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Behavioral Characteristics of Adult Patients on Highly Active Antiretroviral Therapy (HAART) in Uganda.
Global Journal of Medicine and Public Health. 2012 Jan-Feb; 1(1):39-41.Background: Behavioral factors have an impact on patient adherence and treatment outcomes. Specific information on behavioral factors is however minimal at health facilities in resource settings. Such information is vital in helping health facilities to provide targeted interventions. Method: Adherence surveys (n=783) were carried out to assess self-reported condom use, alcohol intake in the past month and disclosure in patients 19 years and above on HAART in 19 HIV clinics. Health workers were trained on how to administer the survey questions. The questions aimed at determining risky behaviors and disclosure of HIV illness. Results: More than half of the patients (59%) do not use condoms in the 19 HIV clinics. 30% reported using condoms always. Most of the patients (79%) on HAART had not taken alcohol in the past one month suggesting that most patients on HAART did not use alcohol. The majority of the patients (99%) disclosed their status with implications for better adherence and increased psychosocial support. Conclusion: It may be important to relate condom use, alcohol intake and disclosure to viral suppression and also advocate for comprehensive positive prevention at the HIV clinics. There is need to carry out an in-depth analysis of alcohol intake among HAART patients. Steps should be taken to address these behavioral issues in support groups and community programs. and prevent periodontal disease, and possibility of low birth weight.
Global Journal of Medicine and Public Health. 2012 Jul-Aug; 1(4):42-48.Background: Low birth weight can cause devastating long term medical and economical impacts to the family as whole and much interest prevails in preventing LBW by controlling its potential risk factors. Pregnancy periodontitis, being reported as one of such risk factors, is amenable to prevention, control and cure. Confirmative evidence can bring drastic improvements in birth weight and also health of the mother. This cohort study was an attempt to find if such a relation exists since limited conclusive evidence is available. Objectives: To determine the relation between pregnancy periodontitis and low birth weight of newborn in primigravida women in rural Belgaum. To assess the oral health status of the same primigravida women in rural Belgaum. Materials and Methods: Study Design and Period: A cohort study for 18 months Study location: 3 rural field areas of JNMC (Handiganur, Kinaye and Vantamuri) in Belgaum. Study Population: Primigravida women in the 3 villages in their first trimester in January/February 2011 during enrolment and expected to deliver in August/September 2011. Sample Size: 240 (120 in each cohort). Data Collection: After ethical review, a pilot study was conducted on 10% of study population in each village to essentially pre-test the interview schedule. Then screening visit to enrol women based on eligibility criteria was done. Subsequent screening periodontal examination was done by CPI to allocate the women into study (pregnant women with periodontitis) and control (pregnant women without periodontitis) cohort. Oral health status was also recorded using OHI-S and DMFT indices. Follow up visits consisted of trimester-wise visit to check on periodontal status and a post-delivery visit to record term of delivery and LBW. Data was entered in Microsoft Excel 2007 and SPSS (ß version 20) and analyzed in in proportions, percentages, Odds Ratio, Relative Risk, Chi-Square test and Logistic Regression Analysis.Results: The total incidence of LBW was 15% (22.5% in study cohort, 7.5% in control cohort). Incidence of PTB was 17.5%. 33.3% of PTB had LBW, while only 11.1% of term deliveries had LBW. Preterm birth (aOR=3.266; 1.384-7.704,p<.05), pregnancy periodontitis (aOR=2.403;1.1011-5.712,p<.05), anaemia (aOR=2.746;1.212-6.222,p<0.5) were significantly associated with LBW. Two thirds of study population had fair oral hygiene. Half of study population had dental caries while majority did not have filled or missing teeth. Conclusion: Preterm birth, pregnancy periodontitis and anaemia were found to be independent risk factors for LBW. This is importance because periodontal disease is a factor amenable to prevention and cure. Simple regular oral hygiene practices during pregnancy can effectively control.
Global Journal of Medicine and Public Health. 2012 Jul-Aug; 1(4):29-33.Background: Unmet need is a valuable indicator for assessing the achievements of national family planning programs. The present study was undertaken with the objectives to determine the magnitude of unmet need for family planning among the married women of reproductive age group (15-49 years), to evaluate the various factors that influence the unmet need and to explore the common reasons for unmet need for family planning. Methods: A community based, cross-sectional study was conducted from February to April 2012 in Laucha village in Kishanganj, Bihar through multistage sampling. Married women aged 15-49 years, who were permanent residents of the village, were selected by complete enumeration (330 in total) and interviewed through house to house survey with the help of a pre-designed, pre-tested and semi-structured questionnaire. Results: The total unmet need for family planning was 23.9%; 9.4% for spacing births and 14.5% for limiting births. The unmet need varied significantly with age (p < 0.05) and was highest inAdd to my documents.4376436
Predictors of consistent condom use among University students: Hierarchical analysis Debre Berhan, Ethiopia.
Global Journal of Medicine and Public Health. 2012 Jul-Aug; 1(4):23-28.Background: HIV/AIDS, STI, and unwanted pregnancies are prevalent in higher institutions. To minimize this triple burden, an effective strategy is consistent condom use. Purpose: To assess determinant factors for consistent condom use among university students. Methods: A cross-sectional study design was conducted in March, 2012. A two-stage, stratified sampling method was employed for the selection of 576 study subjects. Hierarchical logistic regression was employed to identify determinate factors. Result: The findings showed 36.5% of students were sexually active. Of these, 53.4% reportedly used condoms during sexual intercourse and 55.6% of them reportedly used condoms irregularly. The multivariate logistic regression showed that sex/gender, students’ family residence, drinking alcohol, multiple sexual partners and khat chewing had an association on the intent of consistent condom use. Conclusion: Though there is an increase in the use of consistent condom use, large numbers of students are still at risk for acquiring HIV. Sex, drinking alcohol, chewing khat, families’ place of residence, and number of sexual partners are predictors of consistent condom use.5376406
A study on socio-demographic correlates of maternal health care utilization in a rural area of West Bengal, India.
Global Journal of Medicine and Public Health. 2012 Jul-Aug; 1(4):7-12.Background: Improving health of the mother is a global concern. However there is a wide regional variation in maternal health care utilization. The present study was planned to explore the prevailing condition at local level. Objectives: To estimate the proportion of women who had utilized maternal health care services and to explore relevant socio-demographic, behavioral and biological co-variates. Methods: It was a community based cross-sectional study using cluster sampling technique. The respondents were interviewed with a pre-designed, pre-tested semi-structured questionnaire. Results: Most of the respondents were below 25 years, primary educated, primi-para house wives. 80% had early pregnancy registration, 88% had four or more antenatal checkups and 93.6% women had institutional delivery. Most women went to government institutes for their ante-natal checkups and delivery. Majority of the utilization variables were significantly associated with age, education and household wealth index of the respondents. Conclusions: utilization of all the components of maternal health care was lower among younger age, lower education and poorer household wealth index.6376405
Global Journal of Medicine and Public Health. 2012 Sep-Oct; 1(5):58-63.This exploratory qualitative study aimed to identify perceived benefits, barriers and motivational factors impacting condom use for out-of-school youth ages 15-24 years. The study was carried out in Kinondoni Municipality of Tanzania between April and May 2010. A semi-structured guide was used in 8 in-depth interviews and two focus group discussions (FGDs) among 30 respondents chosen through convenient sampling. The Health belief Model (HBM) served as the conceptual framework for the study. Findings indicate that psychosocial and utilization problems were identified as main barriers to condom use. Additionally, lack of negotiation skills for safer sex was perceived as a serious impediment to condom use, particularly among women. An effective behavior-change programme for HIV prevention, which address psychosocial and utilization related barriers to condom use is needed. A well-designed strategy would improve condom use by putting emphasis on skills for correct condom use and negotiation for safer sex, particularly for women.7376389
Menstruation and menstrual hygiene among adolescent girls of West Bengal, India: A school based comparative study.
Global Journal of Medicine and Public Health. 2012 Sep-Oct; 1(5):50-57.Background: Adolescents are often less informed, less experienced, and less comfortable accessing reproductive health information and services than adults. In many developing countries, a culture of silence surrounds the topic of menstruation and related issues; as a result many young girls lack appropriate and sufficient information regarding menstrual hygiene. This may result in incorrect and unhealthy behaviour during their menstrual period. Objectives: To assess and compare knowledge, belief, ideas, source of knowledge and practice of menstrual hygiene between school-going adolescents in an urban and a rural school of West Bengal, India. Methods: Cross-sectional, descriptive study was conducted among adolescent female students of Howrah district of West Bengal, India in the year 2011. Data was collected by pre-designed, pre-tested semi-structured self-administered questionnaire. Results: The mean age at menarche was 12.1 years among urban and 12.2 years among the rural participants. More than 80% participants had some restrictions imposed during menstruation. Significantly higher number of urban girls had pre-menarchal knowledge on menstruation and used sanitary napkins. Conclusions: Menstrual hygiene is a vital aspect of health education for adolescent girls. For improvement of menstrual hygiene, sanitary napkins should be made universally available and affordable.8376371
Assessment of maternal and child health (MCH) practices with a focus on Janani Suraksh Yojana (JSY).
Global Journal of Medicine and Public Health. 2012; 1(6):9 p.Background: Janani Suraksha Yojana (JSY) is a safe motherhood intervention encompassing conditional cash transfer scheme initiated under National Rural Health Mission (NRHM). Objective A rapid appraisal was conducted to assess selected maternal and child health (MCH) practices among rural mothers in a block of Haryana with a focus on JSY. Methodology: Using stratified random sampling, 6 health subcentre area in a rural block of Haryana were selected and all available JSY (n=72) mothers with their child in age-group of 6-11 months were covered. Similar numbers of non-JSY (n=76) mother were also contacted by the investigators using pre-designed, pre-tested semi-structure interview schedule. Results: Out of 148 mothers, majority (77.02%) were in the age-group of 20-24 years; overall 52.02% [45.83% (JSY) vs. 57.89% (non-JSY)] had completed atleast 9 years of schooling; all (100%) JSY beneficiaries belonged to affirmative group (OBC/SC) but only 38.89% of them possessed BPL-card; a total of 68 (45.94%), 62 (41.89%) and 18 (12.16%) mothers had one, two & three living children respectively and 93% women were home-maker. Higher proportion of non-JSY (72.36%) viz. JSY (54.16%) mothers had institutional delivery (p<0.05). Pre-lacteal feed was administered to 60% of newborn while 95% received colostrum; however only 32.43% were initiated on breast-milk within first hour of birth inspite of all being normal vaginal deliveries. Nearly 91.66% of JSY and 22.36% of non-JSY mothers were aware of the financial scheme (p<0.05); only 20.83% JSY mothers received money within one-month of delivery; 47.22% of mothers spent money either on themselves or child care while amongst rest it got utilized within general family pool.9376362
Spatial, socio-economic and demographic variation of childlessness in India: A special reference to reproductive health and marital breakdown.
Global Journal of Medicine and Public Health. 2012; 1(6):15 p.Background/Objective: India observe double burden of fertility -childlessness along with high fertility, which brings it close to a developed country. Childlessness has serious demographic, social and health implications. We explored spatial variation of childlessness women in India along with several socio-economic and demographic correlates. Further we examined maternal and reproductive health problems among childless women and linkages between marital breakdown (divorce) and childlessness, in comparison to fertile women. Methods: Cross-sectional data from 27,505 currently married women, aged 21-49 years, who were interviewed in 1998-99 National Family Health Survey (NFHS-2). These women had been filtered out from all India samples (90,303) based on criteria such as, age more than 20 years, currently not using any family planning methods, marital duration more than 3 years and staying with their husband. Multiple logistic regression analysis was used to estimate the prevalence odds ratios for childlessness, adjusting for various covariates. Results: Overall, 7% of currently married women in India were childless. Southern (10.9) and Western (10.7) region shows highest percentage of childless women while central region exhibits lowest (4.7%) percentage of childlessness. Andhra Pradesh state shows highest percent of childless women (13.3%) followed by Goa (11.8%). Women with high school complete and above education (OR:1.16;p=0.053), women belonging to other religion (OR:1.51;p=0.004), women belonging to other (general) caste (OR:1.20;p=0.007), women belonging to higher standard of living households (OR:1.30;p<0.0001), currently not working women (OR:1.42;p<0.0001), spousal age gap of 15 years and above (OR:1.55;p<0.0001) were more likely to be childless whereas women in rural area (OR:0.53;p<0.0001) and Muslims women (OR:0.53;p<0.0001) were almost half likely to be childless than their counterparts. Maternal health problems, self-reported reproductive health problems and violence against women also emerged significantly higher among childless women than fertile women. Autonomy, examined in terms of women’s decision-making on what to cook and obtaining health care, we found childless women in both type of decision-making are behind the fertile women. The study also found that there is a more than five-fold gap in childlessness between divorced women (37.8%) and currently married women (7%). Conclusion: The study has clearly brought out various dimensions of childlessness at the national and state level. Our study indicates wide differences in the prevalence of childlessness among women by their place of residence, religion, caste/tribe status, educational attainment and standard of living. Along with population problems of high fertility in India, the issue of childlessness should also be considered in a more rational manner. More medical facilities especially infertility clinics are needed to address the problems. Going through the miserable situation of childless women in India regarding their poor health, lack of autonomy and social problems, attention is needed to mitigate the psychosocial trauma associated with childlessness.10394977
Family Planning, Natural Family Planning, and Abortion Use among U.S. Hispanic Women: Analysis of Data from Cycle 7 of the National Survey of Family Growth.
Linacre Quarterly. 2012 May; 79(2):192-207.Hispanics are the largest minority group in the U.S. and they contribute to over 50 percent of Catholics under the age of 25. The purpose of this study was to determine the patterns of contraceptive use (current and ever), natural family planning (NFP), and abortion among U.S. Hispanic women between the ages of 15 and 44 years and to compare their patterns of use to non-Hispanic women of the same age range. A particular interest was to determine the influence of faith on the choice of family-planning methods among the sexually active U.S. Catholic Hispanic women. Data for this study came from the National Survey of Family Growth 2006-2008, which included 1,613 Hispanic and 5,743 non-Hispanic women between the ages of 15 and 44. Approximately 57 percent of the Hispanic women are Catholic. In general, U.S. Hispanic women had significantly less frequent use of the hormonal pill, male condom, withdrawal, and vasectomy (of male partner) but more frequent use of the IUD and Depo-Provera compared to non-Hispanic women. There was little use of NFP and no difference in the frequency of reported abortion. Catholic Hispanic women had significantly less frequent use of the male condom, the Pill, vasectomy, and abortion and more use of NFP compared to non-Catholic Hispanic women. Although there is some positive influence of faith among the sexually active Hispanic women of reproductive age, overall, the amount of ever use of sterilization (21 percent), condom use (80 percent), Pill use (66 percent), and Depo-Provera (30 percent) is remarkable. The more frequent use of Depo-Provera and the IUD might reflect the economic level of the participants and the use of federally funded family-planning services.11394976
Linacre Quarterly. 2012 Nov; 79(4):460-473.The Standard Days Method (SDM) is a method of family planning that assumes ovulation to be close to the midpoint of the menstrual cycle; fertility falls between days 8 and 19; and is most effective for cycle lengths between twenty-six and thirty-two days. The purpose of this study was to evaluate the assumptions of the SDM with a new data set of 714 menstrual cycles produced by 131 women (mean age twenty-nine) who tracked their fertility with an electronic fertility monitor that measured urinary estrogen and luteinizing hormone (LH). The LH peak was used to estimate the day of ovulation (EDO) and the six-day fertile window. Results indicated the majority (80 percent) of menstrual cycles had EDOs within three days of the midpoint of the cycle (86 percent with cycle lengths between twenty-six and thirty-two days). Approximately 22.5 percent (172) of the cycles had fertile window days outside of days 8 to 19, 10.2 percent (78) before, and 12.1 percent (92) after. However, there is a low probability of pregnancy when women experience short cycles and the early days of the fertile window are outside of days 8 through 19. We concluded assumptions of the SDM outside of the fertile window with long cycles could be problematic. However, the SDM is valid for women who have most cycles within the twenty-six to thirty-two day range.12394975
Comparing Current, Former, and Never Users of Natural Family Planning An Analysis of Demographic, Socioeconomic, and Attitudinal Variables.
Linacre Quarterly. 2012 Nov; 79(4):474-486.This project examines how women who currently use natural family planning (NFP), those who formerly used NFP, and those who have never used NFP compare along demographic, socioeconomic, and attitudinal variables. Bivariate analyses of data from the National Survey of Family Growth 2006-2010 (N = 10,598 female respondents) suggest that current NFP users varied socioeconomically and demographically from former NFP users, but differences were more prominent between current NFP users and never NFP users. In many cases, there was little variation between former NFP users and never NFP users. Current NFP users were less likely to be black and more likely to be Hispanic or other race, married, Catholic or other religion, have a bachelor's degree, and earn higher income than the other two groups. Understanding how current NFP users differ from those who formerly used NFP and those who have never tried NFP provides important clues about which populations to target for promotional efforts.13394974
Natural Family Planning Instruction as a Marriage Requirement a Retrospective Analysis of the First Two Years' Experience in the Diocese of Covington().
Linacre Quarterly. 2012 Nov; 79(4):487-498.Beginning January 1, 2009, the Roman Catholic Diocese of Covington mandated that all engaged couples take a full course of NFP instruction as part of preparation for marriage within the Church. Using data from the Couple to Couple League and its Covington-based instructors, overall NFP instruction and characteristics of the couples attending classes before and after the mandate were examined. In the first two years, 66 percent and 77 percent of couples who married in the diocese, respectively, attended an NFP class. The mandate shifted the reasons for couples taking NFP instruction; prior to the mandate, 40 percent of engaged couples attended classes solely due to a pastor's requirement while 74 percent of engaged couples did so afterward (p < 0.001). Hormonal contraceptive use was common; 54 percent reported current use while another 23 percent reported former use. Current hormonal contraceptive use was significantly more common among those attending solely due to the mandate compared to those attending for multiple reasons (59 percent vs. 41 percent respectively, p = 0.004) and was significantly more common among engaged compared to married couples (53 percent vs. 8 percent respectively, p < 0.001). Cohabiting engaged couples were significantly more likely to have ever used hormonal contraceptives (91 percent vs. 71 percent, p < 0.0001), compared to engaged couples who were not cohabiting at the time of NFP instruction, and were significantly less likely to both be Catholic (55 percent vs. 70 percent, p = 0.002). Overall, implementation of mandatory NFP instruction as part of marriage preparation was successful; in post-class surveys, over 90 percent of couples acknowledged they had a better understanding of their fertility, and 83 percent would recommend the classes to a friend. Longer-term prospective follow-up is needed to evaluate the long-term impacts to couples exposed to such a requirement.14393938
Cochrane Database of Systematic Reviews. 2012 Aug 15; (8):CD009251.BACKGROUND: Tubal sterilization by hysteroscopy involves inserting a foreign body in both fallopian tubes. Over a three-month period, the tubal lumen is occluded by tissue growth stimulated by the insert. Tubal sterilization by hysteroscopy has advantages over laparoscopy or mini-laparotomy, including the avoidance of abdominal incisions and the convenience of performing the procedure in an office-based setting. Pain, an important determinant of procedure acceptability, can be a concern when tubal sterilization is performed in the office. OBJECTIVES: To review all randomized controlled trials that evaluated interventions to decrease pain during tubal sterilization by hysteroscopy. SEARCH METHODS: From January to March 2011, we searched the computerized databases of MEDLINE, POPLINE, CENTRAL, EMBASE, LILACS, and CINAHL for relevant trials. We searched for current trials via Clinicaltrials.gov. We also examined the reference lists of pertinent articles and wrote to known investigators for information about other published or unpublished trials. SELECTION CRITERIA: We included all randomized controlled trials that evaluated pain management at the time of sterilization by hysteroscopy. The intervention could be compared to another intervention or placebo. DATA COLLECTION AND ANALYSIS: Initial data were extracted by one review author. A second review author verified all extracted data. Whenever possible, the analysis was conducted with all women randomized and in the original assigned groups. Data were analyzed using RevMan software. Pain was measured using either a 10-cm or 100-point visual analog scale (VAS). When pain was measured at multiple points during the procedure, the overall pain score was considered the primary treatment effect. If this was not measured, a summation of all pain scores for the procedure was considered to be the primary treatment effect. For continuous variables, the mean difference with 95% confidence interval was computed. MAIN RESULTS: Two trials met the inclusion criteria. The total number of participants was 167. Using a 10-cm VAS to measure pain, no significant difference emerged in overall pain for the entire procedure between women who received a paracervical block with lidocaine versus normal saline (mean difference -0.77; 95% CI -2.67 to 1.13). No significant difference in pain score was noted at the time of injection of study solution to the anterior lip of the cervix (mean difference -0.6; 95% CI -1.3 to 0.1), placement of the device in the tubal ostia (mean difference -0.60; 95% CI -1.8 to 0.7), and postprocedure pain (mean difference 0.2; 95% CI -0.8 to 1.2). Procedure time (mean difference -0.2 minutes; 95% CI -2.2 to 1.8 minutes) and successful bilateral placement (OR 1.0; 95% CI 0.19 to 5.28) was not significantly different between groups. During certain portions of the procedure, such as placement of the tenaculum (mean difference -2.03; 95% CI -2.88 to -1.18), administration of the paracervical block (mean difference -1.92; 95% CI -2.84 to -1.00), and passage of the hysteroscope through the external (mean difference -2.31; 95% CI -3.30 to -1.32) and internal os (mean difference -2.31; 95% CI -3.39 to -1.23), use of paracervical block with lidocaine resulted in lower pain scores.Using a 600-point scale calculated by adding 100-point VAS scores from six different portions of the procedure, no significant difference emerged in overall pain between women who received intravenous conscious sedation versus oral analgesia (mean difference -23.00; CI -62.02 to 16.02). Using a 100-point VAS, no significant difference emerged at the time of speculum insertion (mean difference 4.0; 95% CI -4.0 to 12.0), cervical injection of lidocaine (mean difference -1.8; 95% CI -10.0 to 6.4), insertion of the hysteroscope (mean difference -8.7; 95% CI -19.7 to 2.3), placement of the first device (mean difference -4.4; 95% CI -15.8 to 7.0), and removal of the hysteroscope (mean difference 0.9; 95% CI -3.9 to 5.7). Procedure time (mean difference -0.2 minutes; 95% CI -2.0 to 1.6 minutes) and time in the recovery area (mean difference 3.6 minutes; 95% CI -11.3 to 18.5 minutes) was not different between groups. However, women who received intravenous conscious sedation had lower pain scores at the time of insertion of the second tubal device compared to women who received oral analgesia (mean difference -12.60; CI -23.98 to -1.22). AUTHORS' CONCLUSIONS: The available literature is insufficient to determine the appropriate analgesia or anesthesia for sterilization by hysteroscopy. Compared to paracervical block with normal saline, paracervical block with lidocaine reduced pain during some portions of the procedure. Intravenous sedation resulted in lower pain scores during insertion of the second tubal device. However, neither paracervical block with lidocaine nor conscious sedation significantly reduced overall pain scores for sterilization by hysteroscopy.15393937
Cochrane Database of Systematic Reviews. 2012 Oct 17; 10:CD006759.BACKGROUND: A maternity waiting home (MWH) is a facility within easy reach of a hospital or health centre which provides emergency obstetric care (EmOC). Women may stay in the MWH at the end of their pregnancy and await labour. Once labour starts, women move to the health facility so that labour and giving birth can be assisted by a skilled birth attendant. The aim of the MWH is to improve accessibility to skilled care and thus reduce morbidity and mortality for mother and neonate should complications arise. Some studies report a favourable effect on the outcomes for women and their newborns. Others show that utilisation is low and barriers exist. However, these data are limited in their reliability. OBJECTIVES: To assess the effects of a maternity waiting facility on maternal and perinatal health. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (27 January 2012), CENTRAL (The Cochrane Library 2011, Issue 4 of 4), MEDLINE (1966 to January 2012), EMBASE (1980 to January 2012), CINAHL (1982 to January 2012), African Journals Online (AJOL) (January 2012), POPLINE (January 2012), Dissertation Abstracts (January 2012) and reference lists of retrieved papers. SELECTION CRITERIA: Randomised controlled trials including quasi-randomised and cluster-randomised trials that compared perinatal and maternal outcome in women using a MWH and women who did not. DATA COLLECTION AND ANALYSIS: There were no randomised controlled trials or cluster-randomised trials identified from the search. MAIN RESULTS: There were no randomised controlled trials or cluster-randomised trials identified from the search. AUTHORS' CONCLUSIONS: There is insufficient evidence to determine the effectiveness of maternity waiting facilities for improving maternal and neonatal outcomes.16330787
Assessment of fertility desire and family planning utilization among people living with HIV and on antiretroviral treatment, Asella Hospital, Arsi Zone, Oromia Region.
Ethiopian Journal of Reproductive Health. 2012 Dec; 6(1):22-29.Background: Individual’s desire to have children and intention to use family planning method varies with demographic, socio-economic, and health status, including human immune deficiency virus/acquired immune deficiency syndrome (HIV/AIDS). However, concrete data is lacking on fertility desire and which of the factors affect utilization of family planning services. Objective: To assess fertility desire and family planning utilization among People Living with HIV and on antiretroviral therapy in Asella Hospital, Ethiopia. Methods: A cross-sectional facility based study was conducted among 384 people who are living with HIV virus and on antiretroviral treatment. Face to face interview using structured and pre-tested questionnaire and in-depth interview of health care providers were carried out. Results: More male than female (AOR= 0.01, 95% CI 0 - 0.25) and individuals who have no or one child than those with two or more children (AOR= 115, 95% CI 3868.6) desired for children in the future. Single individuals had less desire than married ones (AOR= 0.01, 95% CI 0 - 0.96). Family planning utilization among people living with HIV was 47.7% before knowing their status while current users were 76.5%. Current family planning use was less among currently un married than married, and among those who were on antiretroviral treatment during the last one - two years (AOR= 0.04, 95% CI 0.02 - 0.1) and (AOR= 0.5, 95% CI 0.28 - 0.89) respectively. Conclusion: The desire for children among people living with HIV and on antiretroviral treatment was high and varies by sex, marital status, and the number of children they already have. Family planning utilization among people on antiretroviral therapy was high and nearly doubled after they knew their HIV status. Married and those who were on antiretroviral treatment for more than two years were more likely to use family planning method. The high fertility desire is a concern for the prevention of mother to child transmission counseling program.17330786
Status of family planning service integration for women in their reproductive age in chronic HIV care clinics in Dessie town, Ethiopia.
Ethiopian Journal of Reproductive Health. 2012 Dec; 6(1):14-21.Background: Integrating of family planning (FP) service in chronic HIV care clinics is an appropriate intervention to prevent newborns from acquiring HIV by enabling women who have the desire to prevent pregnancies. Objective: To assess the level of FP service integration in chronic HIV care clinics in Dessie town, Ethiopia. Methodology: A health facility based cross sectional study was conducted in 2011 in Dessie town, North East Ethiopia, among 401 HIV positive women in the reproductive age who attended chronic HIV care. Clinics. As well as program document review quantitative data were collected using structured questionnaire through clients exit interview method as well as program document review. Qualitative information was gathered from nine chronic HIV care providers and program managers. Result: Three hundred ninety three (98%) HIV positive women who attended chronic HIV care had heard about one FP methods during the course of their care, of which 238 (60.5%) reported receiving counseling about FP. One hundred sixty eight (42.7%) of the respondents reported receiving condoms for FP purpose of which 108 (64.3%) were provided with condoms after being counseled for FP. Among respondents who ever heard about FP, 378 (96.2%) supported the idea of having FP services integrated in the chronic HIV care. Care provider’s work load, level of FP training, lack of space and FP supplies were found to affect extent of service integration. Only 110 (27.9%) of respondents were provided with FP counseling and services during their chronic HIV care visits. Conclusion : Although integration is supported by the health policy, and favored by clients and providers alike, the program environment and facility capacity (both human and logistics), were serious challenges for the integration of FP counseling an d services in to the chronic HIV care.18330785
Factors influencing the practice of modern family planning methods among married women in Ethiopia: Evidence from the 2005 Ethiopian Demographic and Health Survey.
Ethiopian Journal of Reproductive Health. 2012 Dec; 6(1):4-13.Background: Ethiopia is characterized by high fertility rate even when compared with many Sub-Saharan African countries. The practice of modern family planning (FP) methods is also low. Thus, exploring factors that determine the practice of modern FP methods is vital in order to come up with strategies that alleviate the consequences of unmet need for FP. Objective: The objective of this study was to examine and determine factors that predict the practice of modern FP among married women of reproductive age group in Ethiopia and illustrate aspects of data limitations and efforts on how to apply methods in providing estimations about selected determinants of contraceptive use. Method: The 2005 Ethiopian Demographic and Health Survey (EDHS) was the source of data. The survey had collected reproductive health related data on 9066 married women. Univariate analysis was employed to identify the association between the independent explanatory variables and the practice of modern FP methods; and multivariate logistic regression analysis was employed in predicting which factors determined contraceptive practice. Results: Univariate analysis of the independent explanatory variables including age of women, place of residence, number of living children, education and wealth index were found to be statistically significantly associated with the practice of modern FP methods. Multivariate logistic regression analysis has shown that place of residence, education level and wealth index to be potential predictors of the practice of modern FP methods. Conclusion: Differences in fertility level and the practice of modern FP methods reflect differences in socio-economic status and place of residence.19372634
Can universal insecticide-treated net campaigns achieve equity in coverage and use? the case of northern Nigeria.
Malaria Journal. 2012 Feb 1; 11:10 p.Background: Insecticide-treated nets (ITNs) are effective tools for malaria prevention and can significantly reduce severe disease and mortality due to malaria, especially among children under five in endemic areas. However, ITN coverage and use remain low and inequitable among different socio-economic groups in sub-Saharan Africa, particularly in Nigeria. Several strategies have been proposed to increase coverage and use and reduce inequity in Nigeria, including free distribution campaigns recently conducted by the Nigerian federal government. Using data from the first post-campaign survey, the authors investigated the effect of the mass free distribution campaigns in achieving equity in household ownership and use of ITNs. Methods: A post-campaign survey was undertaken in November 2009 in northern Nigeria to assess the effect of the campaigns in addressing equity across different socio-economic groups. The survey included 987 households randomly selected from 60 clusters in Kano state. Using logistic regression and the Lorenz concentration curve and index, the authors assessed equity in ITN coverage and use. Results: ITN ownership coverage increased from 10% before the campaigns to 70%-a more than fivefold increase. The campaigns reduced the ownership coverage gap by 75%, effectively reaching parity among wealth quintiles (Concentration index 0.02, 95% CI (-0.02 ; 0.05) versus 0.21 95%CI (0.08 ; 0.34) before the campaigns). ITN use (individuals reporting having slept under an ITN the night before the survey visit) among individuals from households owning at least one ITN, was 53.1% with no statistically significant difference between the lowest, second, third and fourth wealth quintiles and the highest wealth quintile (lowest: odds ratio (OR) 0.87, 95% confidence interval (CI) (0.67 ; 1.13); second: OR 0.85, 95% CI (0.66 ; 1.24); third: OR 1.10 95% CI (0.86 ; 1.4) and fourth OR 0.91 95% CI (0.72 ; 1.15). Conclusion: The campaign had a significant impact by increasing ITN coverage and reducing inequity in ownership and use. Free ITN distribution campaigns should be sustained to increase equitable coverage. These campaigns should be supplemented with other ITN distribution strategies to cover newborns and replace aging nets.20325915
Analysis of cost impact of HIV/AIDS on health service provision in nine regions, Tanzania: Methodological challenges and lessons for policy.
Rwanda Journal of Health Sciences. 2012; 1(1):8-20.Background: Tanzania is one of African countries that have since 1983 been facing the human immuno-deficiency virus-acquired immune-deficiency syndrome (HIV-AIDS) pandemic, thereby, drawing attention to the general public, the governmental and non-governmental organizations and government’s partner development agencies. Due to few socio-economic studies done so far to evaluate the impact this pandemic, a study was designed and undertaken in 2001 to analyse how this disease had impacted on health service provision in Tanzania from a cost perspective. Methods: The study involved a review of health service management information documents at selected health facilities in nine regions within mainland Tanzania, interviews with health service workers (HWs) at selected health facilities and health managers at district and regional levels as well as focus group discussions with people living with HIV/AIDS (PLWA). Findings: We noted that on average, HIV/AIDS caused 72% of all the deaths recorded at the study hospitals. The health management information system (HMIS) missed some data in relation to HIV/AIDS services, including the costs of such services which limited the investigators’ ability to determine the actual costs impact. Using their experience, health managers and HWs reported substantial amounts of funds, labour time, supplies and other resources to have been spent on HIV/AIDS preventive and curative services. The frontline HWs reported to face a problem of identifying the PLWA among those who presented multiple illness conditions at HF levels which means sometimes the services given to such people could not be separated for easy costing from services delivered to other categories of the patients. Such respondents and their superiors (i.e. Health managers) testified that PLWA were being screened and receiving treatment. HWs were concerned with spending much time on counselling PLWA, attending home-based care, sick-leaves and funeral ceremonies either after their relatives or co-staff have died of AIDS, lowering time for delivering services to other patients. HWs together with their superiors at district and regional levels reported increasing shortages of essential supplies, office-working space and other facilities at HF levels, although actual costs of such items were not documented. Conclusion: The cost impact of HIV/AIDS to the health sector is undoubtedly high even though it is not easy to establish the cost of each service delivered to PLWA in Tanzania. As adopted in the present study, designers of methods for analysing impacts of diseases like this should consider a mixture of both quantitative and qualitative techniques. Meanwhile concerted measures are needed to improve health service record keeping so as enhancing data usability for research and rational management decision-making purposes.21374688
Washington, D.C., Advocates for Youth, 2012 Oct.. 8 p.Long-acting reversible contraceptive (LARC) methods include intrauterine devices (IUDs) and contraceptive implants. These methods are safe, effective, and reversible, require lit¬tle to no maintenance, are cost-effective over time, and have much better compliance rates than other hormonal methods. For these reasons, they are ideal for many women, es¬pecially young women who wish to delay or avoid pregnancy for at least three years. Yet fewer than nine percent of women in the United States who use contraception use an IUD and less than one percent use contracep¬tive implants. However, communities around the country are developing new strategies and creative initiatives to improve access to these methods. Youth-serving professionals, educators, and health care providers can play an important role in helping to dispel myths among youth people so that they can make informed decisions about contraception and choose the best option for them.22323658
Washington, D.C., Population Council, 2015. 1 p.This user's guide is part of a larger publication titled The Balanced Counseling Strategy Plus (BCS+): A Toolkit for Family Planning Service Providers Working in High STI/HIV Prevalence Settings available from: http://www.popcouncil.org/research/the-balanced-counseling-strategy-plus-a-toolkit-for-family-planning-service. The third edition of the BCS+ includes content updated according to the latest WHO Medical Eligibility Criteria (2015). This algorithm summarizes the 19 steps needed to implement the BCS+ during a family planning counseling session. These steps are organized into four stages: pre-choice, method choice, post-choice, and STI / HIV counseling.23366015
Washington, D.C., World Bank, 2012 Oct. 45 p.Nearly 60 percent of Uganda's population is aged below twenty. This generation faces health and economic challenges associated with human immunodeficiency virus (HIV), early pregnancy, and unemployment. Whether these challenges are due to a lack of information and or vocational skills is however uncertain. A programme was conducted to provide: (i) vocational training to run small-scale enterprises; and (ii) information on health and risky behaviors. The programme conducted, positively impacts behaviors on both economic and health margins. On economic margins, the intervention raises the likelihood that girls engage in income generating activities by 32 percent mainly driven by increased participation in self-employment. On health related margins, self-reported routine condom usage increases by 50 percent among the sexually active, and the probability of having a child decreases by 26 percent. Strikingly, the share of girls reporting sex against their will drops from 21 percent to almost zero. The findings suggest combined interventions might be more effective among adolescent girls than single-pronged interventions aiming to improve labor market outcomes solely through vocational training, or to change risky behaviors solely through education programmes.24374523
Community-based family planning model for faith-based health networks: experience with the Christian Health Association of Kenya (CHAK).
Washington, D.C., Georgetown University, Institute for Reproductive Health, 2012. 19 p.This document summarizes the methodology, objectives, and activities of a capacity building strategy for community-based family planning provision in church-based health networks like Christian Health Associations. The strategy was designed by Georgetown University’s Institute for Reproductive Health in collaboration with the Christian Health Association of Kenya (CHAK). Five components have been identified as critical to implementing a successful community-based family planning program within African Christian Health Associations. These five components are described in detail in the report and include lessons learned from an experience implementing the project in Kenya.25374458
Washington, D.C., PAI, 2012 Jul. 2 p.Offering family planning/reproductive health (FP/RH) and HIV/ AIDS services together is central to ensuring universal access to reproductive health care and HIV prevention, treatment, care and support. Failure to integrate these services is a missed opportunity that may undermine the effectiveness of these programs. An estimated 2.6 million people become infected with HIV annu¬ally. Women are particularly affected, making up 60 percent of people living with HIV in sub-Saharan Africa. Sub-Saharan Africa also has high maternal mortality rates, and 53 million women in this region want to prevent pregnancy, but lack contraception. To curb HIV prevalence rates and address the demand for fam¬ily planning across the globe, there is an overwhelming need to increase access to FP/RH and HIV/AIDS information and services through integration. (excerpt)