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Implementation effectiveness of revised (post-2010) World Health Organization guidelines on prevention of mother-to-child transmission of HIV using routinely collected data in sub-Saharan Africa: A systematic literature review.
Medicine. 2017 Oct; 96(40):e8055.BACKGROUND: To synthesize and evaluate the impact of implementing post-2010 World Health Organization (WHO) prevention of mother-to-child transmission (PMTCT) guidelines on attainment of PMTCT targets. METHODS: Retrospective and prospective cohort study designs that utilized routinely collected data with a focus on provision and utilization of the cascade of PMTCT services were included. The outcomes included the proportion of pregnant women who were tested during their antenatal clinic (ANC) visits; mother-to-child transmission (MTCT) rate; adherence; retention rate; and loss to follow-up (LTFU). RESULTS: Of the 1210 references screened, 45 met the inclusion criteria. The studies originated from 14 countries in sub-Saharan Africa. The highest number of studies originated from Malawi (10) followed by Nigeria and South Africa with 7 studies each. More than half of the studies were on option A while the majority of option B+ studies were conducted in Malawi. These studies indicated a high uptake of human immunodeficiency virus (HIV) testing ranging from 75% in Nigeria to over 96% in Zimbabwe and South Africa. High proportions of CD4 count testing were reported in studies only from South Africa despite that in most of the countries CD4 testing was a prerequisite to access treatment. MTCT rate ranged from 1.1% to 15.1% and it was higher in studies where data were collected in the early days of the WHO 2010 PMTCT guidelines. During the postpartum period, adherence and retention rate decreased, and LTFU increased for both HIV-positive mothers and exposed infants. CONCLUSION: Irrespective of which option was followed, uptake of antenatal HIV testing was high but there was a large drop off along later points in the PMTCT cascade. More research is needed on how to improve later components of the PMTCT cascade, especially of option B+ which is now the norm throughout sub-Saharan Africa.
Decreased emergence of HIV-1 drug resistance mutations in a cohort of Ugandan women initiating option B+ for PMTCT.
PloS One. 2017; 12(5):e0178297.BACKGROUND: Since 2012, WHO guidelines for the prevention of mother-to-child transmission (PMTCT) of HIV-1 in resource-limited settings recommend the initiation of lifelong antiretroviral combination therapy (cART) for all pregnant HIV-1 positive women independent of CD4 count and WHO clinical stage (Option B+). However, long-term outcomes regarding development of drug resistance are lacking until now. Therefore, we analysed the emergence of drug resistance mutations (DRMs) in women initiating Option B+ in Fort Portal, Uganda, at 12 and 18 months postpartum (ppm). METHODS AND FINDINGS: 124 HIV-1 positive pregnant women were enrolled within antenatal care services in Fort Portal, Uganda. Blood samples were collected at the first visit prior starting Option B+ and postpartum at week six, month six, 12 and 18. Viral load was determined by real-time RT-PCR. An RT-PCR covering resistance associated positions in the protease and reverse transcriptase HIV-1 genomic region was performed. PCR-positive samples at 12/18 ppm and respective baseline samples were analysed by next generation sequencing regarding HIV-1 drug resistant variants including low-frequency variants. Furthermore, vertical transmission of HIV-1 was analysed. 49/124 (39.5%) women were included into the DRM analysis. Virological failure, defined as >1000 copies HIV-1 RNA/ml, was observed in three and seven women at 12 and 18 ppm, respectively. Sequences were obtained for three and six of these. In total, DRMs were detected in 3/49 (6.1%) women. Two women displayed dual-class resistance against all recommended first-line regimen drugs. Of 49 mother-infant-pairs no infant was HIV-1 positive at 12 or 18 ppm. CONCLUSION: Our findings suggest that the WHO-recommended Option B+ for PMTCT is effective in a cohort of Ugandan HIV-1 positive pregnant women with regard to the low selection rate of DRMs and vertical transmission. Therefore, these results are encouraging for other countries considering the implementation of lifelong cART for all pregnant HIV-1 positive women.
BJOG. 2018 Feb; 125(3):288.Against a background of an increasing demand for surgical intervention for the treatment of FGM/C related complications, Berg et al
Note for typesetter: Please update reference when assigned to an issue.have conducted a systematic review of 62 studies involving 5829 women, to assess the effectiveness of defibulation, excision of cysts and clitoral reconstructive surgery. Berg et al report that defibulation showed a lower risk of Caesarean section and perineal tears; excision of cysts commonly resulted in resolution of symptoms; and clitoral reconstruction resulted in most women self-reporting improvements in their sexual health. However, Berg et al highlight that they had little confidence in the effect estimate for all outcomes as most of the studies were observational and conclude that there is currently poor quality of evidence on the benefits and/or harm of surgical interventions to be able to counsel women appropriately. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Integrated person-centered health care for all women during pregnancy: implementing World Health Organization recommendations on antenatal care for a positive pregnancy experience.
Global Health: Science and Practice. 2017 Jun 27; 5(2):197-201.Add to my documents.
[New recommendations from the World Health Organization (WHO) for the use of contraceptive methods] Nuevas recomendaciones de la Organizacion Mundial de la Salud (OMS) para el uso de los metodos anticonceptivos.
Gaceta Medica De Mexico. 2016 Sep - Oct; 152(5):601-603.The Medical Eligibility Criteria for Contraceptive Use of the World Health Organization have been updated recently. These criteria constitute a guideline for the selection of family planning methods appropriated for women and men with known medical conditions or personal characteristics of medical relevance. The guidelines last updating incorporates recommendations for the use of a new emergency contraceptive pill and three long-acting hormonal methods, and revises some previously established recommendations. This article provides information on the last edition of such document and aims to contribute to its dissemination.
Implementation of the WHO safe childbirth checklist program at a tertiary care setting in Sri Lanka: a developing country experience.
BMC Pregnancy and Childbirth. 2015; 15:12.BACKGROUND: To study institutionalization of the World Health Organization's Safe Childbirth Checklist (SCC) in a tertiary care center in Sri Lanka. METHOD: A hospital-based, prospective observational study was conducted in the De Soysa Hospital for Women, Colombo, Sri Lanka. Healthcare workers were educated regarding the SCC, which was to be used for each woman admitted to the labor room during the study period. A qualitatively pretested, self-administered questionnaire was given to all nursing and midwifery staff to assess knowledge and attitudes towards the checklist. Each item of the SCC was reviewed for adherence. RESULTS: A total of 824 births in which the checklist used were studied. There were a total of births 1800 during the period, giving an adoption rate of 45.8%. Out of the 170 health workers in the hospital (nurses, midwives and nurse midwives) 98 answered the questionnaire (response rate = 57.6%). The average number of childbirth practices checked in the checklist was 21 out of 29 (95% CI 20.2, 21.3). Educating the mother to seek help during labor, after delivery and after discharge from hospital, seeking an assistant during labor, early breast-feeding, maternal HIV infection and discussing contraceptive options were checked least often. The mean level of knowledge on the checklist among health workers was 60.1% (95% CI 57.2, 63.1). Attitudes for acceptance of using the checklist were satisfactory. Average adherence to checklist practices was 71.3%. Sixty eight (69.4%) agreed that the Checklist stimulates inter-personal communication and teamwork. Increased workload, poor enthusiasm of health workers towards new additions to their routine schedule and level of user-friendliness of Checklist were limitations to its greater use. CONCLUSIONS: Amongst users, the attitude towards the checklist was satisfactory. Adoption rate amongst all workers was 45.8% and knowledge regarding the checklist was 60.1%. These two factors are probably linked. Therefore prior to introducing it to a facility awareness about the value and correct use of the SCC needs to be increased, while giving attention to satisfactory staffing levels.
U S. Medical Eligibility Criteria for Contraceptive Use, 2010: adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition.
MMWR. Recommendations and Reports. 2010 Jun 18; 59(RR-4):1-86.CDC created U.S. Medical Eligibility Criteria for Contraceptive Use, 2010, from guidance developed by the World Health Organization (WHO) and finalized the recommendations after consultation with a group of health professionals who met in Atlanta, Georgia, during February 2009. This guidance comprises recommendations for the use of specific contraceptive methods by women and men who have certain characteristics or medical conditions. The majority of the U.S. guidance does not differ from the WHO guidance and covers >60 characteristics or medical conditions. However, some WHO recommendations were modified for use in the United States, including recommendations about contraceptive use for women with venous thromboembolism, valvular heart disease, ovarian cancer, and uterine fibroids and for postpartum and breastfeeding women. Recommendations were added to the U.S. guidance for women with rheumatoid arthritis, history of bariatric surgery, peripartum cardiomyopathy, endometrial hyperplasia, inflammatory bowel disease, and solid organ transplantation. The recommendations in this document are intended to assist health-care providers when they counsel women, men, and couples about contraceptive method choice. Although these recommendations are meant to serve as a source of clinical guidance, health-care providers should always consider the individual clinical circumstances of each person seeking family planning services.
Geneva, Switzerland, UNAIDS, 2007.  p. (UNAIDS/07.07E; JC1274E)These Practical Guidelines for Intensifying HIV Prevention: Towards Universal Access are designed to provide policy makers and planners with practical guidance to tailor their national HIV prevention response so that they respond to the epidemic dynamics and social context of the country and populations who remain most vulnerable to and at risk of HIV infection. They have been developed in consultation with the UNAIDS cosponsors, international collaborating partners, government, civil society leaders and other experts. They build on Intensifying HIV Prevention: UNAIDS Policy Position Paper and the UNAIDS Action Plan on Intensifying HIV Prevention. In 2006, governments committed themselves to scaling up HIV prevention and treatment responses to ensure universal access by 2010. While in the past five years treatment access has expanded rapidly, the number of new HIV infections has not decreased - estimated at 4.3 (3.6-6.6) million in 2006 - with many people unable to access prevention services to prevent HIV infection. These Guidelines recognize that to sustain the advances in antiretroviral treatment and to ensure true universal access requires that prevention services be scaled up simultaneously with treatment. (excerpt)
Contraception Report. 1998 Sep; 9(4): p..In 1995, the World Health Organization (WHO) released revised medical eligibility criteria guidelines to assist family planning agencies and clinicians prescribe contraceptives. By eliminating overly restrictive barriers to use, WHO hopes to increase access to and use of birth control methods. This article briefly reviews some of the important WHO guidelines concerning intrauterine devices. Introduction WHO researchers evaluated the benefits and risks of using IUDs in healthy women and in women with certain medical conditions or individual characteristics, such as parity and exposure or susceptibility to sexually transmitted diseases. A previous article describes WHO's methods for devising the criteria in detail. Briefly, the eligibility criteria were developed by international experts from many organizations. WHO experts reviewed the medical literature from the past 10 years and devised recommended medical eligibility criteria for different contraceptive methods. One main concern was to address outdated contraindications. WHO notes that "The contraindications for many contraceptives tend to become very rigid, resulting in denial of contraceptive access to many women. Relative contraindications tend to become absolute." (excerpt)
Research Triangle Park, North Carolina, FHI, 2002.  p. (FHI Research Brief No. 6; RB-02-06E)Community-based workers worldwide use checklists to determine whether women are medically eligible to use combined oral contraceptives (COCs) or depot-medroxyprogesterone acetate (DMPA). However, problems may arise when outdated and inaccurate checklists are used. With input from dozens of experts, Family Health International developed new checklists that are easily understandable and consistent with the World Health Organization's (WHO) medical eligibility requirements. (author's)
FHI's quick reference chart for the WHO medical eligibility criteria for contraceptive use. To initiate or continue the use of combined oral contraceptive (COC), Noristerat (NET-EN), Depo-Provera (DMPA), copper intrauterine device (Cu-IUD).
[Research Triangle Park, North Carolina], FHI, 2004 Mar.  p.I/C (Initiation/Continuation): A woman may fall into either one category or another, depending on whether she is initiating or continuing to use a method. For example, a client with current PID who wants to initiate IUD use would be considered as Category 4, and should not have an IUD inserted. However, if she develops PID while using the IUD, she would be considered as Category 2. This means she could generally continue using the IUD and be treated for PID with the IUD in place. Where I/C is not marked, a woman with that condition falls in the category indicated - whether or not she is initiating or continuing use of the method. (excerpt)
[Unpublished] 2000 Apr. 7 p.This paper explains briefly the role of the International Labor Organization (ILO) in maternity protection, the process of adopting and revising ILO standards on maternity protection and the main differences between the existing international standards and the draft Maternity Protection Convention. Presented in a questionnaire form, this fact sheet focuses on maternity protection. It answers questions as to what constitutes a maternity protection and how it is provided, and what ILO standards relate to maternity protection. In addition, it enumerates international labor standards and explains its effects; it explains the revision process of the Convention No. 103; and highlights some of the differences between Convention No. 103 and the Draft Convention.
REPRODUCTIVE HEALTH MATTERS. 1993 May; (1):97-100.Various practices keep women from receiving and using contraception. These medical barriers include those pertaining to eligibility, process, and regulatory and provider bias. Eligibility barriers place too strict criteria on what women may use a particular contraceptive. For example, severe migraine headaches are a relative contraindication for oral contraceptives (OCs), but some community-based distribution programs include headaches without being specific on their checklist, resulting in denying OCs to women who have had a recent headache. Blood tests to rule out liver and cardiovascular diseases as a prerequisite for a prescription of combined OCs in some West African countries represent a process hurdle. Yet, just a brief medical history can identify women at risk of these diseases. Restricting IUD insertion to physicians in some countries is another example of a medical barrier. Family planning providers or program managers sometimes determine themselves what methods are best suited for various women. This provider bias essentially eliminates women's choice of methods. Until 1992, the US Food and Drug Administration (FDA) had not approved the 3-month injectable contraceptive method, Depo-Provera, despite many studies confirming its safety. The lack of FDA approval prevented other countries from approving it. Despite 30 years of OC use worldwide, Japan still does not allow OC use. According to a WHO survey of 50 collaborating centers, the most common medical barrier to contraceptive use is requiring women who use OCs and IUDs to return for follow-up examinations more often than is necessary. This recent survey concludes that no overall standardized information about contraceptives, their side effects, and who can and cannot use them safely exists. WHO and other groups are developing internationally accepted guidelines to counteract conflicting information and outdated criteria for contraceptive delivery.
NETWORK. 1991 Sep; 12(2):14-7, 27.Many unwanted births and pregnancies could be avoided by improving instructions for and comprehension of the use of oral contraceptives. Employed less than only the IUD, the oral contraceptive pill is the 2nd- most widely used reversible form of contraception, used by 8% of all married women of reproductive age. 6-20% of pill users, however, fall pregnant due to improper pill use. Improving instructions in the pill pack, ensuring that instructions are correct, and working to facilitate user understanding and motivation have been identified as priorities in maximizing the overall potential effectiveness of the pill against pregnancy. Since packets in developing countries may consist of pills in cycles of 21, 22, 28, or 35 days, providers must also be trained to instruct users in a manner consistent with the written instructions. Pictorial information should be available especially for semi-literate and illiterate audiences. The essay describes recommendation for instruction standardization and simplification put forth by Family Health International, and endorsed by the U.S. Food and Drug Administration. International Planned Parenthood Federation efforts to increase awareness of this issues are discussed.
Women At Work. 1984; (2):1-71.This document describes the current status of maternity protection legislation in developed and developing countries and is based primarily on the findings of the International Labor Organization's (ILO's) global assessment of laws and regulations concerning working women before and after pregnancy. The global survey collected information from 18 Asian and Pacific countries, 36 African nations, 28 North and South American countries, 14 Middle Eastern countries, 19 European market economy countries, and 11 European socialist countries. Articles in 2 ILO conventions provide standards for maternity protection. According to the operative clauses of these conventions working women are entitled to 1) 12 weeks of maternity leave, 2) cash benefits during maternity leaves, 3) nursing breaks during the work day, and 4) protection against dismissal during maternity. Most countries have some qualifying conditions for granting maternity leaves. These conditions either state that a worker must be employed for a certain period of time or contributed to an insurance plan over a defined period of time before a maternity leave will be granted. About 1/2 of the countries in the Asia and Pacific region, the Americas, Africa, and in the Europe market economy group provide maternity leaves of 12 or more weeks. In all European socialist countries, women are entitled to at least 12 weeks maternity leave and in many leaves are considerably longer than 12 months. In the Middle East all but 3 countries provide leaves of less than 12 weeks. Most countries which provide maternity leaves also provide cash benefits, which are usually equivalent to 50%-100% of the worker's wages, and job protection during maternity leaves. Some countries extend job protection beyond the maternity leave. For example, in Czechoslovakia women receive job protection during pregnancy and for 3 years following the birth, if the woman is caring for the child. Nursing breaks are allowed in 5 of the Asian and Pacific countries, 30 of African countries, 18 of the countries in the Americas, 9 of the Middle East countries, 16 of European market economy countries, and in all of the European socialist countries. Several new trends in maternity protection were observed in the survey. A number of countries grant child rearing leaves following maternity leaves. In some countries these leaves can be granted to either the husband or the wife. Some countries have regulations which allow parents to work part time while rearing their children and some permit parents to take time off to care for sick children. In most of the countries, the maternity protection laws and regulations are applied to government workers and in many countries they are also applied to workers in the industrial sector. A list of the countries which have ratified the articles in the ILO convenants concerning maternity benefits is included.
Populi. 1985; 12(2):57-66.The UN Statistical Office is endeavoring to improve the collection and analysis of statistical information on women. Accurate statistical information is a prerequisite for assessing the current status of sexual inequality in the world and for monitoring responses to policies aimed at removing sexual inequalities. The Statistical Office in conjunction with several other UN agencies is 1) seeking to improve methods of collecting and analyzing information on women, 2) developing a computerized data base for statistical information on women at the international level, 3) conducting workshops for researchers and users of statistical in formation on women, and 4) helping countries develop systems for collecting relevant information. The Office publishes 3 documents on methodological problems. The 1st document, "Sex-based Stereotypes, Sex Biases and National Data System," identifies cultural factors which impede information gathering on women and suggests strategies for overcoming these obstacles. The 2nd publication, "Compiling Social Indicators on the Situation of Women," describes available data on women, discusses how this data can be most effectively used, and identifies indicators which can be developed from the available data. The 3rd document, "Methods for Statistics and Indicators on the Situation of Women," describes and evaluates the concepts and methods currently used in collecting and a analyzing information on women and makes a series of recommendations for improving the collection of data on women. In 1984, the Office began developing a data base for statistical information on women. At the present time, the data is available in a form which can be appropriately utilized only by individuals with sophisticated statistical skills. The information will eventually be available on diskettes. The Office is helping to develop workshops for the dual purpose of informing researchers about the information needs of planners and of teaching potential users, unfamiliar with statistical techniques, how to interpret and effectively use statistical information on women. The 1st workshop was held in early 1985 for participants from 11 English-speaking countries in Eastern and Southern Africa. A 2nd conference of Portuguese-speaking Africa countries is currently being organized, and workshops in other developing regions are anticipated. The UN helps countries develop census and registration systems and expand their survey capabilities. Although the original goal of these activities was not to collect data on women, efforts are now being made to ensure that data collecting instruments include a component for eliciting information on women. The Statistical Office's activities are guided by recommendations made by experts at a UN-sponsored meeting held in New York in 1983. These recommendations called for 1) methodological improvements, 2) the use of available data to develop indicators women's situation at the national and international level, 3) increased interaction between data collectors and data users, and 4) improved data collection of information on women at the national level. The Office has made considerable progress in pursuing these goals, but much remains to be done.
New York, UNFPA, June 1979. (Report No. 13) 151 pThis report is intended to serve, and has already to some extent so served, as part of the background material used by the United Nations Fund for Population Activities to evaluate project proposals as they relate to basic country needs for population assistance to Thailand, and in broader terms to define priorities of need in working towards eventual self-reliance in implementing the country's population activities. The function of the study is to determine the extent to which activities in the field of population provide Thailand with the fundamental capacity to deal with major population problems in accordance with its development policies. The assessment of population activities in Thailand involves a 3-fold approach. The main body of the report examines 7 categories of population activities rather broadly in the context of 10 elements considered to reflect effect ve government action. The 7 categories of population activities are: 1) basic data collection; 2) population dynamics; 3) formulation and evaluation of population policies and programs; 4) implementation of policies; 5) family planning programs; 6) communication a and education; and 7) special programs. The 10 elements comprise: 1) decennial census of population, housing, and agriculture; 2) an effective registration system; 3) assessment of the implications of population trends; 4) formulation of a comprehensive national population policy; 5) implementation of action programs integrated with related programs of economic and social development; 6) continued reduction in the population growth rate; 7) effective utilization of the services of private and voluntary organizations in action programs; 8) a central administrative unit to coordinate action programs; 9) evaluation of the national capacity in technical training, research, and production of equipment and supplies; and 10) maintenance of continuing liason and cooperation with other countries and with regional and international organizations.
In: Diczfalusy, E., ed. Regulation of human fertility. (Proceedings of the WHO Symposium on Advances in Fertility Regulation, Moscow, USSR, November 16-19, 1976) Copenhagen, Denmark, Scriptor, 1977. p. 236-252A 4-stage clinical testing program to test for effectiveness and untoward side effects of contraceptive drugs or devices is outlined tabularly and discussed. Stage 1, clinical pharmacology, requires few subjects (10-20) and a short (10 days) study period, performed at a single testing center. Stage 2, to determine or indicate effectiveness, would involve about 50 subjects during a trial of about 3 months. Stage 3 necessitates controlling conditions to evaluate effectiveness and side effects; 1000-2000 subjects would participate for 6 months-1 year in this stage of testing. Field condition effectiveness and problems constitute Stage 4, involving different cultural and socioeconomic populations for 1-2 years of testing. Completion of each stage and analysis of all results favorably are required before proceeding with the next testing step. This methodology is equally applicable to device (e.g., IUD testing during Stage 1 would test for local irritation effects rather than systemic ones) testing as to contraceptive drug evaluation.