showed a spherical shape with EE% of 65.01 ± 1.24%, PS of 243.75 ± 8.13 nm, PDI of 0.203 ± 0.01, ZP of 49.80 ± 0.42 mV, and Q6h of 53.16 ± 0.73%. Differential scanning calorimetry study asserted the capability of INVs to entrap PNL. Permeation studies confirmed the desired sustained effect of PNL-loaded INVs-gel compared to PNL-gel, INVs, and PNL solution. Sperm motility assay proved the potency of INVs-gel to inhibit sperm motility. Besides, the histopathological investigation verified the tolerability of the prepared INVs-gel. Taken together, the gained data justified the efficacy of PNL-loaded INVs-gel as a potential locally acting contraceptive.


Assuntos
Lipossomos , Propranolol , Administração Cutânea , Anticoncepcionais , Humanos , Masculino , Tamanho da Partícula , Propranolol/farmacologia , Sêmen , Motilidade Espermática , Terpenos
2.
PLoS One ; 17(8): e0271967, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35913995

RESUMO

BACKGROUND: Short inter-pregnancy interval is a public health concern because it results in adverse perinatal outcomes such as postpartum hemorrhage, anemia, premature birth, low birth weight, and perinatal deaths. Although it is critical to understand the factors that contribute to short inter-pregnancy interval to reduce the risk of these negative outcomes, adequate evidence about the factors in the urban context is lacking. Therefore, we aimed to assess the duration of the inter-pregnancy interval and its predictors among pregnant women in urban South Ethiopia. METHODS: A community-based retrospective follow-up study was conducted among 2171 pregnant women in five geographically diverse urban settings in South Ethiopia. For the analysis, a Cox gamma shared frailty (random-effect) model was used. Adjusted hazard ratio (AHR) with a 95% CI was used to assess significant predictors. The median hazard ratio (MHR) used to report clustering effect. RESULTS: The median duration of the inter-pregnancy interval was 22 months, 95% CI (21, 23), with an inter-quartile range of 14 months. Maternal age ≥30 years [AHR = 0.75, 95% CI: 0.58, 0.97], having no formal education [AHR = 0.60, 95% CI: 0.46, 0.78], contraceptive non-use [AHR = 2.27, 95% CI: 1.94, 2.66], breastfeeding for <24 months [AHR = 4.92, 95% CI: 3.95, 6.12], death of recent child [AHR = 2.90, 95% CI: 1.41, 5.97], plan pregnancy within 24 months [AHR = 1.72, 95% CI: 1.26, 2.35], lack of discussion with husband [AHR = 1.33, 95% CI: 1.10, 1.60] and lack of husband encouragement about pregnancy spacing [AHR = 1.25, 95% CI: 1.05, 1.48] were predictors of short inter-pregnancy interval. Adjusting for predictors, the median increase in the hazard of short inter-pregnancy interval in a cluster with higher short inter-pregnancy interval is 30% [MHR = 1.30, 95% CI: 1.11, 1.43] than lower cluster. CONCLUSIONS: In the study settings, the duration of the inter-pregnancy interval was shorter than the World Health Organization recommendation. There is a need to improve contraceptive use and breastfeeding duration to maximize the inter-pregnancy interval. Men's involvement in reproductive health services and advocacy for women's reproductive decision-making autonomy are fundamental. The contextual disparities in the inter-pregnancy interval suggests further study and interventions.


Assuntos
Intervalo entre Nascimentos , Gestantes , Adulto , Anticoncepcionais , Etiópia/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Parto , Gravidez , Estudos Retrospectivos
3.
BMC Health Serv Res ; 22(1): 981, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35915491

RESUMO

BACKGROUND: CPs and PPMVs are an important source of modern contraceptives in Nigeria, yet many lack the requisite knowledge and skills to capably provide these services. This skills gap might be addressed through targeted family planning (FP) training. This study measures family planning knowledge retention of CPs and PPMVs after receiving training in FP counseling and services in Kaduna and Lagos States, in Nigeria. METHODS: In a quasi-experimental longitudinal design without a comparison group, 559 CPs and PPMVs who were enrolled in the IntegratE project between January and December 2019, completed a self-administered questionnaire to assess their knowledge related to the provision of FP counseling, and injectable and implant contraceptive services at three points in time: 1) before the training; 2) immediately after the training; and 3) 9-months after the training in Kaduna and Lagos states, Nigeria. Adjusted multivariate logistic regression analysis was used to assess the effect of provider characteristics and receipt of job aids on FP knowledge retention 9 months after the training. 95% confidence intervals and p-values were used to assess statistical significance. RESULTS: Majority of study participants were females (60.3%) and between 30 and 49 years old (63.4%). The study revealed the importance of jobs aids as influence on knowledge retention. CPs and PPMVs who reported having the Balanced Counseling Strategy plus (BCS+) counseling cards, were more likely to retain knowledge (AOR: 2.92; 95% CI: 1.01-8.40, p-value = 0.05) at 9 months follow-up. Similarly, in terms of knowledge of injectable contraceptives, CPs and Tier 2 PPMVs who reported receiving the Medical Eligibility Criteria (MEC) Wheel were 2.1 times more likely to retain knowledge of injectable contraceptives 9-months later on (95% CI: 1.14-3.99, p-value = 0.02). CONCLUSION: Community Pharmacists and Proprietary Medicine Vendors had good retention of family planning knowledge, especially when combined with job aids. Training and providing them with job aids on FP will therefore support task shifting and task sharing on family planning services provision in Nigeria.


Assuntos
Serviços de Planejamento Familiar , Medicamentos sem Prescrição , Adulto , Anticoncepção , Anticoncepcionais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Farmacêuticos
4.
Sex Reprod Health Matters ; 29(2): 2097044, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35939308

RESUMO

Bangladesh is one of the major labour-exporting countries in the world, with large-scale labour migration flows occurring both internationally and domestically. Spousal separation due to migration has the potential to disrupt women's ability to use contraception in line with their reproductive goals. This qualitative study complements the 2014 Bangladesh Demographic and Health Survey (BDHS) data; we conducted in-depth interviews with a sub-sample of 23 BDHS respondents whose husbands stayed elsewhere but returned at least once a year to Barisal Division, Bangladesh. The study explores how husbands' migration patterns influence couples' fertility intentions, contraceptive decision-making and behaviour, and unintended pregnancies. Results showed that contraceptive use was high among the study participants, with nearly all couples using some method to avoid pregnancy - usually pills and condoms. However, the use was episodic and inconsistent, reducing effectiveness. Experiences of side effects were commonplace, which contributed to this pattern of inconsistent use: women used pills only during the duration of their husband's visits. Half of the informants experienced unintended pregnancies either due to the inconsistent use of pills or other method failures. The study findings indicate that women with migrant husbands need family planning education related to their particular circumstances and access to a wider range of family planning choices. Quality counselling should respect women's experiences with side effects and include thorough discussion of viable alternatives.


Assuntos
Serviços de Planejamento Familiar , Migrantes , Bangladesh , Anticoncepcionais , Serviços de Planejamento Familiar/métodos , Feminino , Humanos , Gravidez , Educação Sexual , Cônjuges
5.
BMC Womens Health ; 22(1): 337, 2022 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-35941648

RESUMO

BACKGROUND: Fertility desire is one of the predictors of contraceptive behavior and fertility-related outcomes. However, information is scarce on individual and community-level factors of women's fertility decisions in sub-Saharan Africa. OBJECTIVE: To assess fertility decisions and their associated factors in Sub-Saharan Africa. METHODS: The 35 Sub-Saharan African country's most recent demographic and health surveys (DHS) data conducted from 2008 to 2020 was used. A total of 284,744 (weighted) married women were used for analysis. The proportion of fertility decisions with their 95%CI was estimated. To assess the factors associated with fertility decisions, both random effect and fixed effect analyses were conducted. In the fixed analysis, particularly in the multivariable analysis, adjusted relative risk ratio (aRRR) with its 95% confidence interval (CI) was reported and variables with a p-value < 0.05 were considered significant predictors of fertility decisions. RESULTS: In this study, 64.35% (95%CI: 64.2%, 64.5%) of the study participants had fertility desire. However, 5.4% (95%CI: 5.3, 5.5) of the study participants had undecided fertility behavior. In the multivariable analysis, desire for more children and undecided fertility desire were relatively lower among older women, women with primary, secondary, and higher education, working women, women who currently use contraceptives, women with a higher number of living children, women with higher parity, women from eastern and southern Africa, and women from wealthy households. While, the ideal number of children, women who had decision-making autonomy, and women from the rural residence were all associated with a relatively higher desire for more children and undecided fertility desire. Furthermore, respondents' education and sex of household head were associated with the desire for more children while media exposure was associated with undecided fertility desire. CONCLUSION: In this study, around two-thirds of women had a desire for more children and only 5.4% of women had undecided fertility desires. Both individual and community-level factors were associated with both desires for more children and undecided fertility desires. As a result, the aforementioned factors should be considered while developing reproductive health programs.


Assuntos
Comportamento Contraceptivo , Anticoncepcionais , África ao Sul do Saara , Idoso , Criança , Feminino , Fertilidade , Humanos , Modelos Logísticos , Análise Multinível , Gravidez
6.
Pan Afr Med J ; 42: 45, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35949473

RESUMO

Introduction: globally, 600,000 women died of complications due to pregnancies among more than 2 million women on antiretroviral treatment who get pregnant every year due to low utilization of dual contraception and unsafe sex. The failure rate of preventing of mother-to-child transmission of HIV/AIDS (PMTCT) in Rwanda was 2% in 2019. In Rwanda, there was no research done and published on this topic. To fill the gap, the study aimed to assess the use of dual contraceptives and associated factors among women aged 15-49 years on antiretroviral (ART) in Kayonza District, Rwanda. Methods: a cross-sectional design was conducted in October 2021. The sample was 345 participants selected by cluster simple random sampling from a targeted population of 1426 women. The interviews were conducted, and structured questionnaires were filled out before entering and analyzing data into Statistical Package Social Sciences (SPSS). Descriptive statistics analysis was used to determine frequencies and percentages, while multivariate seconded the bivariate regression analysis determine the factors associated to dual contraception by odds ratio with 95% CI. Results: the mean age of interviewees was 35.59 years and the majority of them were married women (60.9%). The dual contraception rate was 40%. The multivariate analysis of factors associated with dual contraception revealed that single women were most likely (AOR=38.123, 95% CI: 6.575-221.040, p<0.001) to use combinations of condoms and other methods. The odds of utilizing dual contraceptive methods were 7.347 times (AOR=7.347, 95% CI: 0.936-57.671, p=0.049) higher among women whose partners were casual laborers. Women who did not desire to have a baby were most likely (AOR=3.990, 95% CI: 1.796-8.865, p=0.001) to utilize dual contraception. The odds of utilizing dual methods were 5.634 times (AOR=5.634, 95% CI: 2.277-13.939, p<0.001) higher among women whose sexual partners did not desire a baby compared to those whose partners did. The odds of using dual methods were 1.354 times (AOR=1.354, 95% CI: 0.705-2.602) higher among women who disclosed their HIV status to their sexual partners compared to those who did not. The odds of using dual contraception were 5.526 times (AOR=5.526, 95% CI: 2.186-13.968, p<0.001) higher among women who were in HIV program for more than five years compared to those who were in the program for one year or less. Conclusion: the rate of dual contraception in this area is still low according to World Health Organization (WHO) recommendation and strategies to increase it are of paramount importance to be put in place by the Ministry of Health through Rwanda Biomedical Center, health facilities and partners in terms of training, health education, availability of dual methods at the level of the health system and men involvement in family planning.


Assuntos
Anticoncepcionais , Infecções por HIV , Adulto , Antirretrovirais/uso terapêutico , Anticoncepção , Comportamento Contraceptivo , Anticoncepcionais/uso terapêutico , Estudos Transversais , Serviços de Planejamento Familiar , Feminino , Infecções por HIV/prevenção & controle , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Masculino , Gravidez , Ruanda
7.
Hawaii J Health Soc Welf ; 81(8): 218-222, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35923386

RESUMO

In 2017, the state of Hawai'i passed Act 067 which allows trained pharmacists to prescribe hormonal contraceptives in an effort to expand access to contraception. The extent to which this policy has been implemented is not known. This study aimed to determine the proportion of Hawai'i pharmacies that currently provide pharmacist-prescribed hormonal contraceptives. In June 2020, a list of retail pharmacies was compiled using Google and Google Maps searches and pharmacy directories from major health insurance providers. Between June 23, 2020, and July 2, 2020, two trained interviewers called pharmacies and inquired about the availability of pharmacist-prescribed contraceptives using a "secret shopper" technique. Of the 175 pharmacies included in our analysis, 54 (31%) offered pharmacist-prescribed contraceptives. Kaua'i (40%) had the highest proportion of pharmacies offering pharmacist-prescribed contraceptives, followed by Maui (35%), O'ahu (30%), and Hawai'i Island (29%) (P=.88). Among pharmacies located in rural communities, 20 of 63 (32%) prescribed contraceptives, compared to 34 of 112 (30 %) pharmacies located in urban communities (P=.85). Of the 118 pharmacies that did not prescribe contraceptives and provided a reason for not doing so 33% cited lack of training and 28% lack of knowledge about Act 067. Thirty-one pharmacies provided information on the cost of pharmacist-prescribed contraceptives with 71% (22) stating that the patient would have to pay extra for the consultation (mean cost = $34.6, range $30-$45). Findings from this study can help inform future public health policies and implementation strategies aimed at improving contraceptive access in Hawai'i.


Assuntos
Farmacêuticos , Farmácia , Anticoncepção/métodos , Anticoncepcionais , Hawaii , Humanos
8.
Tex Heart Inst J ; 49(4)2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35939276

RESUMO

Cardiac thrombus, the most common intracardiac mass, is typically seen in the left side of the heart in the presence of atrial fibrillation, mitral stenosis, or impaired global wall motion. Right atrial thrombus, which is rarer, is usually associated with central venous catheter placement or pulmonary embolism. We present the case of a 24-year-old woman with a history of mitral valve prolapse who presented with fatigue and palpitations. Echocardiograms and cardiac magnetic resonance images revealed a right atrial mass compatible with a myxoma. However, after surgical excision of this and a second mass discovered intraoperatively, pathologic evaluation confirmed organized thrombus rather than myxoma. The patient's only risk factor was her use of oral contraceptive pills. Test results for hypercoagulable disorders revealed the presence of antiphosphatidylserine, an uncommon antiphospholipid antibody. The patient stopped taking the contraceptive. This case suggests the need to examine further the role of antiphosphatidylserine antibodies in the diagnosis of antiphospholipid syndrome.


Assuntos
Neoplasias Cardíacas , Mixoma , Trombose , Adulto , Anticorpos Antifosfolipídeos , Anticoncepcionais , Diagnóstico Diferencial , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Neoplasias Cardíacas/patologia , Humanos , Mixoma/diagnóstico , Mixoma/cirurgia , Trombose/diagnóstico , Trombose/etiologia , Adulto Jovem
9.
BMC Womens Health ; 22(1): 327, 2022 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-35918666

RESUMO

BACKGROUND: Out-of-pocket costs continue to be a barrier to accessing necessary healthcare services, including contraception. We explored how eliminating out-of-pocket cost affects contraceptive method choice among people reporting difficulty paying for healthcare in the previous year, and whether method satisfaction differed by method choice. METHODS: We used data from the HER Salt Lake Contraceptive Initiative. This prospective cohort study provided participants with no-cost contraception (April 2016-March 2017) following a control period that provided no reduction in cost for the contraceptive implant, a reduced price for the hormonal IUD, and a sliding scale that decreased to no-cost for the copper IUD (September 2015-March 2016). We restricted the study population to those who reported difficulty paying for healthcare in the past 12 months. For our primary outcome assessing changes in method selection between intervention and control periods, we ran simultaneous multivariable logistic regression models for each method, applying test corrections for multiple comparisons. Among participants who continued their method for 1 year, we explored differences in method satisfaction using multivariable logistic regression. RESULTS: Of the 1,029 participants reporting difficulty paying for healthcare and controlling for other factors, participants more frequently selected the implant (aOR 6.0, 95% CI 2.7, 13.2) and the hormonal IUD (aOR 3.2, 95% CI 1.7, 5.9) during the intervention than control period. Comparing the same periods, participants less frequently chose the injection (aOR 0.5, 95% CI 0.3, 0.8) and the pill (aOR 0.4, 95% CI 0.3, 0.6). We did not observe a difference in uptake of the copper IUD (aOR 2.0, 95% CI 1.0, 4.1).Contraceptive satisfaction scores differed minimally by contraceptive method used among contraceptive continuers (n = 534). Those who selected LNG IUDs were less likely to report low satisfaction with their method (aOR 0.5, 95% CI 0.3, 0.97). CONCLUSION: With costs removed, participants who reported difficulty paying for healthcare were more likely to select hormonal IUDs and implants and less likely to select the injectable or contraceptive pills. Among continuers, there were few differences in method satisfaction. CLINICALTRIALS: gov Identifier NCT02734199.


Assuntos
Anticoncepcionais Femininos , Dispositivos Intrauterinos de Cobre , Anticoncepção/métodos , Anticoncepcionais , Anticoncepcionais Femininos/uso terapêutico , Atenção à Saúde , Feminino , Humanos , Estudos Prospectivos
10.
BMC Womens Health ; 22(1): 324, 2022 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-35918693

RESUMO

BACKGROUND: Modern contraceptive use among adolescents is low despite the adverse effects of adolescent pregnancies. Understanding correlates of modern contraceptive use in different settings is key to the design of effective context-specific interventions. We aimed to determine factors associated with modern contraceptives use among adolescents in rural and urban settings of Zambia. METHODS: We analyzed secondary data from 2018 Zambia demographic and health survey (ZDHS) focusing on adolescent girls aged 15-19 years. We used multivariable logistic regression in SPSS version 25 to examine rural-urban variations in factors associated with modern contraceptive utilization. RESULTS: Overall, 12.0% (360/3000, 95% CI: 10.9-13.2) of adolescents in Zambia were using modern contraceptives. Use of modern contraceptives was higher in rural areas at 13.7% (230/1677, 95% CI: 12.1-15.3) compared to 9.8% (130/1323, 95% CI: 8.3-11.6) in urban areas. In the rural areas, having a child (aOR = 13.99; 95% CI 8.60-22.77), being married (aOR = 2.13; 95% CI 1.42-3.18), being older at 19 years (aOR = 3.90; 95% CI 1.52-10.03), having been visited by a field health worker (aOR = 1.62; 95% CI 1.01-2.64), having been exposed to family planning messages on mass media (aOR = 2.87; 95% CI 1.01-8.18) and belonging to the richest wealth quintile (aOR = 2.27; 95% CI 1.43-3.62) were associated with higher odds of contraceptive utilization. Furthermore, adolescents in the Northern (aOR = 0.29; 95% CI 0.11-0.80) and Luapula (aOR = 0.35; 95% CI 0.15-0.81) provinces were associated with less odds of utilizing contraceptives compared to those in Western province. In the urban areas, older age at 19 years (aOR = 4.80; 95% CI 1.55-14.84) and having a child (aOR = 18.52; 95% CI 9.50-36.14) were the only factors significantly associated with modern contraceptive utilization. CONCLUSION: Age and having a child were associated with modern contraceptive use in both rural and urban areas. In rural areas (province, marital status, being visited by field health workers, family planning messages exposure and wealth index) were the only associated factors. This indicates that interventions aiming to increase contraceptive utilization should be context specific.


Assuntos
Comportamento Contraceptivo , Anticoncepcionais , Adolescente , Criança , Anticoncepcionais/uso terapêutico , Estudos Transversais , Serviços de Planejamento Familiar , Feminino , Humanos , Gravidez , Zâmbia
11.
Sex Reprod Health Matters ; 30(1): 2098557, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35920612

RESUMO

The COVID-19 pandemic has disproportionate effects on people living in low- and middle-income countries (LMICs), exacerbating weak health systems. We conducted a scoping review to identify, map, and synthesise studies in LMICs that measured the impact of COVID-19 on demand for, provision of, and access to contraceptive and abortion-related services, and reproductive outcomes of these impacts. Using a pre-established protocol, we searched bibliographic databases (December 2019-February 2021) and key grey literature sources (December 2019-April 2021). Of 71 studies included, the majority (61%) were not peer-reviewed, and 42% were based in Africa, 35% in Asia, 17% were multi-region, and 6% were in Latin America and the Caribbean. Most studies were based on data through June 2020. The magnitude of contraceptive service-related impacts varied widely across 55 studies (24 of which also included information on abortion). Nearly all studies assessing changes over time to contraceptive service provision noted declines of varying magnitude, but severe disruptions were relatively uncommon or of limited duration. Twenty-six studies addressed the impacts of COVID-19 on abortion and postabortion care (PAC). Overall, studies found increases in demand, reductions in provision and increases in barriers to accessing these services. The use of abortion services declined, but the use of PAC was more mixed with some studies finding increases compared to pre-COVID-19 levels. The impacts of COVID-19 varied substantially, including the country context, health service, and population studied. Continued monitoring is needed to assess impacts on these key health services, as the COVID-19 pandemic evolves.


Assuntos
Aborto Induzido , COVID-19 , COVID-19/epidemiologia , Anticoncepcionais , Países em Desenvolvimento , Feminino , Humanos , Pandemias , Gravidez
12.
PLoS One ; 17(8): e0272507, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35921369

RESUMO

OBJECTIVES: The unmet needs of contraception can lead to unintended pregnancy and transmission of sexually transmitted infections (STI). Therefore, this study aimed to evaluate the contraception use, knowledge, and attitude on STI among students under Royan University of Bhutan (RUB). METHODS: This was a cross-sectional study using an online questionnaire. The questionnaire was developed in Google forms and the link was shared through the college WeChat groups. The questionnaire consisted of four parts on socio-demographic, sexual behaviour and contraceptive use, knowledge, and attitude on STIs. All the students under RUB were invited to participate voluntarily in this study. The socio-demography was presented in frequency and proportion. RESULT: A total of 1,283 students participated in this survey and 55.0% (701) were females. Of this, 29.4% (377) were sexually active and 94.4% reported using modern contraception. Commonly used contraceptives were: condoms (83.8%, 316) and emergency contraceptives (20.6%, 78), respectively. The mean knowledge and attitude scores on STI were 9.94 (range 2-20) and 12 (range 2-14), respectively. Good knowledge and attitude on STI were reported in 53.2% (683) and 70.1% (899) of participants. CONCLUSION: Students reported average knowledge and a good attitude towards STI. Contraceptive use among university students was low. There is a need to strengthen health education on STIs in schools and universities. All forms of contraceptives especially condoms should be made easily available to sexually active people.


Assuntos
Anticoncepcionais , Infecções Sexualmente Transmissíveis , Butão , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Gravidez , Comportamento Sexual , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Estudantes , Inquéritos e Questionários , Universidades
13.
J Int AIDS Soc ; 25(8): e25958, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35929343

RESUMO

INTRODUCTION: As the range of effective HIV prevention options, including multiple biomedical tools, increases, there are many challenges to measuring HIV prevention efforts. In part, there is the challenge of varying prevention needs, between individuals as well as within individuals over time. The field of contraception faces many similar challenges, such as the range of prevention methods and changing contraceptive needs, and has developed many metrics for assessing contraceptive use at the program level, using frameworks that move beyond the HIV prevention cascade. We explore these similarities and differences between these two prevention fields and then discuss how each of these contraceptive metrics could be adapted to assessing HIV prevention. DISCUSSION: We examined measures of initiation, coverage and persistence. Among measures of initiation, HIV Prevention-Post Testing would be a useful corollary to Contraceptive Use-Post Partum for a subset of the population. As a measure of coverage, both Net Prevention Coverage and HIV Protection Index (modelled off the Contraception Protection Index) may be useful. Finally, as a measure of persistence, Person-Years of HIV Protection could be adapted from Couple-Years Protection. As in contraception, most programs will not reach 100% on HIV prevention metrics but these metrics are highly useful for making comparisons. CONCLUSIONS: While we may not be able to perfectly capture the true population of who would benefit from HIV prevention, by building off the work of the contraceptive field to use and refine these metrics, we can assess and compare HIV prevention over time and across programs. Furthermore, these metrics can help us reach global targets, such as the 2025 UNAIDS Goals, and reduce HIV incidence.


Assuntos
Infecções por HIV , Anticoncepção/métodos , Anticoncepcionais , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Incidência , Período Pós-Parto
14.
BMC Public Health ; 22(1): 1291, 2022 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-35788216

RESUMO

BACKGROUND: Over time, demographic and health survey (DHS) data remain valuable to examine variables relating to nationally representative population outcomes for low- and middle-income countries. In Tanzania, there are very limited DHS-based studies on the uptake of Modern Contraceptive Use (MCU). Present studies have focused on measurements at the level of individuals, yet research has shown that MCU variations exists at other levels within populations. In this study, we use a variance component modelling approach to explore variation in MCU at primary sampling unit (PSU) and regional levels while considering survey sample weights. METHODS: Using DHS data from 2016-2017 in Tanzania, we study different variance structures and the respective variation on MCU in a sample of 5263 Women of Reproductive Age (WRA) defined as between the ages of 15-49 years. First, a single variance component was used, followed by its extension to a random coefficient model and we tracked changes in the models. RESULTS: There was an influence of random variations on MCU on the levels of populations much explained by PSU-level clustering than region. On the fixed part, age of a woman, husband education level, desire to have children, and exposure to media and wealth tertiles were important determinants for MCU. Compared to WRA in 15-19 years, the odds of MCU among middle aged women (20-29 and 30-39 years) were 1.94 (95%CI:1.244-3.024) and 2.28 (95%CI:1.372-3.803). Also, increases in media exposure and middle and rich wealth tertiles women led to higher odds for MCU. We also found the presence of random effects influence of wealth tertiles levels on MCU. CONCLUSION: This study highlighted the utility of accounting for variance structures in addressing determinants of MCU while using DHS national level data. Apart from MCU, the DHS data have been widely applied to examine other variables pertaining to public health issues. This approach could be considered a better modelling technique for the DHS studies compared to traditional survey approaches, and to guide hierarchical population-based interventions to increase MCU.


Assuntos
Comportamento Contraceptivo , Anticoncepcionais , Inquéritos Epidemiológicos , Adolescente , Adulto , Análise de Variância , Análise por Conglomerados , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais/uso terapêutico , Anticoncepcionais Femininos/uso terapêutico , Dispositivos Anticoncepcionais Femininos/estatística & dados numéricos , Demografia , Escolaridade , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Modelos Estatísticos , Tanzânia/epidemiologia , Adulto Jovem
15.
BMJ Glob Health ; 7(7)2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35853673

RESUMO

Since 1984, Republican administrations in the US have enacted the global gag rule (GGR), which prohibits non-US-based non-governmental organisations (NGOs) from providing, referring for, or counselling on abortion as a method of family planning, or advocating for the liberalisation of abortion laws, as a condition for receiving certain categories of US Global Health Assistance. Versions of the GGR implemented before 2017 applied to US Family Planning Assistance only, but the Trump administration expanded the policy's reach by applying it to nearly all types of Global Health Assistance. Documentation of the policy's harms in the peer-reviewed and grey literature has grown considerably in recent years, however few cross-country analyses exist. This paper presents a qualitative analysis of the GGR's impacts across three countries with distinct abortion laws: Kenya, Madagascar and Nepal. We conducted 479 in-depth qualitative interviews between August 2018 and March 2020. Participants included representatives of Ministries of Health and NGOs that did and did not certify the GGR, providers of sexual and reproductive health (SRH) services at public and private facilities, community health workers, and contraceptive clients. We observed greater breakdown of NGO coordination and chilling effects in countries where abortion is legal and there is a sizeable community of non-US-based NGOs working on SRH. However, we found that the GGR fractured SRH service delivery in all countries, irrespective of the legal status of abortion. Contraceptive service availability, accessibility and training for providers were particularly damaged. Further, this analysis makes clear that the GGR has substantial and deleterious effects on public sector infrastructure for SRH in addition to NGOs.


Assuntos
Anticoncepcionais , Saúde Global , Feminino , Humanos , Quênia , Madagáscar , Nepal , Gravidez , Estados Unidos
17.
Front Neuroendocrinol ; 66: 101017, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35843303

RESUMO

Steroid hormones influence different aspects of brain function, including development, neurogenesis, neuronal excitability, and plasticity, thus affecting emotional states, cognition, sociality, and reward. In women, their levels fluctuate across the lifespan and through the reproductive stages but are also altered by exogenous administration of hormonal contraceptives (HC). HC are widely used by women throughout their fertile life both for contraceptive and therapeutic benefits. However, awareness of their effects on brain function and behavior is still poorly appreciated, despite the emerging evidence of their action at the level of the central nervous system. Here, we summarize results obtained in preclinical studies, mostly conducted in intact female rodents, aimed at investigating the neurobiological effects of HC. HC can alter neuroactive hormones, neurotransmitters, neuropeptides, as well as emotional states, cognition, social and sexual behaviors. Animal studies provide insights into the neurobiological effects of HC with the aim to improve women's health and well-being.


Assuntos
Encéfalo , Anticoncepcionais , Animais , Anticoncepcionais/farmacologia , Emoções , Feminino , Hormônios , Humanos , Comportamento Sexual
18.
Expert Rev Clin Pharmacol ; 15(6): 659-670, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35802958

RESUMO

INTRODUCTION: A non-hormonal prescription vaginal pH modulator (VPM) gel (Phexxi®), with active ingredients lactic acid, citric acid and potassium bitartrate, has recently been approved for prevention of pregnancy in the United States. The objective of this review is to compile the evidence available from published preclinical and clinical trials to support its use. AREAS COVERED: PubMed was searched for published literature on VPM gel. Two Phase III trials were found on clinicaltrials.gov database. The results demonstrated that VPM gel is safe, with minimal side effects, and effective (cumulative 6-7 cycle pregnancy rate of 4.1-13.65%, (Pearl Index 27.5) as a contraceptive. Microbicidal effects suggest potential for the prevention of sexually transmitted infections (STIs); currently a Phase III clinical trial is being conducted to evaluate prevention of chlamydia and gonorrhea. EXPERT OPINION: Non-hormonal reversible contraceptive options have been limited to the highly effective copper-releasing intrauterine device that requires insertion by a trained clinician, and less effective coitally associated barrier and spermicide options which are typically available over-the-counter. Spermicides, which improve efficacy of barrier devices, may increase the risk of HIV/STIs. VPM gel provides a new safe, effective non-hormonal contraceptive option, with potential for prevention of STIs.


Assuntos
Infecções Sexualmente Transmissíveis , Espermicidas , Ácido Cítrico , Anticoncepção/métodos , Anticoncepcionais , Feminino , Humanos , Concentração de Íons de Hidrogênio , Ácido Láctico , Laxantes , Potássio , Gravidez , Prescrições , Infecções Sexualmente Transmissíveis/prevenção & controle , Estados Unidos
19.
Womens Health (Lond) ; 18: 17455057221109362, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35848351

RESUMO

BACKGROUND: Postpartum preeclampsia has been implicated in increasing hospital re-admissions, maternal morbidity, and mortality worldwide. The knowledge of the risk factors of postpartum preeclampsia would be helpful in formulating strategies to aid in the prevention, early diagnosis, and timely treatment of this disorder. Thus, this study aimed to identify the risk factors associated with the development of new-onset postpartum preeclampsia and persistent postpartum preeclampsia in the Ghanaian setting. METHODS: This case-control study was conducted at the Obstetrics and Gynecology units of Komfo Anokye Teaching Hospital and the Kumasi Regional Hospital, both located in the Ashanti Region of Ghana. A total of 65 postpartum preeclamptic women (33 new-onset postpartum preeclampsia and 32 persistent postpartum preeclampsia) and 65 normotensive postpartum mothers were recruited from 48 h to 6 weeks post-delivery. Questionnaires were administered to assess the socio-demographic, lifestyle, obstetric characteristics, and past medical history of the study participants. RESULTS: Physical inactivity (p < 0.0001), infrequent antenatal visits (p < 0.0001), analgesic use (p < 0.0001), and cesarean delivery (p = 0.021) were significantly associated with both the new-onset postpartum preeclampsia and persistent postpartum preeclampsia. Contraceptive use was significantly associated with the development of new-onset postpartum preeclampsia (p < 0.0001) while women with low-birthweight babies are also at high risk of developing persistent postpartum preeclampsia (p < 0.0001). CONCLUSION: Physical inactivity, infrequent antenatal visits, analgesic use, contraceptive use, and cesarean delivery are major predisposing risk factors for the development of postpartum preeclampsia. Screening using these risk factors, close monitoring and follow-up observation of women after delivery would be beneficial in identifying and managing postpartum preeclampsia.


Assuntos
Pré-Eclâmpsia , Estudos de Casos e Controles , Anticoncepcionais , Feminino , Gana/epidemiologia , Humanos , Período Pós-Parto , Pré-Eclâmpsia/epidemiologia , Gravidez , Fatores de Risco
20.
Int J Public Health ; 67: 1604905, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35845431

RESUMO

Objectives: The present study identifies factors that affect intention to use contraceptives among married women in countries in sub-Saharan Africa. Methods: Secondary data analysis was conducted using Demographic and Health Surveys. A total of 334386 weighted sample women who were fecund were included in the analysis. Multi-level mixed-effect logistic regression analysis was fitted to identify individual and community level factors associated with intention to use contraceptives. Results: The prevalence of intention to use contraceptives was 45.76%. Age, educational status, and wealth quintile were factors affecting the intention to use contraceptives. Conclusion: Several individual and community level factors were associated with the intention to use contraceptives in SSA. Therefore, governmental and non-governmental organizations should consider these factors when implementing strategies.


Assuntos
Comportamento Contraceptivo , Anticoncepcionais , Escolaridade , Feminino , Inquéritos Epidemiológicos , Humanos , Intenção , Casamento
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