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Jean de Dieu H, Lambert M. Predictors of contraceptive discontinuation in Rwanda: evidence from demographic and health survey 2019-2020. Contracept Reprod Med 2024; 9:19. [PMID: 38664853 PMCID: PMC11044445 DOI: 10.1186/s40834-024-00282-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Despite advancements, Rwanda continues to face challenges regarding contraceptive discontinuation. The 2019-2020 Rwanda Demographic and Health Survey (DHS) reported a 30% discontinuation rate among women within the first year of use. This study analyses predictors of discontinuation using this DHS data, with the goal of strengthening Rwanda's family planning programs. METHODS Data from the 2019-20 Rwanda DHS (14,634 women aged 15-49) was examined. A two-stage sampling design informed the survey. Life table methods and Cox proportional hazard models were used to analyze discontinuation rates, median usage duration across contraceptive methods, and the influence of demographic and other factors. RESULTS Results indicated a progressive rise in contraceptive discontinuation over different period: 16.69% at 6 months, 29.29% at 12 months, and 47.21% at 24 months. Pills and male condoms showed higher discontinuation probabilities early on. While injectables and LAM initially showed lower discontinuation, rates rose significantly by the 24th month. Health concerns and side effects were the primary reasons cited for discontinuation. The Cox proportional hazards analysis revealed significant factors influencing discontinuation: contraceptive method, desire for pregnancy, husband's disapproval, access/availability, and the desire for a more effective method. CONCLUSION This study highlights substantial contraceptive discontinuation rates in Rwanda, particularly for pills and injectables. Method type, health concerns, side effects, and method failure were associated with discontinuation. Interventions should focus on improving contraceptive continuation and investigating alternative methods with lower discontinuation tendencies.
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Chipako I, Singhal S, Hollingsworth B. Impact of sexual and reproductive health interventions among young people in sub-Saharan Africa: a scoping review. Front Glob Womens Health 2024; 5:1344135. [PMID: 38699461 PMCID: PMC11063325 DOI: 10.3389/fgwh.2024.1344135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/29/2024] [Indexed: 05/05/2024] Open
Abstract
Objectives The aim of this scoping review was to identify and provide an overview of the impact of sexual and reproductive health (SRH) interventions on reproductive health outcomes among young people in sub-Saharan Africa. Methods Searches were carried out in five data bases. The databases were searched using variations and combinations of the following keywords: contraception, family planning, birth control, young people and adolescents. The Cochrane risk-of-bias 2 and Risk of Bias in Non-Randomized Studies-of-Interventions tools were used to assess risk of bias for articles included. Results Community-based programs, mHealth, SRH education, counselling, community health workers, youth friendly health services, economic support and mass media interventions generally had a positive effect on childbirth spacing, modern contraceptive knowledge, modern contraceptive use/uptake, adolescent sexual abstinence, pregnancy and myths and misperceptions about modern contraception. Conclusion Sexual and reproductive health interventions have a positive impact on sexual and reproductive health outcomes. With the increasing popularity of mHealth coupled with the effectiveness of youth friendly health services, future youth SRH interventions could integrate both strategies to improve SRH services access and utilization.
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Affiliation(s)
- Isaac Chipako
- Health Economics and Policy Department, Division of Health Research Graduate College, Lancaster University, Lancaster, United Kingdom
| | - Saurabh Singhal
- Economics Department, Lancaster University, Lancaster, United Kingdom
| | - Bruce Hollingsworth
- Health Economics and Policy Department, Division of Health Research Graduate College, Lancaster University, Lancaster, United Kingdom
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Phiri M, Odimegwu C, Adewoyin Y. Social context of contraceptive use transition among sexually active women in Zambia (1992-2018): A decomposition analysis. PLoS One 2024; 19:e0300506. [PMID: 38625959 PMCID: PMC11020625 DOI: 10.1371/journal.pone.0300506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/28/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Contraception is an important public health initiative for addressing maternal health outcomes associated with unplanned pregnancies, unsafe abortions and maternal deaths. Although contraceptive use has been on the rise globally, the observed increases in sub-Saharan Africa (SSA) are sub-optimal and vary among countries. In Zambia, drivers of contraceptive use transition are not well documented. Thus, this study examined the drivers of contraceptive use change among sexually active women in Zambia between 1992 and 2018. METHODS Data came from the six Zambia Demographic and Health Surveys conducted between 1992 and 2018. A sample of 44,762 fecund sexually active women aged 15-49 years was analysed using multivariable Blinder Oaxaca decomposition regression analysis. Analysis took into account the complex survey design. Results were presented using adjusted coefficients, their 95% confidence intervals, and percentages. RESULTS The prevalence of contraceptive use among sexually active women increased significantly by 30.8 percentage points from 14.2% (95% CI: 12.8, 15.6) to 45.0% (95% CI: 43.6, 46.4) during the period 1992 to 2018. The major share of the increase happened during the period 1992-1996 (10.2%) while the least increase occurred between 2013 and 2018 (0.2%). Overall, about 15% of the increase in the prevalence of contraceptive use was attributable to changes in the compositional characteristics of women. On the other hand, 85% of the increase was due to change in contraceptive behaviour of sexually active women. Changes in women's compositional characteristics such as secondary education (5.84%), fertility preference (5.63%), number of living children (3.30%) and experience of child mortality (7.68%) were associated with the increase in contraceptive use prevalence. CONCLUSION Change in contraceptive behaviour of sexually active women contributed largely to the observed increase in contraceptive use prevalence in Zambia. Increase in the proportion of women attaining secondary education, decrease in the percentage of women who want large families and improvement in child survival were the major compositional factors driving the rise in contraceptive use. The findings imply that increasing investment in education sector and enhancing existing family planning programmes has the potential to further improve contraceptive use prevalence in Zambia.
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Affiliation(s)
- Million Phiri
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Demography, Population Sciences, Monitoring and Evaluation, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Clifford Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yemi Adewoyin
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Geography, University of Nigeria, Nsukka, Nigeria
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Mohammed A, Donkoh IE, Aboagye RG, Ahinkorah BO, Seidu AA. Access to quality contraceptive counselling among adolescent girls and young women in sub-Saharan Africa. Contracept Reprod Med 2024; 9:16. [PMID: 38622719 PMCID: PMC11017582 DOI: 10.1186/s40834-024-00267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/27/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Improving women's access to and use of modern contraceptives is a key global strategy for improving the sexual and reproductive health of women. However, the use of modern contraceptives among adolescent girls and young women in sub-Saharan Africa (SSA) remains relatively low, despite the numerous interventions to increase patronage. This study examined adolescent girls and young women's receipt of quality contraceptive counselling and its associated factors in SSA. METHODS Data for the study were extracted from the recent Demographic and Health Surveys of 20 countries in SSA, spanning from 2015 to 2021. A sample of 19,398 adolescent girls and young women aged 15 to 24 years was included in the study. We presented the proportion of adolescent girls and young women who received quality contraceptive counselling using a spatial map. Multilevel binary logistic regression analysis was carried out to examine the factors associated with the receipt of quality contraceptive counselling. RESULTS Overall, 33.2% of adolescent girls and young women had access to quality contraceptive counselling, ranging from 13.0% in Cameroon to 67.0% in Sierra Leone. The odds of receiving quality contraceptive counselling was higher among adolescent girls and young women aged 20-24 (AOR = 1.48, CI: 1.32-1.67), those with primary (AOR = 1.32, CI: 1.11-1.57) and secondary or higher education (AOR = 1.31, CI: 1.09-1.58), and those married (AOR = 1.32, CI: 1.15-1.52), cohabiting (AOR = 1.47, CI: 1.23-1.76), and previously married (AOR = 1.48, CI: 1.20-1.83) compared to their counterparts in the reference groups. Adolescent girls and young women who were currently working (AOR = 1.22, CI: 1.09-1.37), those who heard of family planning from radio in the last few months (AOR = 1.34, CI:1.21-1.50), those who visited the health facility in the last 12 months (AOR = 1.69, CI: 1.52-1.88), and those residing in the Southern (AOR = 5.01, CI: 3.86-6.51), Eastern (AOR = 2.54, CI: 1.96-3.30), and Western (AOR = 4.09, CI: 3.19-5.25) SSA were more likely to receive quality contraceptive counselling compared to their counterparts in the reference groups. Conversely, adolescent girls and young women who used the internet, those who had problem getting permission to seek medical help, those facing problem in seeking medical help for not wanting to go alone, those from the middle and richest wealth indices, and those from the rural areas were less likely to receive quality contraceptive counselling compared to their counterparts in the reference groups. CONCLUSION Receipt of quality contraceptive counselling among adolescent girls and young women was low. Considering the importance of quality contraceptive counselling on the uptake and continuation of contraception, policymakers need to institute measures that improve adolescent girls and young women's access to quality contraceptive counselling in SSA, especially in countries like Cameroon, Angola, Madagascar, Mauritania, and Guinea, taking into consideration the factors identified in the study. Increasing adolescent girls and young women's access to quality contraceptive counselling could greatly minimize the risk of unintended pregnancies and its associated maternal and child health burden in SSA and subsequently contribute to the attainment of the Sustainable Development Goal 3, target 3.7.
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Affiliation(s)
- Aliu Mohammed
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Irene Esi Donkoh
- Department of Medical Laboratory Science, University of Cape Coast, Cape Coast, Ghana
| | - Richard Gyan Aboagye
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia.
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.
| | - Bright Opoku Ahinkorah
- School of Clinical Medicine, University of New South Sydney, Sydney, Australia
- REMS Consultancy Services Limited, Sekondi-Takoradi, Western Region, Ghana
| | - Abdul-Aziz Seidu
- REMS Consultancy Services Limited, Sekondi-Takoradi, Western Region, Ghana
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
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Aizire J, Yende-Zuma N, Hanley S, Nematadzira T, Nyati MM, Dadabhai S, Chinula L, Nakaye C, Fowler MG, Taha T. Unintended pregnancy and contraception use among African women living with HIV: Baseline analysis of the multi-country US PEPFAR PROMOTE cohort. PLoS One 2024; 19:e0290285. [PMID: 38466748 PMCID: PMC10927155 DOI: 10.1371/journal.pone.0290285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 08/04/2023] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND About 90% of unintended pregnancies are attributed to non-use of effective contraception-tubal ligation, or reversible effective contraception (REC) including injectables, oral pills, intra-uterine contraceptive device (IUCD), and implant. We assessed the prevalence of unintended pregnancy and factors associated with using RECs, and Long-Acting-Reversible-Contraceptives (LARCs)-implants and IUCDs, among women living with HIV (WLHIV) receiving antiretroviral therapy (ART). METHODS We conducted cross-sectional analyses of the US-PEPFAR PROMOTE study WLHIV on ART at enrollment. Separate outcome (REC and LARC) modified-Poisson regression models were used to estimate prevalence risk ratio (PRR) and corresponding 95% confidence interval (CI). RESULTS Of 1,987 enrolled WLHIV, 990 (49.8%) reported their last/current pregnancy was unintended; 1,027/1,254 (81.9%) non-pregnant women with a potential to become pregnant reported current use of effective contraception including 215/1,254 (17.1%) LARC users. Compared to Zimbabwe, REC rates were similar in South Africa, aPRR = 0.97 (95% CI: 0.90-1.04), p = 0.355, lower in Malawi, aPRR = 0.84 (95% CI: 0.78-0.91), p<0.001, and Uganda, 0.82 (95% CI: 0.73-0.91), p<0.001. Additionally, REC use was independently associated with education attained, primary versus higher education, aPRR = 1.10 (95% CI: 1.02-1.18), p = 0.013; marriage/stable union, aPRR = 1.10 (95% CI: 1.01-1.21), p = 0.039; no desire for another child, PRR = 1.10 (95% CI: 1.02-1.16), p = 0.016; infrequent sex (none in the last 3 months), aPRR = 1.24 (95% CI: 1.15-1.33), p<0001; and controlled HIV load (≤ 1000 copies/ml), PRR = 1.10 (95% CI: 1.02-1.19), p = 0.014. LARC use was independently associated with country (Zimbabwe ref: South Africa, PRR = 0.39 (95% CI: 0.26-0.57), p<0.001; Uganda, PRR = 0.65 (95% CI: 0.42-1.01), p = 0.054; and Malawi, aPRR = 0.87 (95% CI: 0.64-1.19), p = 0.386; HIV load (≤ 1000 copies/ml copies/ml), aPRR=1.73 (95% CI: 1.26-2.37), p<0.001; and formal/self-employment, aPRR = 1.37 (95% CI: 1.02-1.91), p = 0.027. CONCLUSIONS Unintended pregnancy was common while use of effective contraception methods particularly LARCs was low among these African WLHIV. HIV viral load, education, sexual-activity, fertility desires, and economic independence are pertinent individual-level factors integral to the multi-level barriers to utilization of effective contraception among African WLHIV. National programs should prioritize strategies for effective integration of HIV and reproductive health care in the respective African countries.
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Affiliation(s)
- Jim Aizire
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Nonhlanhla Yende-Zuma
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- South Africa Medical Research Council (SAMRC)-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Sherika Hanley
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Umlazi Clinical Research Site, Durban, South Africa
| | - Teacler Nematadzira
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre, Harare, Zimbabwe
| | - Mandisa M. Nyati
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sufia Dadabhai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Lameck Chinula
- University of North Carolina (UNC) Project-Malawi, Lilongwe, Malawi
- UNC-CH Department of Obstetrics and Gynecology, Chapel Hill, NC, United States of America
| | - Catherine Nakaye
- Makerere University-Johns Hopkins University (MUJHU) Research Collaboration, Kampala, Uganda
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Taha Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Liu M, Vicetti Miguel RD, Quispe Calla NE, Aceves KM, Fritts L, Miller CJ, Moss JA, Baum MM, Cherpes TL. Genital epithelial barrier function is conserved by intravaginal rings releasing etonogestrel and ethinyl estradiol. Tissue Barriers 2024; 12:2186672. [PMID: 36899465 PMCID: PMC10832912 DOI: 10.1080/21688370.2023.2186672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/25/2023] [Indexed: 03/12/2023] Open
Abstract
The injectable progestin depot-medroxyprogesterone acetate (DMPA) is a popular contraceptive choice in sub-Saharan Africa although mouse models indicate it weakens genital epithelial integrity and barrier function and increases susceptibility to genital infection. The intravaginal ring NuvaRing® is another contraceptive option that like DMPA suppresses hypothalamic pituitary ovarian (HPO) axis function with local release of progestin (etonogestrel) and estrogen (ethinyl estradiol). As we previously reported that treating mice with DMPA and estrogen averts the loss of genital epithelial integrity and barrier function induced by DMPA alone, in the current investigation we compared genital levels of the cell-cell adhesion molecule desmoglein-1 (DSG1) and genital epithelial permeability in rhesus macaques (RM) treated with DMPA or a NuvaRing®re-sized for RM (N-IVR). While these studies demonstrated comparable inhibition of the HPO axis with DMPA or N-IVR, DMPA induced significantly lower genital DSG1 levels and greater tissue permeability to intravaginally administered low molecular mass molecules. By identifying greater compromise of genital epithelial integrity and barrier function in RM administered DMPA vs. N-IVR, our results add to the growing body of evidence that indicate DMPA weakens a fundamental mechanism of anti-pathogen host defense in the female genital tract.
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Affiliation(s)
- Mohan Liu
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University (OSU) College of Medicine, Columbus, OH, USA
- Comparative Biomedical Sciences Graduate Program, OSU College of Veterinary Medicine, Columbus, OH, USA
| | - Rodolfo D. Vicetti Miguel
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University (OSU) College of Medicine, Columbus, OH, USA
| | - Nirk E. Quispe Calla
- Department of Comparative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Kristen M. Aceves
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA, USA
| | - Linda Fritts
- California National Primate Research Center, University of California, Davis, Davis, CA, USA
| | - Christopher J. Miller
- California National Primate Research Center, University of California, Davis, Davis, CA, USA
- Center for Comparative Medicine, University of California, Davis, Davis, CA, USA
| | - John A. Moss
- Department of Chemistry, Oak Crest Institute of Science, Monrovia, CA, USA
| | - Marc M. Baum
- Department of Chemistry, Oak Crest Institute of Science, Monrovia, CA, USA
| | - Thomas L. Cherpes
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University (OSU) College of Medicine, Columbus, OH, USA
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Sciannameo S, Zalazar V, Spadaccini L, Duarte M, Cahn P, Aristegui I, Sued O. Preference for long-acting injectable for ART and PrEP among people with and without HIV: a cross-sectional study in Argentina. Ther Adv Infect Dis 2024; 11:20499361241228341. [PMID: 38380160 PMCID: PMC10878205 DOI: 10.1177/20499361241228341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/09/2024] [Indexed: 02/22/2024] Open
Abstract
Background Little is known about the preferences for antiretroviral therapy (ART) administration methods, such as oral daily pills or long-acting injectable (LAI) options, as well as preferences for pre-exposure prophylaxis (PrEP) administration methods among people without HIV in Latin America. Objectives This study aimed to assess the preferences for ART administration methods among people with HIV and PrEP methods among those without HIV, as well as to examine the correlations and reasons for these preferences. Design We conducted a cross-sectional web-based questionnaire between April and July 2021, using social media accounts of a HIV non-governmental organization. The questionnaire was open to all adults living in Argentina, irrespective of their sexual orientation or gender identity. Methods The questionnaire included questions on substance use, depression, chronic treatment, previous experiences with injectable medication, and HIV status. Those with HIV answered questions about ART adherence and their preferences for ART methods, while those without HIV were asked about condom use, awareness of PrEP, and their preferences for PrEP methods. Results Out of 1676 respondents, 804 had HIV, and 872 did not. Among those with HIV, 91.5% expressed a high preference for LAI-ART, with significantly higher preferences among participants with higher educational levels, cisgender gay, bisexual, and queer men, younger individuals, and those with prior injectable medication experience. Among those without HIV, 68% preferred LAI-PrEP, and this preference was positively associated with previous positive experiences with injectable medication. Conclusion The strong preference for LAI-ART suggests the potential for improved adherence and well-being among people with HIV. Additionally, the preference for LAI-PrEP among those without HIV emphasizes the importance of considering this option for HIV prevention strategies. This study highlights the need to offer diverse methods for ART and prevention to accommodate different preferences and improve health care outcomes in Latin America.
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Affiliation(s)
| | - Virginia Zalazar
- Fundación Huésped, Pasaje Carlos Gianantonio 3932, Buenos Aires C1202AB, Argentina
| | | | - Mariana Duarte
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Pedro Cahn
- Research Department, Fundación Huésped, Buenos Aires, Argentina
| | - Ines Aristegui
- Research Department, Fundación Huésped, Buenos Aires, Argentina
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Wondimagegene YA, Debelew GT, Koricha ZB. Effectiveness of peer-led education interventions on contraceptive use, unmet need, and demand among adolescent girls in Gedeo Zone, South Ethiopia. A cluster randomized controlled trial. Glob Health Action 2023; 16:2160543. [PMID: 36695098 PMCID: PMC9879192 DOI: 10.1080/16549716.2022.2160543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Peer-led education interventions are assumed to be an effective means of increasing contraceptive utilization and demand in adolescents. However evidence is lacking on whether peer-led education is effective in promoting the demand for and use of contraceptives in adolescent girls, especially in resource-limited settings. OBJECTIVE The present study evaluated the effectiveness of peer-led education interventions in improving contraceptive use, unmet needs, and demand among sexually active secondary school adolescent girls in Gedeo Zone, South Ethiopia. METHODS A single-blinded cluster randomised controlled trial study was performed in six randomly selected secondary schools in the Gedeo Zone, southern Ethiopia. A total of 224 participants were recruited and randomly assigned to the intervention and control groups. The intervention group received peer-led education intervention for six months. A pre-tested and validated questionnaire was used to measure contraceptive use, unmet need, and contraceptive demand. A generalised estimating equation (GEE) model was used to examine the effectiveness of the intervention. RESULT After six months of intervention, the Differences-in-difference in contraceptive use, unmet need, and contraceptive demand between the intervention and control groups were 25.1%, 7.4%, and 17.7%, respectively. There was a statistically significant difference in contraceptive use [AOR = 8.7, 95% CI: (3.66, 20.83), unmet need for contraceptives [AOR = 6.2, 95% CI: (1.61, 24.36)] and contraceptive demand [AOR = 6.1, 95% CI: (2.43, 15.11)] between the intervention and control groups. CONCLUSIONS School-based peer education intervention effectively improved contraceptive use and unmet needs in a low-resource setting and created demand in sexually active adolescent girls. These results support the potential utility of this approach in similar settings for the promotion of contraception use and demand.
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Affiliation(s)
- Yohannes Addisu Wondimagegene
- College of Health Sciences and Medicine, Department of Health, Behavior, and Society, Dilla University, Dilla, Ethiopia,CONTACT Yohannes Addisu Wondimagegene College of Health Sciences and Medicine, Department of Health, Behavior, and Society, Dilla University, Ethiopia
| | - Gurmesa Tura Debelew
- Institute of Health, Faculty of Public Health, Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Zewdie Birhanu Koricha
- Institute of Health, Faculty of Public Health, Department of Health, Behavior, and Society, Jimma University, Jimma, Ethiopia
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Burke HM, Callahan RL, Lawton A, Turinayo A, Oyekenu O, Niyonsaba S, Taiwo O, Semaganda VM, Awiti A, Fratus A, Mubiru F, OlaOlorun FM. Using Human-Centered Design to Explore Potential Users' and Men's Views of New Injectable Contraceptives in Kampala and Lagos. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2300215. [PMID: 38135521 PMCID: PMC10749653 DOI: 10.9745/ghsp-d-23-00215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/10/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Injectable contraceptives are the most used method in sub-Saharan Africa. We conducted market research to assess potential user attitudes toward 4- and 6-month injectables. We also present user suggestions for marketing these new injectables once they are available. METHODS We implemented a 2-phase market research study from October through December 2021 in Kampala, Uganda, and Lagos, Nigeria. We conducted 11 focus group discussions (FGDs) with 51 participants in Kampala and 12 FGDs with 67 participants in Lagos. FGDs included current and potential injectable users and men stratified by marital status and age. Next, 23 women in Kampala and 24 in Lagos participated in cocreation workshops using human-centered design methods to explore marketing and communications strategies for each injectable. Data collection teams completed semistructured data extraction tables that were then analyzed thematically. RESULTS Participants liked both injectable options due to the reduced number of facility visits that would save time and money and increase privacy. Primary concerns included side effects, delayed return to fertility, cost, self-efficacy to self-inject, and stock-outs. Participants in Kampala preferred a shorter reinjection window (or "grace period") because it is easier to remember and they assumed it meant a quicker return to fertility, but participants in Lagos preferred a longer window because it provides extra time for reinjection. Citing norms around women needing to get pregnant quickly after marriage, participants in both sites felt that the 4-month injectable would benefit young people with busy lifestyles or limited access to facilities, whereas the 6-month injectable would benefit women who already had children. CONCLUSIONS We found that participants in Kampala and Lagos would prefer additional injectable options to meet the wide-ranging needs of users in different stages of their reproductive lives. Family planning program planners can apply the marketing insights we identified when these new injectables become available.
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Affiliation(s)
- Holly M Burke
- Reproductive, Maternal, Newborn, Child Health, FHI 360, Durham, NC, USA.
| | | | - Anna Lawton
- Product Development and Introduction, FHI 360, Durham, NC, USA
| | | | | | | | | | | | | | - Audrey Fratus
- Product Development and Introduction, FHI 360, Durham, NC, USA
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Kungu W. Contraceptive use and discontinuation among women aged 15-24 years in Kenya. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1192193. [PMID: 38034414 PMCID: PMC10684736 DOI: 10.3389/frph.2023.1192193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction The 15-24-year-old age group of young women make up about 15% of the population of 47 million Kenyans which comes to 7 million. Addressing the reproductive health goals of this cohort is thus a policy priority because of the high potential they pose for unintended pregnancy through incorrect and intermittent use of contraception. Objective The study sought to present evidence on contraceptive use among women aged 15-24 in Kenya between 2012 and 2014 using Kenya Demographic and Health Survey (KDHS) 2014 Contraceptive calendar data and make recommendations on enhancing the correct and consistent use of contraception. Methodology The data used was obtained from the Choices and Challenges tool developed by Population Reference Bureau (PRB) and visualized innovatively using Sankey Diagrams that show contraceptive use/non-use, continuation, switching/discontinuation, and pregnancy. Results The use of contraceptives went up by about 30% during the study period while the use of modern methods went up by 83%. The uptake of Long-Acting Reversible Contraception (LARC) went up by 87% while that of Short Acting Methods (SAM) went up by 70% but the progress was clouded by discontinuation rates of 35% with side effects being the leading reason for the abandonment of contraception. Conclusion For Kenya to achieve transformative results in ending the unmet need for contraception and preventable maternal deaths, it is critical to sustaining the current gains in contraceptive prevalence rate (CPR) by promoting the retention of youth users and encouraging new users.
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Affiliation(s)
- Wambui Kungu
- Research and Centre of Excellence, National Council for Population and Development, Nairobi, Kenya
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11
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Adebamowo CA, Adebamowo SN. Population-based study of the reproductive risk factors for transvaginal ultrasound diagnosed uterine fibroids in Nigerian women. Sci Rep 2023; 13:18926. [PMID: 37919335 PMCID: PMC10622570 DOI: 10.1038/s41598-023-44703-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023] Open
Abstract
There has been no previous systematic, epidemiological study of the reproductive risk factors for uterine fibroids (UF) in African populations despite African women having the highest burden of UF in the world. Improved knowledge of the associations between UF and reproductive factors would contribute to better understanding of the etiology of UF and may suggest novel opportunities for prevention and therapeutic interventions. We used nurse administered questionnaires to survey the demographic and reproductive risk factors of UF among 484 women who are members of the African Collaborative Center for Microbiome and Genomics Research (ACCME) Study Cohort in central Nigeria, and who had transvaginal ultrasound diagnosis (TVUS). We used logistic regression models to the evaluate associations between reproductive risk factors and UF, adjusted for significant covariates. In our multivariable logistic regression models, we found inverse associations with number of children (OR = 0.83, 95%CI = 0.74-0.93, p-value = 0.002), parity (OR = 0.41, 95%CI = 0.24-0.73, p-value = 0.002), history of any type of abortion (OR = 0.53, 95%CI = 0.35-0.82, p-value = 0.004), duration of use of Depot Medroxyprogesterone Acetate (DMPA) (p-value for trend = 0.02), menopausal status (OR = 0.48, 95%CI = 0.27-0.84, p-value = 0.01), and a non-linear positive association with age (OR = 1.04, 95%CI = 1.01-1.07, p-value = 0.003). Other reproductive risk factors that have been reported in other populations (age at menarche and menopause, and oral contraceptives) were not associated with UF in this study. Our study confirms some of the reproductive risk factors for UF that have been found in other populations and shows that some of them are stronger in the Nigerian population. The associations we found with DMPA suggest opportunities for further research to understand the mechanisms of action of progesterone and its analogues in the etiology of UF, their potential use for prevention and treatment of UF.
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Affiliation(s)
- Clement A Adebamowo
- Department of Epidemiology and Public Health, and the Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 660 West Redwood Street, Baltimore, MD, 21201, USA.
- Center for Bioethics and Research, Ibadan, Nigeria.
- Institute of Human Virology Nigeria, Abuja, Nigeria.
| | - Sally N Adebamowo
- Department of Epidemiology and Public Health, and the Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 660 West Redwood Street, Baltimore, MD, 21201, USA
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Yeboah D, Issah AN, Kpordoxah MR, Akiti C, Boah M. Prevalence and factors associated with the intention to use contraception among women of reproductive age who are not already using a contraceptive method in Liberia: findings from a secondary analysis of the 2019-2020 Liberia Demographic Health Survey. BMJ Open 2023; 13:e072282. [PMID: 37802625 PMCID: PMC10565247 DOI: 10.1136/bmjopen-2023-072282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Contraception constitutes a vital aspect of sexual and reproductive healthcare. However, the high prevalence of non-use has become a great public health concern globally. This study examined the intention to use contraceptives and its associated factors among women of reproductive age who were not using any method in Liberia. DESIGN AND SETTING A cross-sectional population-based study was conducted. We used data from the 2019-2020 Liberia Demographic and Health Survey. The research framework used the theory of planned behaviour to identify the factors that influence women's intention to use contraception. PARTICIPANTS The study analysed a weighted sample of 4504 women aged 15-49 who were not currently using any form of contraception. DATA ANALYSIS The outcome variable was the intention to use a contraceptive method. A binary logistic regression was used to identify factors associated with the intention to use contraceptives in Stata V.13.0. RESULTS Of the 4504 women, 39.42% intended to use contraception. Contraception intention was significantly lower in married women than in never married women (adjusted OR (aOR) 0.78; 95% CI 0.62 to 0.98). Additionally, women aged 25-34 (aOR 0.434; 95% CI 0.339 to 0.556) and 35-49 (aOR 0.120; 95% CI 0.088 to 0.163) had a reduced intent to use contraceptives than those aged 15-24. However, women with at least one child, those with prior contraception experience and those who had their first sexual encounter at the age of 13 or older were more likely to intend to use contraception. Notably, Muslim and wealthy women displayed a lower likelihood of intending to use contraception. CONCLUSION These findings highlight that attitudes, subjective norms and perceived behavioural control significantly influence women's intentions to use contraception. Understanding and addressing these factors are crucial for promoting effective contraceptive use among women, facilitating informed reproductive choices.
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Affiliation(s)
- Daudi Yeboah
- Department of Epidemiology, Biostatistics, and Disease Control, University for Development Studies, Tamale, Ghana
| | - Abdul-Nasir Issah
- Department of Health Services, Policy, Planning Management, and Economics, University for Development Studies, Tamale, Ghana
| | - Mary Rachael Kpordoxah
- Department of Global and International Health, University for Development Studies, Tamale, Ghana
| | - Caselia Akiti
- Department of Bilogical Sciences, University of Liberia, Monrovia, Liberia
- Monitoring and Evaluation Unit, Ministry of Health, Congo Town, Monrovia, Liberia
| | - Michael Boah
- Department of Epidemiology, Biostatistics, and Disease Control, University for Development Studies, Tamale, Ghana
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Steyn PS, Cordero JP, Nai D, Shamba D, Fuseini K, Mrema S, Habib N, Nguyen MH, Kiarie J. The impact of community and provider-driven social accountability interventions on contraceptive use: findings from a cohort study of new users in Ghana and Tanzania. Int J Equity Health 2023; 22:167. [PMID: 37641059 PMCID: PMC10464246 DOI: 10.1186/s12939-023-01928-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/30/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Although contraceptive use has increased over 15 years, discontinuation rates remain high. Contraceptive use is becoming more important when addressing unmet need for family planning. Social accountability, defined here as collective processes for holding duty bearers to account for their actions, is a rights-based participatory process that supports service provision and person-centred care, as well as, informed decision-making among community members regarding their health. A study implemented in Ghana and Tanzania was designed to understand and evaluate how social accountability and participatory processes influences quality of care and client satisfaction and whether this results in increased contraceptive uptake and use. We report here on the relationship between social accountability and the use of modern contraceptives, i.e., contraceptive method discontinuation, contraceptive method switching, and contraceptive discontinuation. METHODS As part of Community and Provider driven Social Accountability Intervention (CaPSAI) Project, a cohort of women aged 15 to 49 years who were new users of contraception and accessing family planning and contraceptives services at the study facilities across both intervention and control groups were followed-up over a 12-month period to measure changes contraceptive use. RESULTS In this cohort study over a one-year duration, we did not find a statistically significant difference in Ghana and Tanzania in overall method discontinuation, switching, and contraceptive discontinuation after exposure to a social accountability intervention. In Ghana but not in Tanzania, when stratified by the type of facility (district level vs. health centre), there were significantly less method and contraceptive discontinuation in the district level facility and significantly more method and contraceptive discontinuation in the health centres in the intervention group. In Ghana, the most important reasons reported for stopping a method were fear of side-effects, health concerns and wanting to become pregnant in the control group and fear of side-effects wanting a more effective method and infrequent sex in the intervention group. In Tanzania, the most important reasons reported for stopping a method were fear of side-effects, wanting a more effective method, and method not available in the control group compared to wanting a more effective method, fear of side-effects and health concerns in the intervention group. CONCLUSIONS We did not demonstrate a statistically significant impact of a six-month CaPSAI intervention on contraceptives use among new users in Tanzania and Ghana. However, since social accountability have important impacts beyond contraceptive use it is important consider results of the intermediate outcomes, cases of change, and process evaluation to fully understand the impact of this intervention. TRIAL REGISTRATION The CaPSAI Project has been registered at Australian New Zealand Clinical Trials Registry (ACTRN12619000378123, 11/03/2019).
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Affiliation(s)
- Petrus S Steyn
- Development and Research Training in Human Reproduction, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Avenue Appia 20, 1202, Geneva, Switzerland.
| | - Joanna Paula Cordero
- Development and Research Training in Human Reproduction, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Avenue Appia 20, 1202, Geneva, Switzerland
| | - Dela Nai
- Population Council, 204 Yiyiwa Drive, Abelemkpe, Accra, Ghana
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, P.O.BOX 78373, Dar Es Salaam, Tanzania
| | - Kamil Fuseini
- Population Council, 204 Yiyiwa Drive, Abelemkpe, Accra, Ghana
| | - Sigilbert Mrema
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, P.O.BOX 78373, Dar Es Salaam, Tanzania
| | - Ndema Habib
- Development and Research Training in Human Reproduction, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Avenue Appia 20, 1202, Geneva, Switzerland
| | - My Huong Nguyen
- Development and Research Training in Human Reproduction, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Avenue Appia 20, 1202, Geneva, Switzerland
| | - James Kiarie
- Development and Research Training in Human Reproduction, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Avenue Appia 20, 1202, Geneva, Switzerland
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Baynes C, Steyn PS, Sherr K, Kiarie J. Enhancing the Introduction and Scale Up of Self-Administered Injectable Contraception (DMPA-SC) in Health Systems (the EASIER Project): Protocol for Embedded Implementation Research. JMIR Res Protoc 2023; 12:e44222. [PMID: 37610819 PMCID: PMC10483301 DOI: 10.2196/44222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/09/2023] [Accepted: 03/06/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The introduction of self-administered injectable contraception presents an opportunity to address the unmet need for family planning. As ministries of health scale up self-administered injectable contraception, there is a scarcity of knowledge on the implementation practices and contextual conditions that help and hinder these efforts. The World Health Organization has launched the "enhancing self-administered family planning through embedded research project" (EASIER) to address this challenge. OBJECTIVE EASIER's objectives are to: (1) assess the coverage of self-injectable contraception, and the readiness of health systems to integrate it into the contraceptive method mix; (2) document strategies used to introduce and scale up self-injectable contraception and understand practices that have led to success and challenges; (3) identify the contextual factors that affect the adoption and implementation of self-injectable contraception throughout health systems; (4) understand whether implementation addresses users' preferences and needs; (5) strengthen collaboration between decision makers, researchers, and implementers; support and build capacity to use evidence. METHODS EASIER developed a global protocol that implementation research (IR) teams in Burkina Faso, Ghana, and Kenya adapted into country-level embedded IR projects. In all countries (1) at the national level, IR teams evaluate the policy environment for scaling up by conducting a desk review and in-depth interviews; (2) at the local level, IR teams implement quantitative questionnaires on structural and organizational readiness to integrate self-injection into the method mix; (3) in "case study" localities, IR teams conduct in-depth interviews and focus group discussions with implementers, method users, and community members; and (4) IR teams use participatory action research to elicit stakeholder participation and translate findings into programmatic decisions. RESULTS EASIER has been launched in all 3 countries. Preliminary findings are available from Burkina Faso and Kenya. In Burkina Faso, IR teams identified the need to strengthen health worker training approaches to ensure that family planning providers at primary health care facilities are adequately oriented to depo-medroxyprogesterone acetate subcutaneous (DMPA-SC) and self-injection and capacitated to initiate women to the method. In addition, they report the need for service communication strategies that reach potential users of the method with knowledge about self-injection and how to initiate the practice. In Kenya, the findings illuminate the need for practice guidelines that county health teams can use to coordinate the rollout of self-administered DMPA-SC. In addition, Kenya's findings underscore the importance of addressing logistical bottlenecks to help avoid stock-outs. CONCLUSIONS EASIER presents a strategy to embed IR in contraceptive method introduction and scale-up, address local knowledge needs, devise ways to maximize the impact of new technologies in health systems, and build capacity for using evidence in programmatic decisions. Adaptation and implementation of country-level IR studies will advance the use of IR to strengthen family planning programs. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry ACTRN12622001228774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384534&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44222.
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Affiliation(s)
- Colin Baynes
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Petrus S Steyn
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Geneva, Switzerland
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Industrial and Systems Engineering, University of Washington, Seattle, WA, United States
| | - James Kiarie
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Geneva, Switzerland
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Dabee S, Balle C, Onono M, Innes S, Nair G, Palanee-Phillips T, Burgener AD, Bosinger SE, Passmore JAS, Heffron R, Jaspan H, Happel AU. Update on the Impact of Depot Medroxyprogesterone Acetate on Vaginal Mucosal Endpoints and Relevance to Sexually Transmitted Infections. Curr HIV/AIDS Rep 2023; 20:251-260. [PMID: 37341916 PMCID: PMC10403392 DOI: 10.1007/s11904-023-00662-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE OF REVIEW The long-acting reversible intramuscularly-injected contraceptive depot medroxyprogesterone acetate (DMPA-IM) is widely used by cisgender women in Africa. Although DMPA-IM provides reliable contraception, potential effects on the female genital tract (FGT) mucosa have raised concern, including risk of HIV infection. This review summarises and compares evidence from observational cohort studies and the randomised Evidence for Contraceptive Options in HIV Outcomes (ECHO) Trial. RECENT FINDINGS Although previous observational studies found women using DMPA-IM had higher abundance of bacterial vaginosis (BV)-associated bacteria, increased inflammation, increased cervicovaginal HIV target cell density, and epithelial barrier damage, sub-studies of the ECHO Trial found no adverse changes in vaginal microbiome, inflammation, proteome, transcriptome, and risk of viral and bacterial STIs, other than an increase in Th17-like cells. Randomised data suggest that DMPA-IM use does not adversely change mucosal endpoints associated with acquisition of infections. These findings support the safe use of DMPA-IM in women at high risk of acquiring STIs, including HIV.
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Affiliation(s)
- Smritee Dabee
- Center for Global Infectious Disease, Seattle Children’s Research Institute, 307 Westlake Ave. N, Seattle, WA 98109 USA
| | - Christina Balle
- Department of Pathology, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
| | | | - Steve Innes
- Desmond Tutu Health Foundation, 3 Woodlands Rd, Woodstock, Cape Town, 7915 South Africa
| | - Gonasagrie Nair
- Desmond Tutu Health Foundation, 3 Woodlands Rd, Woodstock, Cape Town, 7915 South Africa
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Klein St & Esselen St, Hillbrow, Johannesburg 2001 South Africa
| | - Adam D. Burgener
- Center for Global Health and Diseases, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106 USA
- Department of Obstetrics and Gynecology, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB R3T 2N2 Canada
- Unit of Infectious Diseases, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institute, Karolinska University Hospital, Visionsgatan 18, L8, 171 76 Solna, Sweden
| | - Steven E. Bosinger
- ENPRC Genomics Core Laboratory, Emory National Primate Research Center, 954 Gatewood Rd NE, Atlanta, GA 30329 USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307 USA
- Emory Vaccine Center, Emory University, 7 1st Ave, Atlanta, GA 30317 USA
| | - Jo-Ann S. Passmore
- Department of Pathology, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
- National Health Laboratory Service, Anzio Road, Observatory, Cape Town, 7925 South Africa
| | - Renee Heffron
- Department of Medicine, University of Alabama at Birmingham, 845 19th Street South, AL 35294-2170 Birmingham, USA
- Department of Global Health, University of Washington, 1510 San Juan Road NE, Seattle, WA 98195 USA
| | - Heather Jaspan
- Center for Global Infectious Disease, Seattle Children’s Research Institute, 307 Westlake Ave. N, Seattle, WA 98109 USA
- Department of Pathology, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
- Department of Pediatrics, University of Washington, 1959 NE Pacific St., Seattle, WA 98195 USA
- Department of Global Health, University of Washington, 1510 San Juan Road NE, Seattle, WA 98195 USA
| | - Anna-Ursula Happel
- Department of Pathology, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
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16
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Church AC, Ibitoye M, Chettri S, Casterline JB. Traditional supports and contemporary disrupters of high fertility desires in sub-Saharan Africa: a scoping review. Reprod Health 2023; 20:86. [PMID: 37280648 DOI: 10.1186/s12978-023-01627-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
RATIONALE The desired number of children is markedly higher in Sub-Saharan Africa (SSA) than in other major regions. Efforts to understand how and why these desires are generated and maintained have yielded a broad research literature. Yet there is no full picture of the range of contextual, cultural, and economic factors that support and disrupt high fertility desires. OBJECTIVE This scoping review synthesizes thirty years of research on the determinants of fertility desires in SSA to better understand what factors underlie men and women's stated fertility desires and how they weigh the costs and benefits of having (more) children. METHOD We identified and screened 9863 studies published from 1990 to 2021 from 18 social science, demographic, and health databases. We appraised determinants of fertility desires from 258 studies that met inclusion criteria according to their roles as traditional supports or contemporary disrupters of high fertility desires. RESULTS We identified 31 determinants of high fertility desires, which we organized into six overarching themes: economy and costs; marriage; the influence of others; education and status; health and mortality; and demographic predictors. For each theme, we summarize ways in which the determinants both support and disrupt high fertility desires. We find that high fertility remains desirable in many regions of sub-Saharan Africa but contemporary disrupters, such as the economic situations and increases to family planning and education, cause individuals to decrease their desired fertility with such decreases often viewed as a temporary adjustment to temporary conditions. Most included studies were quantitative, cross-sectional, and based on survey data. CONCLUSION This review demonstrates how traditionally supportive and contemporary disruptive forces simultaneously influence fertility desires in sub-Saharan Africa. Future studies analyzing fertility desires in sub-Saharan Africa should be informed by the lived experiences of men and women in this region, with qualitative and longitudinal studies prioritized.
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Affiliation(s)
- Anna C Church
- Department of Sociology, The Ohio State University, 238 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43210, USA.
| | - Mobolaji Ibitoye
- Institute for Population Research, The Ohio State University, 060 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43210, USA
| | - Shibani Chettri
- College of Public Health, The Ohio State University, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA
| | - John B Casterline
- Institute for Population Research, The Ohio State University, 060 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43210, USA
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Bershteyn A, Resar D, Kim HY, Platais I, Mullick S. Optimizing the pipeline of multipurpose prevention technologies: opportunities across women's reproductive lifespans. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1169110. [PMID: 37325241 PMCID: PMC10266103 DOI: 10.3389/frph.2023.1169110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
HIV/AIDS and maternal mortality are the two leading causes of death among women of reproductive age in sub-Saharan Africa. A growing body of research investigates opportunities for multipurpose prevention technologies (MPTs) that prevent unintended pregnancy, HIV, and/or other sexually transmitted infections (STIs) with a single product. More than two dozen MPTs are currently in development, most of them combining contraception with HIV pre-exposure prophylaxis, with or without protection from other STIs. If successful, such MPTs could offer women benefits at multiple levels: greater motivation for effective use; lower product administration burden; accelerated integration of HIV, STI, and reproductive health services; and opportunities to circumvent stigma by using contraception as a "fig leaf" for HIV and/or STI prevention. However, even if women find respite from product burden, lack of motivation, and/or stigma in contraceptive-containing MPTs, their use of MPTs will be interrupted, often multiple times, over the reproductive lifecourse due to desire for pregnancy, pregnancy and breastfeeding, menopause, and changes in risk. Interruptions to the benefits of MPTs could be avoided by combining HIV/STI prevention with other life-stage-appropriate reproductive health products. New product concepts could include combining prenatal supplements with HIV and STI prevention, emergency contraception with HIV post-exposure prophylaxis, or hormone replacement therapies for menopause with HIV and STI prevention. Research is needed to optimize the MPT pipeline based on the populations underserved by available options and the capacity of resource-constrained health systems to deliver novel preventative healthcare products.
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Affiliation(s)
- Anna Bershteyn
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Danielle Resar
- Clinton Health Access Initiative, Boston, MA, United States
| | - Hae-Young Kim
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Ingrida Platais
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Saiqa Mullick
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
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Essis EML, Yeo KJ, Amalaman D, Konan LL, Bamba I, Coulibaly KSA, Kpebo DOD, Orsot T, Delafosse J, Aka J. Libido-sexual disorders and abandonment of injectable contraceptives among users of the Ivorian Association for Family Well-Being in Korhogo, Côte d'Ivoire. Front Glob Womens Health 2023; 4:1026253. [PMID: 37275208 PMCID: PMC10235761 DOI: 10.3389/fgwh.2023.1026253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/19/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction The recent introduction of modern contraceptive methods in resource-limited countries is confronted with the occurrence of undesirable effects that hinder their use in the long term. This study conducted among the users of the Ivorian Association for Family Well-Being in Korhogo describes the libido-sexual problems associated with the discontinuation of injectable contraceptives in former users. The objective of the study was to identify the factors that led to the abandonment of injectable contraceptives among female users of the Ivorian Association for Family Well-Being in Korhogo between 2018 and 2019. Materials and methods Qualitative data were collected from 15 former users (24-38 years old) of injectable contraceptives duration of 2-3 months. Additional data were collected from five health workers aged 35-60 years. In-depth interviews were conducted to explore the experience with injectable contraceptives and reasons for discontinuation. Following data collection, audio-recorded data were transcribed, translated, and coded using thematic analysis through an inductive approach. Results Side effects identified as associated with injectable contraceptives include libido-sexual disorders, unusual bleeding, and weight gain. The most common reason for discontinuation were libido-sexual disorders, which impacted the households' intimacy and provoked their abandonment or the change of contraceptive methods among injectable contraceptive users. Conclusion Adverse events were dominated by libido-sexual disorders, unusual bleeding, and weight gain leading to the abandonment or change of the contraceptive. These results suggest points of intervention for increasing continuation among users. This intervention should include training of health workers to investigate and manage adverse events related to the use of injectable contraceptives and the improvement of communication between health workers and users on adverse events of injectable contraceptive use.
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Affiliation(s)
- Esme Marie-Laure Essis
- Center for Population and Health Policy and Systems Research, National Institute of Public Health, Abidjan, Côte d'Ivoire
- Reproductive Health Research Unit of Cote d'Ivoire, Abidjan, Côte d'Ivoire
| | - Katienin Jeanne Yeo
- Department of Sociology and Anthropology, Peleforo Gon COULIBALY University of Korhogo, Korhogo, Côte d'Ivoire
| | - Djedou Martin Amalaman
- Department of Sociology and Anthropology, Peleforo Gon COULIBALY University of Korhogo, Korhogo, Côte d'Ivoire
| | - Loukou Leandres Konan
- Center for Population and Health Policy and Systems Research, National Institute of Public Health, Abidjan, Côte d'Ivoire
| | - Iba Bamba
- Center for Population and Health Policy and Systems Research, National Institute of Public Health, Abidjan, Côte d'Ivoire
| | | | - D. Olga Denise Kpebo
- Reproductive Health Research Unit of Cote d'Ivoire, Abidjan, Côte d'Ivoire
- Department of Public Health and Biostatistics, Faculty of Medicine, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Tetchi Orsot
- Center for Population and Health Policy and Systems Research, National Institute of Public Health, Abidjan, Côte d'Ivoire
- Department of Public Health and Biostatistics, Faculty of Medicine, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Joseph Delafosse
- Department of Public Health and Biostatistics, Faculty of Medicine, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Joseph Aka
- Center for Population and Health Policy and Systems Research, National Institute of Public Health, Abidjan, Côte d'Ivoire
- Department of Public Health and Biostatistics, Faculty of Medicine, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
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19
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Adebamowo CA, Adebamowo SN. Population-based study of the reproductive risk factors for Transvaginal Ultrasound diagnosed Uterine Fibroids in Nigerian women. RESEARCH SQUARE 2023:rs.3.rs-2917100. [PMID: 37292609 PMCID: PMC10246270 DOI: 10.21203/rs.3.rs-2917100/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objective There has been no previous systematic, epidemiological study of the reproductive risk factors for uterine fibroids (UF) in African populations despite African women having the highest burden of UF in the world. Improved knowledge of the associations between UF and reproductive factors would contribute to better understanding of the etiology of UF and may suggest novel opportunities for prevention and therapeutic interventions. Design We used nurse administered questionnaires to survey the demographic and reproductive risk factors of UF among 484 women who are members of the African Collaborative Center for Microbiome and Genomics Research (ACCME) Study Cohort in central Nigeria, and who had transvaginal ultrasound diagnosis (TVUS). We used logistic regression models to the evaluate associations between reproductive risk factors and UF, adjusted for significant covariates. Results In our multivariable logistic regression models, we found inverse associations with number of children (OR = 0.83, 95%CI = 0.74-0.93, p-value = 0.002), parity (OR = 0.41, 95%CI = 0.24-0.73, p-value = 0.02), history of any type of abortion (OR = 0.53, 95%CI = 0.35-0.82, p-value = 0.004), duration of use of Depot Medroxyprogesterone Acetate (DMPA) (p-value for trend = 0.02), menopausal status (OR = 0.48, 95%CI = 0.27-0.84, p-value = 0.01), and a non-linear positive association with age (OR = 1.04, 95%CI = 1.01-1.07, p-value = 0.003). Other reproductive risk factors that have been reported in other populations (age at menarche and menopause, and oral contraceptives) were not associated with UF in this study. Conclusion Our study confirms the reproductive risk factors for UF that have been found in other populations and shows that some of them are stronger in the Nigerian population. The associations we found with DMPA suggest opportunities for further research to understand the mechanisms of action of progesterone and its analogues in the etiology of UF, their potential use for prevention and treatment of UF.
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Mruts KB, Tessema GA, Kassaw NA, Gebremedhin AT, Scott JA, Pereira G. Achieving reductions in the unmet need for contraception with postpartum family planning counselling in Ethiopia, 2019-2020: a national longitudinal study. Arch Public Health 2023; 81:79. [PMID: 37127656 PMCID: PMC10150151 DOI: 10.1186/s13690-023-01096-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/23/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND An unmet need for contraception is associated with unintended pregnancy and adverse maternal and childhood outcomes. Family planning counselling is linked with reduced unmet need for contraception. However, evidence is lacking in Ethiopia on the impact of integrated family planning counselling on the unmet need for contraception. This study aimed to examine the association between family planning counselling and the unmet need for contraception in Ethiopia. METHODS We used community-based prospective cohort study data from a nationally representative survey conducted by Performance Monitoring for Action Ethiopia between 2019 and 2020. Women who had received three maternal and child health (MCH) services (n = 769) - antenatal care (ANC), facility delivery and child immunisation - were included in this study. The primary exposure variable was family planning counselling provided during the different MCH services. A weighted modified Poisson regression model was used to estimate the adjusted relative risk (aRR) of the unmet need for contraception. RESULTS The prevalence of family planning counselling during ANC, prior to discharge, and child immunisation was 22%, 28%, and 28%, respectively. Approximately one-third (34%) of the women had an unmet need for contraception. Family planning counselling prior to discharge from the facility was associated with reductions in the unmet need for contraception (aRR 0.88; 95% CI 0.67, 1.16). The risk of unmet need for contraception was 31% (aRR 0.69; 95% CI 0.48, 0.98) less likely among women who had received family planning counselling during child immunisation services. However, family planning counselling during ANC was associated with an increased unmet need for contraception (aRR 1.24; 95% CI 0.93, 1.64). CONCLUSION Strongest evidence was observed for moderate associations between reductions in the unmet need for contraception and family planning counselling during the provision of child immunisation services in Ethiopia.
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Affiliation(s)
- Kalayu Brhane Mruts
- School of Public Health, Debre Berhan University, P.O. Box 445, Debre Berhan, Ethiopia.
- Curtin School of Population Health, Curtin University, Perth, Australia.
| | - Gizachew A Tessema
- Curtin School of Population Health, Curtin University, Perth, Australia
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Nigussie Assefa Kassaw
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Jane A Scott
- Curtin School of Population Health, Curtin University, Perth, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- enAble Institute, Curtin University, Perth, Australia
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21
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Seidu AA, Ahinkorah BO, Anjorin SS, Tetteh JK, Hagan JE, Zegeye B, Adu-Gyamfi AB, Yaya S. High-risk fertility behaviours among women in sub-Saharan Africa. J Public Health (Oxf) 2023; 45:21-31. [PMID: 34850201 DOI: 10.1093/pubmed/fdab381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/30/2021] [Accepted: 10/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND High-risk fertility behaviours such as too early or advanced age at delivery, shorter birth interval, birth order and a higher number of live births to a woman often lead to adverse maternal and child health outcomes. We assessed high-risk fertility behaviours and their associated factors among women in sub-Saharan Africa (SSA). METHODS Data on 200 716 women pooled from the demographic and health surveys of 27 countries conducted between 2010 and 2020 in SSA were analysed. High-risk fertility behaviour from four indicators, mother aged <18 years at the time of delivery; mother aged >34 years at the time of delivery; mother of a child born after a short birth interval (<24 months) and mother of high parity (>3 children), was derived. Multi-level multi-variable logistic regression analyses were carried out and the results were presented as adjusted odds ratios at 95% confidence interval. RESULTS Women who were in polygamous marriages had higher odds of single and multiple high-risk fertility behaviour compared with their counterparts who were in monogamous marriages. Women with middle or high maternal decision-making power had higher odds of single and multiple high-risk fertility behaviours compared with those with low decision-making power. Single and multiple high-risk fertility behaviours were lower among women with access to family planning, those with at least primary education and those whose partners had at least primary education compared with their counterparts who had no access to family planning, those with no formal education and those whose partners had no formal education. CONCLUSION Family structure, women's decision-making power, access to family planning, women's level of education and partners' level of education were identified as predictors of high-risk fertility behaviours in SSA. These findings are crucial in addressing maternal health and fertility challenges. Policy makers, maternal health and fertility stakeholders in countries with high prevalence of high parity and short birth intervals should organize programs that will help to reduce the prevalence of these high-risk factors, taking into consideration the factors that predispose women to high-risk fertility behaviours.
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Affiliation(s)
- Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, PBM TF0494; Cape Coast, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland QLD 4811, Australia.,Department of Estate Management, Takoradi Technical University, Takoradi, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, NSW2007, Australia
| | - Seun Stephen Anjorin
- Warwick Centre for Global Health, Division of Health Sciences, University of Warwick, CV47AL, Coventry, United Kingdom
| | - Justice Kanor Tetteh
- Department of Population and Health, University of Cape Coast, PBM TF0494; Cape Coast, Ghana
| | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, PMBTF0494 Cape Coast, Ghana.,Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld-Germany
| | - Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, PMB, Shewarobit, Ethiopia
| | | | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON K1N 6N5, Canada.,The George Institute for Global Health, Imperial College London, London, W12OBZ, United Kingdom
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22
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Anglewicz P, Sarnak D, Gemmill A, Becker S. Characteristics Associated with Reliability in Reporting of Contraceptive Use: Assessing the Reliability of the Contraceptive Calendar in Seven Countries. Stud Fam Plann 2023; 54:17-38. [PMID: 36715569 DOI: 10.1111/sifp.12226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Although the reproductive calendar is the primary tool for measuring contraceptive dynamics in low-income settings, the reliability of calendar data has seldom been evaluated, primarily due to the lack of longitudinal panel data. In this research, we evaluated the reproductive calendar using data from the Performance Monitoring for Action Project. We used population-based longitudinal data from nine settings in seven countries: Burkina Faso, Nigeria (Kano and Lagos States), Democratic Republic of Congo (Kinshasa and Kongo Central Provinces), Kenya, Uganda, Cote d'Ivoire, and India. To evaluate reliability, we compared the baseline cross-sectional report of contraceptive use (overall and by contraceptive method), nonuse, or pregnancy with the retrospective reproductive calendar entry for the corresponding month, measured at follow-up. We use multivariable regressions to identify characteristics associated with reliability or reporting. Overall, we find that the reliability of the calendar is in the "moderate/substantial" range for nearly all geographies and tests (Kappa statistics between 0.58 and 0.81). Measures of the complexity of the calendar (number of contraceptive use episodes, using the long-acting method at baseline) are associated with reliability. We also find that women who were using contraception without their partners/husband's knowledge (i.e., covertly) were less likely to report reliably in several countries.
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Affiliation(s)
- Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Dana Sarnak
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Stan Becker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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23
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Wondimagegene YA, Debelew GT, Koricha ZB. Effectiveness of peer-led education interventions on contraceptive use, unmet need and demand among secondary school adolescents in Gedeo Zone, South Ethiopia. A study protocol for cluster randomized controlled trial. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023. [DOI: 10.1016/j.cegh.2023.101289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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Chola M, Hlongwana KW, Ginindza TG. Motivators and Influencers of Adolescent Girls' Decision Making Regarding Contraceptive Use in Four Districts of Zambia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3614. [PMID: 36834308 PMCID: PMC9961957 DOI: 10.3390/ijerph20043614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Low contraceptive use in sub-Saharan Africa, and Zambia specifically, negates the potential benefits of contraception in preventing unwanted and early pregnancies. This study aimed to explore and understand the motivators and influencers of adolescent girls' contraceptive decision making. Using thematic analysis, we analysed qualitative data from seven focus group discussions and three key informant interviews with adolescent girls aged 15 to 19 years in four Zambian districts. The data were managed and organised using NVivo version 12 pro (QSR International). Fear of pregnancy, fear of diseases, fear of having more children, and spacing of children (especially among married adolescents) were key motivators for adolescents' contraceptive use. Friends and peers motivated them to use contraceptives while fear of side effects and fear of infertility drove non-use. Peer pressure and fear of mocking by their friends were important deterrents to contraceptive use. Parents, peers and friends, family members, partners, churches, and religious groups influenced adolescent girls' contraceptive decisions. Mixed messages from these influencers, with some in favour and others against contraceptives, make adolescents' decisions to use contraceptives complex. Therefore, interventions targeting increased contraceptive use should be all-inclusive, incorporating multiple influencers, including at institutional and policy levels, to empower adolescents and give them autonomy to make contraceptive decisions.
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Affiliation(s)
- Mumbi Chola
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Epidemiology & Biostatistics, School of Public Health, University of Zambia, Lusaka 10101, Zambia
| | - Khumbulani W. Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
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Agbana RD, Michael TO, Ojo TF. Family planning method discontinuation among Nigerian women: Evidence from the Nigeria Demographic and Health Survey 2018. J Taibah Univ Med Sci 2023; 18:117-124. [PMID: 36398014 PMCID: PMC9643553 DOI: 10.1016/j.jtumed.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/20/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives The cessation of family planning among sexually active women who do not intend to have children increases the number of unplanned pregnancies and the risks to maternal health. This study examined the predictors of family planning method discontinuation among sexually active Nigerian women. Methods Data from the Nigeria Demographic and Health Survey (NDHS) were used. A total of 4553 women 15-49 years of age who had stopped using family planning methods in the previous 5 years were included in the study. Descriptive and binary logistic regression were used in the analysis. Results More than 60% of the women sampled had stopped family planning and had no intention of having children. Respondents discontinued family planning because of adverse effects (15.2%) and method failure (12.9%). Predictors of modern family planning discontinuation were secondary education (OR = 1.302, 95% CI: 1.006-1.685), Islamic religion (OR = 1.281, 95% CI: 1.059-1.550), residence in the South-East geopolitical zone (OR = 0.248, 95% CI: 0.195-0.316), having three or more children (OR = 0.848, 95% CI: 0.735-0.978) and having paid employment (OR = 0.838, 95% CI: 0.715-0.982). Conclusion Socio-economic and cultural factors influence discontinuation of family planning among Nigerian women. Policy options are needed to increase family planning uptake, identify common adverse effects of family planning and focus on raising public awareness regarding the negative consequences of discontinuing family planning on individuals, families and the nation.
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Affiliation(s)
- Richard D. Agbana
- Department of Community Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Turnwait O. Michael
- Demography and Population Studies Unit, Department of Sociology, University of Ibadan, Ibadan, Nigeria
| | - Tolulope F. Ojo
- Department of Public Health, Afe Babalola University, Ado-Ekiti, Nigeria
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Liu M, Miguel RDV, Calla NEQ, Aceves KM, Fritts L, Miller CJ, Moss JA, Baum MM, Cherpes TL. Loss of genital epithelial barrier function is greater with depot-medroxyprogesterone acetate than intravaginal rings that release etonogestrel and ethinyl estradiol. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.25.525538. [PMID: 36747683 PMCID: PMC9900856 DOI: 10.1101/2023.01.25.525538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The injectable progestin depot-medroxyprogesterone acetate (DMPA) is a popular contraceptive choice in sub-Saharan Africa although mouse models indicate it weakens genital epithelial integrity and barrier function and increases susceptibility to genital infection. The intravaginal ring NuvaRing® is another contraceptive option that like DMPA suppresses hypothalamic pituitary ovarian (HPO) axis function with local release of progestin (etonogestrel) and estrogen (ethinyl estradiol). As we previously reported that treating mice with DMPA and estrogen averts the loss of genital epithelial integrity and barrier function induced by DMPA alone, in the current investigation we compared genital levels of the cell-cell adhesion molecule desmoglein-1 (DSG1) and genital epithelial permeability in rhesus macaques (RM) treated with DMPA or a NuvaRing®re-sized for RM (N-IVR). While these studies demonstrated comparable inhibition of the HPO axis with DMPA or N-IVR, DMPA induced significantly lower genital DSG1 levels and greater tissue permeability to intravaginally administered low molecular mass molecules. By identifying greater compromise of genital epithelial integrity and barrier function in RM administered DMPA vs. N-IVR, our results add to the growing body of evidence that indicate DMPA weakens a fundamental mechanism of anti-pathogen host defense in the female genital tract.
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Affiliation(s)
- Mohan Liu
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University (OSU) College of Medicine, Columbus, OH, USA
- Comparative Biomedical Sciences Graduate Program, OSU College of Veterinary Medicine, Columbus, OH, USA
| | - Rodolfo D. Vicetti Miguel
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University (OSU) College of Medicine, Columbus, OH, USA
| | | | | | - Linda Fritts
- California National Primate Research Center, University of California, Davis, Davis, CA, USA
| | - Christopher J. Miller
- California National Primate Research Center, University of California, Davis, Davis, CA, USA
- Center for Comparative Medicine, University of California, Davis, Davis, CA, USA
| | - John A. Moss
- Department of Chemistry, Oak Crest Institute of Science, Monrovia, CA, USA
| | - Marc M. Baum
- Department of Chemistry, Oak Crest Institute of Science, Monrovia, CA, USA
| | - Thomas L. Cherpes
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University (OSU) College of Medicine, Columbus, OH, USA
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Kebede SD, Sebastian Y, Yeneneh A, Chanie AF, Melaku MS, Walle AD. Prediction of contraceptive discontinuation among reproductive-age women in Ethiopia using Ethiopian Demographic and Health Survey 2016 Dataset: A Machine Learning Approach. BMC Med Inform Decis Mak 2023; 23:9. [PMID: 36650511 PMCID: PMC9843668 DOI: 10.1186/s12911-023-02102-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Globally, 38% of contraceptive users discontinue the use of a method within the first twelve months. In Ethiopia, about 35% of contraceptive users also discontinue within twelve months. Discontinuation reduces contraceptive coverage, family planning program effectiveness and contributes to undesired fertility. Hence understanding potential predictors of contraceptive discontinuation is crucial to reducing its undesired outcomes. Predicting the risk of discontinuing contraceptives is also used as an early-warning system to notify family planning programs. Thus, this study could enable to predict and determine the predictors for contraceptive discontinuation in Ethiopia. METHODOLOGY Secondary data analysis was done on the 2016 Ethiopian Demographic and Health Survey. Eight machine learning algorithms were employed on a total sample of 5885 women and evaluated using performance metrics to predict and identify important predictors of discontinuation through python software. Feature importance method was used to select top predictors of contraceptive discontinuation. Finally, association rule mining was applied to discover the relationship between contraceptive discontinuation and its top predictors by using R statistical software. RESULT Random forest was the best predictive model with 68% accuracy which identified the top predictors of contraceptive discontinuation. Association rule mining identified women's age, women's education level, family size, husband's desire for children, husband's education level, and women's fertility preference as predictors most frequently associated with contraceptive discontinuation. CONCLUSION Results have shown that machine learning algorithms can accurately predict the discontinuation status of contraceptives, making them potentially valuable as decision-support tools for the relevant stakeholders. Through association rule mining analysis of a large dataset, our findings also revealed previously unknown patterns and relationships between contraceptive discontinuation and numerous predictors.
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Affiliation(s)
- Shimels Derso Kebede
- Department of Health Informatics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
| | - Yakub Sebastian
- Department of Information Technology, College of Engineering, IT and Environment, Charles Darwin University, Darwin, Australia
| | - Abraham Yeneneh
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Ashenafi Fentahun Chanie
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mequannent Sharew Melaku
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Agmasie Damtew Walle
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, Mettu University, Mettu, Ethiopia
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Compton SD, Manu A, Maya E, Morhe ESK, Dalton VK. Give women what they want: contraceptive discontinuation and method preference in urban Ghana. Contracept Reprod Med 2023; 8:5. [PMID: 36642723 PMCID: PMC9841713 DOI: 10.1186/s40834-022-00200-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/11/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Unmet need for contraception remains high in Ghana. Reducing the number of women who discontinue their contraceptive use is one way to decrease the number of women with an unmet need. In this study, we investigated factors associated with discontinuation among a cohort of Ghanaian women. METHODS Women who were beginning a new method of contraception at one of six urban clinics in Accra and Kumasi, Ghana were invited to participate in our study. Participants were interviewed before and after their counseling session, and at 3-, 6-, 9-, and 12-months post-enrollment to determine continuation. During follow-up, participants who were no longer using their method were asked why, if they were using any method of contraception, and if so, which method. Logistic regression analysis was performed to identify factors associated with discontinuation for reason other than pregnancy or desired pregnancy. RESULTS Of the 472 women who reported leaving their counseling session with a method, 440 (93.2%) had at least one follow-up contact. Of the 440 women, 110 (25%) discontinued their method at some point over the 12-month period, and 94 (85.5%) did so for reasons other than pregnancy or desired pregnancy. In the multivariate regression analysis, women who reported they were given their method of choice were 12.0% less likely to discontinue due to a non-pregnancy reason (p=0.005); those who used a long-acting reversible contraceptive (LARC) method were 11.1% less likely (p=.001); and those who reported they would choose to use that method again, one measure of satisfaction, were 23.4% less likely (p<.001). CONCLUSIONS To our knowledge, the current study is the first to explore method preference and its relation to continuation. Women in our study who reported they were given the contraceptive method of their choice were less likely to discontinue using that method for non-pregnancy-related reasons. Further, those who adopted a LARC method and those who reported they would make the same method choice again were less likely to discontinue. Women should be supported in selecting a contraceptive method of their choice. Providers should work with their clients to find a method which meets their preferences.
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Affiliation(s)
- Sarah D. Compton
- grid.214458.e0000000086837370University of Michigan Department of Obstetrics and Gynecology, 1500 E. Medical Center Dr, Ann Arbor, MI 48109 USA
| | - Adom Manu
- grid.8652.90000 0004 1937 1485Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, P. O. Box LG 13, Legon, Accra, Ghana
| | - Ernest Maya
- grid.8652.90000 0004 1937 1485Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, P. O. Box LG 13, Legon, Accra, Ghana
| | - Emmanuel S. K. Morhe
- grid.449729.50000 0004 7707 5975University of Health and Allied Sciences Department of Obstetrics and Gynaecology, PMB 31, Ho, Volta Region Ghana
| | - Vanessa K. Dalton
- grid.214458.e0000000086837370University of Michigan Department of Obstetrics and Gynecology, 1500 E. Medical Center Dr, Ann Arbor, MI 48109 USA
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Daca CSL, Schumann B, Arnaldo C, San Sebastian M. Wealth inequalities in reproductive and child health preventive care in Mozambique: a decomposition analysis. Glob Health Action 2022; 15:2040150. [PMID: 35290171 PMCID: PMC8928807 DOI: 10.1080/16549716.2022.2040150] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Assessing the gap between rich and poor is important to monitor inequalities in health. Identifying the contribution to that gap can help policymakers to develop interventions towards decreasing that difference. Objective To quantify the wealth inequalities in health preventive measures (bed net use, vaccination, and contraceptive use) to determine the demographic and socioeconomic contribution factors to that inequality using a decomposition analysis. Methods Data from the 2015 Immunisation, Malaria and AIDs Indicators Survey were used. The total sample included 6946 women aged 15–49 years. Outcomes were use of insecticide-treated nets (ITN), child vaccination, and modern contraception use. Wealth Index was the exposure variable and age, marital status, place of residence, region, education, occupation, and household wealth index were the explanatory variables. Wealth inequalities were assessed using concentration indexes (Cindex). Wagstaff-decomposition analysis was conducted to assess the determinants of the wealth inequality. Results The Cindex was −0.081 for non-ITN, −0.189 for lack of vaccination coverage and −0.284 for non-contraceptive use, indicating a pro-poor inequality. The results revealed that 88.41% of wealth gap for ITN was explained by socioeconomic factors, with education and wealth playing the largest roles. Lack of full vaccination, socioeconomic factors made the largest contribution, through the wealth variable, whereas geographic factors came next. Finally, the lack of contraceptive use, socioeconomic factors were the main explanatory factors, but to a lesser degree than the other two outcomes, with wealth and education contributing most to explaining the gap. Conclusion There was a pro-poor inequality in reproductive and child preventive measures in Mozambique. The greater part of this inequality could be attributed to wealth, education, and residence in rural areas. Resources should be channeled into poor and non-educated rural communities to tackle these persistent inequities in preventive care.
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Affiliation(s)
- Chanvo S L Daca
- Department of Cooperation, Ministry of Health, Directorate of Planning and Cooperation, Maputo, Mozambique.,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Barbara Schumann
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Kalinda C, Phiri M, Chimpinde K, Ishimwe MCS, Simona SJ. Trends and socio-demographic components of modern contraceptive use among sexually active women in Rwanda: a multivariate decomposition analysis. Reprod Health 2022; 19:226. [PMID: 36527042 PMCID: PMC9758849 DOI: 10.1186/s12978-022-01545-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The attainment of targets set for modern contraceptive use remains a challenge in sub-Saharan Africa. Rwanda, in its new Family Planning and Adolescent Sexual Reproductive Health/Family Planning (FP/ASRH) Strategic Plan 2018-2024 has set the attainment of a contraceptive prevalence rate (CPR) of 60% by 2024. To achieve this, identifying factors that enhance modern contraceptive use among sexually active women is critical. METHODS We used three Rwanda Demographic Health Surveys (RDHS) datasets collected in 2010, 2015, and 2019/2020 in a multivariable decomposition analysis technique to describe trends and identify factors influencing change in modern contraceptive use among sexually active women aged 15-49 years. Results presented as coefficients and percentages took into consideration the complex survey design weighted using StataSE 17. RESULTS Modern contraceptive use increased from 40% in 2010 to 52.4% in 2020 among sexually active women. About 23.7% of the overall percentage change in modern contraceptive use was attributable to women's characteristics which included women's education levels, number of living children, and being told about family planning at health facilities. Coefficients contributed 76.26% to the change in modern contraceptive use. This change was attributed to modern contraceptive use among young women between the age of 20-24 years, women's education level, the number of living children, changes in family size, and being visited by community health workers. CONCLUSION Rwanda remains on course to archive its 2024 family planning targets. However, there is a need to enhance programs that target sexually active adolescents and young adults, and women from rural areas to sustain the gains made. Furthermore, continuous support of community health workers will be key in exceeding the set targets of modern contraceptive use among sexually active women in Rwanda.
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Affiliation(s)
- Chester Kalinda
- grid.507436.30000 0004 8340 5635Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity, Kigali Heights, Plot 772 KG 7 Ave., P. O. Box 6955, Kigali, Rwanda
| | - Million Phiri
- grid.12984.360000 0000 8914 5257School of Humanities and Social Sciences, University of Zambia, Great East Road Campus, P. O. Box 32379, Lusaka, Zambia ,grid.11951.3d0000 0004 1937 1135School of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kafiswe Chimpinde
- grid.12984.360000 0000 8914 5257School of Humanities and Social Sciences, University of Zambia, Great East Road Campus, P. O. Box 32379, Lusaka, Zambia
| | - Marie C. S. Ishimwe
- grid.507436.30000 0004 8340 5635Institute of Global Health Equity Research (IGHER), University of Global Health Equity, Kigali Heights, Plot 772 KG 7 Ave, P. O. Box 6955, Kigali, Rwanda
| | - Simona J. Simona
- grid.12984.360000 0000 8914 5257School of Humanities and Social Sciences, University of Zambia, Great East Road Campus, P. O. Box 32379, Lusaka, Zambia
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Negash WD, Eshetu HB, Asmamaw DB. Predictors of modern contraceptive use among reproductive age women in high fertility countries in sub-Saharan Africa: evidence from demographic and health surveys. BMC Womens Health 2022; 22:520. [PMID: 36514075 PMCID: PMC9746200 DOI: 10.1186/s12905-022-02121-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The world's population has increased faster than expected due to high fertility rates, with sub-Saharan Africa accounting for most of the increase. Modern contraceptive use is the best option to reduce the high fertility rate. There is limited information on the prevalence of modern contraception and its predictors in sub-Saharan Africa's high-fertility countries. Therefore, this study aimed to assess the prevalence and predictors of modern contraception among reproductive-age women in high fertility countries in sub-Saharan Africa. METHODS We used Demographic and Health Survey data sets from the top 10 high fertility countries in sub-Saharan Africa. Stata version 16.0 software was used to analyze the data, and all statistical analyses were completed after the data had been weighted. Multilevel binary logistic regression was performed to identify factors associated with modern contraceptive use. Adjusted odds ratio with a 95% confidence interval, and a p value < 0.05 was used to declare statistical significance. RESULTS The prevalence of modern contraceptive use in all the countries considered in this study was 10.72% (95% CI 10.57, 10.87). In terms of the predictor variables, young aged women, those who had attended a primary or secondary level of formal education, women who received antenatal care follow up, women who reported distance to the health facility as not a big problem, and women from rich families were more likely to use modern contraceptives. CONCLUSION Only one in 10 women of reproductive age used modern contraceptive methods in high fertility countries in sub-Saharan Africa. To improve the use of modern contraceptives, governments and non-governmental organizations studied in the countries should intensify programs that focus on those women who are economically poor, those with no formal education, no media exposure, and those with no antenatal care follow up.
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Affiliation(s)
- Wubshet Debebe Negash
- grid.59547.3a0000 0000 8539 4635Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia
| | - Habitu Birhan Eshetu
- grid.59547.3a0000 0000 8539 4635Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- grid.59547.3a0000 0000 8539 4635Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Merera AM, Lelisho ME, Pandey D. Prevalence and Determinants of Contraceptive Utilization among Women in the Reproductive Age Group in Ethiopia. J Racial Ethn Health Disparities 2022; 9:2340-2350. [PMID: 34780019 DOI: 10.1007/s40615-021-01171-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/08/2021] [Accepted: 10/14/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Despite the huge advantages of family planning programs, contraception use in Ethiopia remains low. Determining the magnitude and associated factors of contraceptive utilization helps to take action for further improvement. Therefore, this study aimed to assess the prevalence and identify determinants of using contraceptives among women of reproductive age in Ethiopia. METHODS The 2019 Ethiopian Mini Demographic and Health Survey 2019 (EMDHS 2019) dataset was utilized in this population-based investigation. In the current study, 8885 reproductive-age women were included. Binary logistic regression analysis was employed to examine significant factors associated with the utilization of contraceptive methods. The analysis was done using SPSS software version 20. RESULTS The prevalence of contraceptive utilization amongst women's reproductive age in Ethiopia was 37.6%. Of all contraceptive users, a large number of women, 57.0%, used injectable kinds of contraceptives followed by implants (24.3%). Participants aged 20-29 (AOR = 2.32, 95%CI: 1.79-3.01) and aged 30-39 years (AOR = 3.12, 95%CI: 2.58-3.78); from Addis Ababa (AOR = 3.27, 95%CI:2.42-4.43), Dire Dawa (AOR = 2.96, 95%CI:2.28-3.84), and urban residence (AOR = 2.49, 95%CI:2.13-2.91); who had secondary education level 1.391(AOR = 1.14-1.70), diploma and above (AOR = 1.39, 95%CI:1.12-1.72); being in rich wealth index (AOR = 1.260, 95%CI:1.06-1.50); having five or more children (AOR = 1.37, 95%CI:1.17-1.61); and who had knowledge about contraceptives (AOR = 1.88, 95%CI:1.42-2.48) and being married (AOR = 5.82, 95%CI: 4.60-7.36) had higher odds of utilizing contraceptives, while women aged 40-49 years (AOR = 0.93, 95%CI: 0.89-0.96) and from residential region of Oromia (AOR = 0.516, 95%CI: 0.40-0.67), Somalia (AOR = 0.48, 95%CI: 0.38-0.62) and Benishangul (AOR = 0.53, 95%CI: 0.40-0.70) had lower odds of using contraception. CONCLUSIONS The study concluded that the use of contraceptives remained very low (found below the national target) in Ethiopia. Factors like age, educational level, number of children, and region of the women, religion, wealth index, and marital status are determinant factors associated with contraceptive use among reproductive-age women in Ethiopia. For a more successful intervention approach that encourages the use of contraceptive methods, these variables should be considered.
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Affiliation(s)
- Amanuel Mengistu Merera
- Department of statistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia.
| | - Mesfin Esayas Lelisho
- Department of statistics, College of Natural and Computational Science, Mizan-Tepi University, Tepi, Ethiopia
| | - Digvijay Pandey
- Department of Technical Education, IET, Dr. A.P.J Abdul Kalam Technical University, Lucknow, India
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Abstract
It was in the 1990s, that the possibility of increased transmission of HIV with the use of injectable contraceptive Depo-Provera®, was first flagged in medical literature. This has posed a challenge for its use in countries, particularly in the African region, where the prevalence and transmission rate of HIV is high. In 2015, a randomised 'clinical' trial, the Evidence for Contraceptive Options and HIV Outcomes (ECHO) was launched in four African countries to resolve the question whether the increased risk was causal. Contrary to expectations, the ECHO trial successfully recruited and randomised the specified number of girls/women participants. This paper argues that this was made possible by exercising undue influence, by using incentives, coercive language, and by concealing the real nature of the clinical trial during recruitment. The ECHO trial is unique in subjecting a group of healthy girls/women knowingly to a contraceptive drug with an intention not of finding out whether it is efficacious as a contraceptive, but to find out how risky or life-threatening its use could be. Thus, the ECHO trial has violated one of the central tenets of the Helsinki Declaration by privileging pursuit of knowledge over the interests of the girl/women trial participants from Africa.
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Affiliation(s)
- C Sathyamala
- International Institute of Social Studies, Erasmus University Rotterdam, The Hague, The Netherlands
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Mpunga DM, Chenge FM, Mambu TNM, Akilimali PZ, Mapatano MA, Wembodinga GU. Determinants of the use of contraceptive methods by adolescents in the Democratic Republic of the Congo: results of a cross-sectional survey. BMC Womens Health 2022; 22:478. [DOI: 10.1186/s12905-022-02084-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Family planning (FP) is an effective strategy to prevent unintended pregnancies of adolescents. We aimed at identifying the socio-demographic factors underlying the low use of contraceptive methods by teenage girls in the Democratic Republic of the Congo (DRC).
Methods
A secondary analysis targeting teenage girls aged 15–19 was carried out on the Performance, Monitoring and Accountability project 2020 (PMA 2020) round 7 data, collected in Kinshasa and Kongo Central provinces. The dependent variable was the “use of contraceptive methods by sexually active teenage girls”, calculated as the proportion of teenagers using modern, traditional or any contraceptive methods. Independent variables were: level of education, age, province, religion, marital status, number of children, knowledge of contraceptive methods and household income. Pearson's chi-square and logistic regression tests helped to measure the relationship between variables at the alpha significance cut point of 0.05.
Results
A total of 943 teenagers were interviewed; of which 22.6, 18.1 and 19.9% used any contraceptive method respectively in Kinshasa, Kongo Central and overall. The use of modern contraceptive methods was estimated at 9.9, 13.4 and 12.0% respectively in Kinshasa, Kongo Central and overall. However, the use of traditional methods estimated at 8.0% overall, was higher in Kinshasa (12.7%) and lower (4.7%) in Kongo Central (p < .001). Some factors such as poor knowledge of contraceptive methods (aOR = 8.868; 95% CI, 2.997–26.240; p < .001); belonging to low-income households (aOR = 1.797; 95% CI, 1.099–2.940; p = .020); and living in Kongo central (aOR = 3.170; 95% CI, 1.974–5.091; p < .001) made teenagers more likely not to use any contraceptive method.
Conclusion
The progress in the use of contraceptive methods by adolescent girls is not yet sufficient in the DRC. Socio-demographic factors, such as living in rural areas, poor knowledge of FP, and low-income are preventing teenagers from using FP methods. These findings highlight the need to fight against such barriers; and to make contraceptive services available, accessible, and affordable for teenagers.
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Ayalew HG, Liyew AM, Tessema ZT, Worku MG, Tesema GA, Alamneh TS, Teshale AB, Yeshaw Y, Alem AZ. Prevalence and factors associated with unintended pregnancy among adolescent girls and young women in sub-Saharan Africa, a multilevel analysis. BMC Womens Health 2022; 22:464. [PMID: 36404306 PMCID: PMC9677641 DOI: 10.1186/s12905-022-02048-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/06/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Unintended pregnancy predisposes women to unsafe abortion, malnutrition, mental illness, and even death. Though adolescent girls and young women are at higher risk of unintended pregnancy, there is a paucity of evidence in its burden and associated factors in sub-Saharan Africa. Therefore, this study aimed to assess the prevalence and factors associated with unintended pregnancy among adolescent girls and young women in sub-Saharan Africa. METHOD This study was a secondary data analysis of 36 sub-Saharan African countries with a total weighted sample of 17,797 adolescent girls and young women. A multilevel logistic regression model was fitted and, the Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was reported to assess the association between the independent variables and unintended pregnancy in Sub-Saharan Africa. RESULT The pooled prevalence of unintended pregnancy in sub-Saharan Africa was 30.01 with 95% CI (29.38-30.74). In multivariable multilevel logistic regression analysis, adolescent girls, and young women with higher education (AOR = 0.71 95%CI 0.52-0.97), those who know modern contraceptive methods (AOR = 0.86 95%CI 0.75-0.98), and traditional contraceptive methods (AOR = 0.90, 95%CI 0.59-0.95), married (AOR = 0.80, 95%CI 0.73-0.88), those from female-headed households (AOR = 0.86,95%CI 0.78-0.94), had lower odds of unintended pregnancy. Whereas adolescent girls and young women from Central Africa (AOR = 2.09,95%CI 1.23-3.55), southern Africa (AOR = 5.23, 95%CI 2.71-10.09), and Eastern Africa (AOR = 1.07,95%CI 1.07-2.66) had higher odds of unintended pregnancy. CONCLUSION Prevalence of unintended pregnancy in Sub-Saharan Africa is high. Therefore, educating adolescent girls and young women, and improving their knowledge about family planning services is vital. It is also better for the government of countries in sub-Saharan Africa and other global and local stakeholders to work hard to ensure universal access to sexual and reproductive healthcare services, including family planning, education, and the integration of reproductive health into national strategies and programs to reduce unintended pregnancy.
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Affiliation(s)
- Hiwotie Getaneh Ayalew
- Department of Midwifery, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Alemneh Mekuriaw Liyew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia.
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Misganaw Gebrie Worku
- Department of Human Anatomy, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Tesfa Sewunet Alamneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Yigizie Yeshaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
- Department of Human Physiology, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
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Long-acting reversible contraceptives use among adolescent girls and young women in high fertility countries in sub-Saharan Africa. Reprod Health 2022; 19:209. [DOI: 10.1186/s12978-022-01494-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Given the instrumental role long-acting reversible contraceptives (LARCs) play in reducing unintended pregnancies, there is a need to understand the factors that predict their use among adolescent girls and young women in high fertility countries. Our study examined the prevalence and predictors of LARCs use among adolescent girls and young women in high fertility countries in sub-Saharan Africa.
Materials and methods
We pooled data from the women’s files of the most recent Demographic and Health Surveys (DHS) from 2010 to 2020 of the top ten high fertility countries in sub-Saharan Africa, which are part of the DHS programme. The total sample was 5854 sexually active adolescent girls and young women aged 15–24 who were using modern contraceptives at the time of the survey. Descriptive and multilevel logistic regression models were used in the analyses. The results were presented using percentages and adjusted odds ratio (AOR) with their respective 95% confidence intervals (CIs).
Results
At the descriptive level, the overall prevalence of LARCs utilisation was 17.6% in the ten countries, with the lowest of 1.7% in Angola and the highest of 55.8% in Mali. Adolescent girls and young women who were married had a lower likelihood of LARCs utilisation than those who were never married [AOR = 0.63, 95% CI = 0.45, 0.88]. Adolescent girls and young women who wanted no more children had higher odds of LARCs use compared to those who wanted more children [AOR = 1.56, 95% CI = 1.09, 2.26]. Adolescent girls and young women with one to three births [AOR = 6.42, 95% CI = 4.27, 9.67], and those with four or more births [AOR = 7.02, 95% CI = 3.88, 12.67] were more likely to use LARCs compared to those who had no children. Countries in sub-Saharan Africa with lower probability of utilizing LARCs were Angola, Niger and Mozambique, whereas adolescent girls and young women in Mali had higher probability of utilizing LARCs.
Conclusion
Our findings suggest that LARCs utilisation among adolescent girls and young women is low in high fertility countries in sub-Saharan Africa. To reduce the rates of unplanned pregnancies and induced abortions, it is imperative that adolescent girls and young women in sub-Saharan Africa are educated on the advantages of utilising LARCs. Additionally, governments, policymakers, and stakeholders in sub-Saharan Africa should raise awareness by executing health promotion measures to enhance the demand for LARCs among adolescent girls and young women. Achieving these would not only prevent unplanned pregnancies and induced abortions, but also help meet the United Nation’s health and well being for all as enshrined in Sustainable Development Goals 3 and 5.
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Dwomoh D, Amuasi SA, Amoah EM, Gborgbortsi W, Tetteh J. Exposure to family planning messages and contraceptive use among women of reproductive age in sub-Saharan Africa: a cross-sectional program impact evaluation study. Sci Rep 2022; 12:18941. [PMID: 36344715 PMCID: PMC9640631 DOI: 10.1038/s41598-022-22525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
Many women of reproductive age in sub Saharan Africa are not utilizing any contraceptive method which is contributing to the high burden of maternal mortality. This study determined the prevalence, trends, and the impact of exposure to family planning messages (FPM) on contraceptive use (CU) among women of reproductive age in sub-Saharan Africa (SSA). We utilized the most recent data from demographic and health surveys across 26 SSA countries between 2013 and 2019. We assessed the prevalence and trends and quantified the impact of exposure to FPM on contraceptive use using augmented inverse probability weighting with regression adjustment. Sensitivity analysis of the impact estimate was conducted using endogenous treatment effect models, inverse probability weighting, and propensity score with nearest-neighbor matching techniques. The study involved 328,386 women of reproductive age. The overall prevalence of CU and the percentage of women of reproductive age in SSA exposed to FPM were 31.1% (95% CI 30.6-31.5) and 38.9% (95% CI 38.8-39.4) respectively. Exposure to FPM increased CU by 7.1 percentage points (pp) (95% CI 6.7, 7.4; p < 0.001) among women of reproductive age in SSA. The impact of FPM on CU was highest in Central Africa (6.7 pp; 95% CI 5.7-7.7; p < 0.001) and lowest in Southern Africa (2.2 pp; 95% CI [1.3-3.0; p < 0.001). There was a marginal decline in the impact estimate among adolescents (estimate = 6.0 pp; 95% CI 5.0, 8.0; p < 0.001). Exposure to FPM has contributed to an increase in CU among women of reproductive age. Programs that are geared towards intensifying exposure to FPM through traditional media in addition to exploring avenues for promoting the appropriate use of family planning method using electronic media remain critical.
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Affiliation(s)
- Duah Dwomoh
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana.
| | - Susan Ama Amuasi
- Department of Physician Assistantship, School of Medicine and Health Sciences, Central University College, Accra, Greater Accra, Ghana
| | - Emefa Modey Amoah
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Winfred Gborgbortsi
- School of Geography and Environmental Science, University of Southampton, Highfield, SO17BJ, UK
| | - John Tetteh
- Department of Community Health, University of Ghana Medical School, University of Ghana, Accra, Ghana
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Mkwananzi S. Gender differentials of contraceptive knowledge and use among youth – evidence from demographic and health survey data in selected African countries. Front Glob Womens Health 2022; 3:880056. [DOI: 10.3389/fgwh.2022.880056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022] Open
Abstract
Improving family planning demand and uptake has both social and economic benefits, including increasing education attainment, reducing poverty and increased participation in the labour force. Also, contraceptive use remains a key driver in Africa to facilitate demographic transition and the demographic dividend. However, numerous challenges have prevented the take-up of contraception across the continent. This is more so the case among African youth that present the lowest levels of contraceptive use in sub-Saharan Africa. Therefore, the objective of this research was to examine gender differences in contraceptive use and knowledge of sexually active young people (15–24 years) in sub-Saharan African countries. This study used data from nine countries in sub-Saharan Africa through the Demographic and Health Surveys (DHSs) of Benin, Democratic Republic of Congo, Lesotho, Namibia, Niger, Rwanda, Senegal, South Africa and Zimbabwe. Data analysis entailed frequency distributions and cross-tabulations to describe the gender-differentiated levels of contraceptive use and knowledge among youth. Additionally, logistic regression showed the gender-specific predictors of contraceptive use for African youth. Our findings present the gender-specific predictors of contraceptive use and will contribute to policy and programme formulation for African countries and organisations that promote contraceptive use.
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Euliano EM, Sklavounos AA, Wheeler AR, McHugh KJ. Translating diagnostics and drug delivery technologies to low-resource settings. Sci Transl Med 2022; 14:eabm1732. [PMID: 36223447 PMCID: PMC9716722 DOI: 10.1126/scitranslmed.abm1732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Diagnostics and drug delivery technologies engineered for low-resource settings aim to meet their technical design specifications using strategies that are compatible with limited equipment, infrastructure, and operator training. Despite many preclinical successes, very few of these devices have been translated to the clinic. Here, we identify factors that contribute to the clinical success of diagnostics and drug delivery systems for low-resource settings, including the need to engage key stakeholders at an early stage, and provide recommendations for the clinical translation of future medical technologies.
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Affiliation(s)
- Erin M. Euliano
- Department of Bioengineering, Rice University; Houston, Texas 77005, USA
| | - Alexandros A. Sklavounos
- Department of Chemistry, University of Toronto; Toronto, Ontario M5S 3H6, Canada
- Donnelly Centre for Cellular and Biomolecular Research, University of Toronto; Toronto, Ontario M5S 3E1, Canada
| | - Aaron R. Wheeler
- Department of Chemistry, University of Toronto; Toronto, Ontario M5S 3H6, Canada
- Donnelly Centre for Cellular and Biomolecular Research, University of Toronto; Toronto, Ontario M5S 3E1, Canada
- Institute of Biomedical Engineering, University of Toronto; Toronto, Ontario M5S 3G9, Canada
| | - Kevin J. McHugh
- Department of Bioengineering, Rice University; Houston, Texas 77005, USA
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Ujah OI, Kirby RS. Long-Acting Reversible Contraceptive Use by Rural-Urban Residence among Women in Nigeria, 2016-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13027. [PMID: 36293601 PMCID: PMC9602044 DOI: 10.3390/ijerph192013027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
This study examined temporal trends in the association between rural-urban residence and the use of LARCs among women using a method of contraception. A secondary objective was to examine whether the association varied over time. This study was a secondary analysis of data collected by the Performance Monitoring for Action (PMA) project from Nigeria among women aged 15-49 in 2016 (N= 11,054), 2017 (N= 11,380), and 2018 (N = 11,106). Weighted multivariable logistic regression analyses examined the association between place of residence and the likelihood of LARC (overall and specific type) utilization. Using weighted multivariable logistic regression, we show that, of the 6488 women who were using a method of contraception, the rates of LARC utilization in urban areas were significantly lower than in rural areas (OR = 0.52, 95% CI 0.38-0.73), attributed mainly to the high utilization rates of implants. Women in urban areas were more likely to use intrauterine devices (IUDs) (OR = 1.90, 95% CI 1.09-3.30) compared to those in rural areas. Conversely, the use of implants was significantly lower among women in urban areas (OR = 0.39, 95% CI 0.28-0.54). Adjusting for all predictors, we observed a reduction, albeit not significantly different, in odds in overall LARC, IUD, and implant use in urban compared to rural areas. The use of LARCs increased between 2016 and 2018 and the association between LARC use and place of residence also differed by the PMA survey year. There is a need for programs and policies to close gaps in the disparities in overall and specific LARC utilization rates based on place of residence.
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Idris IB, Syed Soffian SS, Baharom M, Baharuddin UM, Hashim S, Nawi AM. Influence of sociocultural beliefs and practices on contraception: a systematic review. Women Health 2022; 62:688-699. [DOI: 10.1080/03630242.2022.2117764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Idayu Badilla Idris
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Mazni Baharom
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ummi Mirza Baharuddin
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Syahirah Hashim
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Azmawati Mohammed Nawi
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Tapsoba JDD, Cover J, Obong’o C, Brady M, Cressey TR, Mori K, Okomo G, Kariithi E, Obanda R, Oluoch-Madiang D, Chen YQ, Drain P, Duerr A. Continued attendance in a PrEP program despite low adherence and non-protective drug levels among adolescent girls and young women in Kenya: Results from a prospective cohort study. PLoS Med 2022; 19:e1004097. [PMID: 36095005 PMCID: PMC9521917 DOI: 10.1371/journal.pmed.1004097] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 09/29/2022] [Accepted: 08/19/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa (SSA), adolescent girls and young women (AGYW) ages 15 to 24 years represent <10% of the population yet account for 1 in 5 new HIV infections. Although oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) can be highly effective, low persistence in PrEP programs and poor adherence have limited its ability to reduce HIV incidence among women. METHODS AND FINDINGS A total of 336 AGYW participating in the PEPFAR-funded DREAMS PrEP program in western Kenya were enrolled into a study of PrEP use conducted between 6/2019 to 1/2020. AGYW, who used daily oral TDF/FTC, completed interviews and provided dried blood spots (DBS) for measurement of tenofovir-diphosphate (TFV-DP) concentrations at enrollment and 3 months later, and 176/302 (58.3%, 95% confidence interval [95% CI 52.3 to 63.8]) met our definition of PrEP persistence: having expressed intention to use PrEP and attended both the second interview and an interim refill visit. Among AGYW with DBS taken at the second interview, only 9/197 (4.6%, [95% CI 1.6 to 7.5]) had protective TFV-DP levels (≥700 fmol/punch) and 163/197 (82.7%, [95% CI 77.5 to 88]) had levels consistent with no recent PrEP use (<10 fmol/punch). Perception of being at moderate-to-high risk for HIV if not taking PrEP was associated with persistence (adjusted odds ratio, 10.17 [95% CI 5.14 to 20.13], p < 0.001) in a model accounting for county of residence and variables that had p-value <0.1 in unadjusted analysis (age, being in school, initiated PrEP 2 to 3 months before the first interview, still active in DREAMS, having children, having multiple sex partners, partner aware of PrEP use, partner very supportive of PrEP use, partner has other partners, AGYW believes that a partner puts her at risk, male condom use, injectable contraceptive use, and implant contraceptive use). Among AGYW who reported continuing PrEP, >90% indicated they were using PrEP to prevent HIV, although almost all had non-protective TFV-DP levels. Limitations included short study duration and inclusion of only DREAMS participants. CONCLUSIONS Many AGYW persisted in the PrEP program without taking PrEP frequently enough to receive benefit. Notably, AGYW who persisted had a higher self-perceived risk of HIV infection. These AGYW may be optimal candidates for long-acting PrEP.
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Affiliation(s)
- Jean de Dieu Tapsoba
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Jane Cover
- PATH, Seattle, Washington, United States of America
| | | | - Martha Brady
- PATH, Seattle, Washington, United States of America
| | | | - Kira Mori
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | | | | | | | | | - Ying Qing Chen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Paul Drain
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Ann Duerr
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- * E-mail:
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Sexual and reproductive health services during outbreaks, epidemics, and pandemics in sub-Saharan Africa: a literature scoping review. Syst Rev 2022; 11:161. [PMID: 35945580 PMCID: PMC9361234 DOI: 10.1186/s13643-022-02035-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic could worsen adolescent sexual and reproductive health (ASRH). We sought evidence on the indirect impacts of previous infectious disease epidemics and the current COVID-19 pandemic on the uptake of ASRH in sub-Saharan Africa (SSA) to design relevant digital solutions. METHODS We undertook a literature scoping review to synthesize evidence on the indirect impacts of COVID-19 on ASRH in SSA per the Arksey and O'Malley framework and PRISMA reporting guidelines. We conducted the search on PubMed, Embase, Google Scholar, and ResearchGate in June and November 2020. We included all peer-reviewed, English-language primary studies on the indirect impacts of infectious disease epidemics on the uptake of sexual and reproductive health (SRH) in SSA. RESULTS We included 21 of 42 identified studies. Sixteen studies (76.2%) quantitatively assessed utilization and access to SRH during epidemics. Five studies (2 [9.6%] qualitative and 3 [14.3%] mixed methods) explored factors affecting SRH services. All studies focused on adult populations, most often on labor and delivery (n = 13 [61.9%]) and family planning (n = 8 [38.1%]) outcomes. Although we sought out to assess all outbreaks, epidemics, and pandemics, the only relevant studies took place during the West African Ebola pandemic (n = 17 [80.9%]) and COVID-19 pandemic (n = 4 [19.0%]). One study (4.8%) highlighted adolescent-specific outcomes and condom use. Most studies found declined access to and utilization of facility delivery, antenatal care, family planning, and HIV care. One study noted an increase in adolescent pregnancies. However, other studies noted similar, or even increasing trends in access to and utilization of other SRH services (family planning visits; HIV diagnosis; ART initiation) during epidemics. Barriers to SRH uptake included factors such as a reduced ability to pay for care due to lost income, travel restrictions, and fear of infection. Supply-side barriers included lack of open facilities, workers, commodities, and services. Community-based peer delivery systems, telemedicine, and transport services improved SRH uptake. CONCLUSION Access to SRH services during epidemics among adolescents and young people in SSA is understudied. We found that no studies focused on SRH outcomes of abortion, emergency contraception, sexually transmitted infections, or cervical cancer. To improve access to and utilization of SRH during pandemics, we recommend the following; in terms of research, key standardized SRH indicators should be included in routine data collection, routine data should be disaggregated by age, gender, and geography to understand gaps in ASRH service delivery, and additional rigorous epidemiological and social-behavioral studies should be conducted. On implementation, community-based peer delivery systems and telemedicine, internet-based, and other technological solutions may better reach adolescent and young people in SSA.
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Ruderman LW, Packer C, Zingani A, Moses P, Burke HM. "Men can take part": examining men's role in supporting self-injectable contraception in southern Malawi, a qualitative exploration. Reprod Health 2022; 19:174. [PMID: 35945601 PMCID: PMC9361263 DOI: 10.1186/s12978-022-01476-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background The male engagement framework for reproductive health, which presents men as family planning users, supportive partners, and agents of change, is being increasingly incorporated into family planning strategies worldwide. We applied this framework to understand the perspectives of and role that men play in supporting the use of self-injection of subcutaneous depot medroxyprogesterone acetate (DMPA-SC). Methods We conducted a qualitative analysis using data from a study conducted in southern Malawi to develop and test a counseling message to introduce DMPA-SC and self-injection. We conducted 4 focus group discussions (FGD) with male community leaders and partners of DMPA-SC users, 13 interviews and FGDs with public and private sector family planning providers, and 30 interviews with female clients. We explored all participant groups’ perspectives on what could facilitate or prevent women from choosing self-injection, including views on men’s attitudes towards DMPA-SC and self-injection. Results Overall, participants expressed ways that men could be engaged as cooperative users, supportive partners, and agents of change, and felt that this would help build a more supportive environment for DMPA-SC self-injection use. Men held favorable opinions of DMPA-SC self-injection: they felt that it is useful, described ways they could actively and emotionally support their partners in its use, and described their role in normalizing it. Conclusions We suggest that DMPA-SC self-injection has the potential to be both a female-controlled and a cooperative method, based on the ability for women to use it autonomously and the option to encourage male partner involvement (only where the woman welcomes this). Shifting the conversation from viewing men as a barrier to men as a resource may allow us to harness the social capital of men and transform traditional power dynamics, therefore establishing more enabling environments to support autonomy and choice for DMPA-SC and self-injection use. Self-injectable contraception (DMPA-SC) has the potential to expand family planning access. Once users are trained to self-inject, they can obtain multiple units and self-inject every three months privately, without needing to return to a health provider. Considering men’s role in supporting self-injection can inform family planning programs’ male engagement strategies. We conducted a study in Southern Malawi which included interviews and focus group discussions with male community leaders and partners of DMPA-SC users, family planning providers, and female family planning clients. We applied the male engagement framework to these data to understand the potential roles men can play as cooperative users, supportive partners, and agents of change. We found that men can support their partners in DMPA-SC self-injection use through actively participating in the injection process, providing emotional support and encouragement, and advocating for other men and communities to accept self-injection and family planning use. We acknowledge that encouraging male participation could potentially lead to women’s autonomy being restricted, so offer concrete suggestions to create an enabling environment that keeps women’s and girls’ needs central. For example, we propose that program materials expand their description of DMPA-SC self-injection to include a potentially cooperative option, which may be appropriate for women who want to involve their partners. Further, we suggest that social and behavioral change programs channel men’s social capital in order to normalize self-injection. When their traditional role as norm influencers is harnessed, men may encourage their communities to support women’s autonomy and choice for DMPA-SC and self-injection use.
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Affiliation(s)
- Lucy W Ruderman
- Reproductive, Maternal, Newborn and Child Health Division, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
| | - Catherine Packer
- Reproductive, Maternal, Newborn and Child Health Division, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA.
| | - Akuzike Zingani
- Centre for Health, Agriculture Development Research and Consulting (CHAD), Blantyre, Malawi
| | - Philemon Moses
- Centre for Health, Agriculture Development Research and Consulting (CHAD), Blantyre, Malawi
| | - Holly M Burke
- Reproductive, Maternal, Newborn and Child Health Division, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
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Verkroost FCJ, Monden CWS. Childlessness and Development in Sub-Saharan Africa: Is There Evidence for a U-shaped Pattern? EUROPEAN JOURNAL OF POPULATION 2022; 38:319-352. [PMID: 35966357 PMCID: PMC9363553 DOI: 10.1007/s10680-022-09608-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/17/2022] [Indexed: 10/31/2022]
Abstract
AbstractIn high-income countries, women increasingly remain permanently childless. Little is known about the relationship between childlessness and socioeconomic development in non-Western societies and particularly sub-Saharan Africa. At lower levels of development, poverty-driven (i.e., involuntary) childlessness may decrease with increases in levels of development, while at higher levels of development opportunity-driven (i.e., voluntary and circumstantial) childlessness may rise with development. Thus, we expect a U-shaped relationship between childlessness and development overall. We examine this idea for sub-Saharan Africa. We further contribute by differentiating between female and male childlessness; and between involuntary, voluntary and circumstantial childlessness. Moreover, we construct new indicators of subnational historical development to assess both inter- and intra-country variation, and distinguish between three components (health, education and income) to investigate the drivers behind the hypothesized U-shaped relationship. Using 291 Demographic and Health Surveys between 1986 and 2018 from 38 countries and 384 regions, we find a U-shaped relationship between female childlessness and development, and a linear relationship for men. The U-shape for women results from negative associations of female involuntary childlessness with health and educational advancements, combined with positive correlations of voluntary and circumstantial childlessness with education and income improvements. While these positive associations are stronger among men than women, the negative relationships of involuntary childlessness with health and education observed for women are absent for men, resulting in an overall positive and linear relationship between development and childlessness among men. Our findings have implications for how we might expect childlessness rates to evolve with future levels of development.
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Olakunde BO, Pharr JR, Adeyinka DA, Chien LC, Benfield RD, Sy FS. Spatial variations in family planning demand to limit childbearing and the demand satisfied with modern methods in sub-Saharan Africa. Reprod Health 2022; 19:144. [PMID: 35733204 PMCID: PMC9215060 DOI: 10.1186/s12978-022-01451-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 05/31/2022] [Indexed: 11/28/2022] Open
Abstract
Background There is an increasing demand for family planning to limit childbearing in sub-Saharan Africa (SSA). However, limited studies have quantified the spatial variations. This study examined: (i) the spatial patterns in the demand for family planning to limit childbearing and satisfied with modern methods, and (ii) the correlates of the demand for family planning to limit childbearing satisfied with modern methods in SSA. Methods This study analyzed secondary data on 306,080 married/in-union women obtained from Demographic Health Surveys conducted between 2010 and 2019 in 33 sub-Saharan African countries. We conducted exploratory spatial data analysis, with countries as the unit of analysis. We also performed regression analysis to determine the factors associated with demand for family planning to limit childbearing satisfied with modern methods in SSA. Results The mean percentage of women who demanded for family planning to limit childbearing by country was 20.5% while the mean prevalence of demand for family planning to limit childbearing satisfied with modern methods by country was 46.5%. There was a significant positive global spatial autocorrelation in the demand for family planning to limit childbearing (global Moran’s I = 0.3, p = 0.001). The cluster map showed the concentration of cold spots (low–low clusters) in western and central Africa (WCA), while hot spots (high–high clusters) were concentrated in eastern and southern Africa (ESA). Also, the demand for family planning to limit childbearing satisfied with modern methods showed significant positive global spatial autocorrelation (global Moran’s I = 0.2, p = 0.004) and concentration of cold spots in WCA. In the final multivariable regression model the joint family planning decision making (β = 0.34, p < 0.001), and antenatal care (β = 13.98, p < 0.001) were the significant factors associated with the demand for family planning to limit childbearing satisfied by modern methods. Conclusions There are significant spatial variations in the demand for family planning to limit childbearing and the demand satisfied by modern methods, with cold spots concentrated in WCA. Promoting joint decision making by partners and increasing uptake of antenatal care may improve the demand for family planning to limit childbearing satisfied with modern methods. In sub-Saharan Africa (SSA), studies have shown that the proportion of married women who want to stop having children has been increasing as well as the proportion using modern contraceptive methods among them. These studies also indicated that this proportion of women are higher in certain regions of Africa than the others. To extend these previous findings, we performed geographical analysis to assess how the proportion of married/in-union women who want to stop having children and the ones using modern methods among them differ geographically. Our findings indicated that neighboring countries where the proportion of married/in-union women who want to stop having children was higher than the overall average were concentrated in eastern and southern Africa (ESA), while neighboring countries in which the proportion of married/in-union women who want to stop having children was lower than the overall average were concentrated in western and central Africa (WCA). Similarly, the results also showed that neighboring countries where the proportion of married/in-union women using modern contraceptive methods among those who want to stop having children was lower than the overall average were concentrated in WCA. Our findings suggest that increasing joint decision making on family planning and uptake of antenatal care in SSA may improve the use of modern contraceptive methods among married/in-union women who want to stop childbearing.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA. .,Department of Community Prevention and Care Services, National Agency for the Control of AIDS, 3, Ziguinchor Street, off IBB Way, Wuse Zone 4, Abuja, Nigeria. .,Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria.
| | - Jennifer R Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Daniel A Adeyinka
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada.,Department of Public Health, National AIDS and STI Control Programme, Federal Ministry of Health, Abuja, Nigeria
| | - Lung-Chang Chien
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | | | - Francisco S Sy
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, USA
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Tolley EE, Zissette S, Taylor J, Hanif H, Ju S, Schwarz J, Thurman A, Tyner D, Brache V, Doncel GF. Acceptability of a Long-Acting, Multipurpose Vaginal Ring: Findings from a Phase I Trial in the U.S. and Dominican Republic. J Womens Health (Larchmt) 2022; 31:1343-1352. [PMID: 35363574 PMCID: PMC9527051 DOI: 10.1089/jwh.2021.0394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Women worldwide face risks from pregnancy, HIV, and other sexually transmitted infections (STIs). To date, highly effective contraceptive methods provide no HIV/STI protection, and HIV prevention products, excluding condoms, provide no pregnancy protection. Intravaginal rings (IVRs) delivering antiretrovirals and contraceptives are a promising multipurpose prevention technology (MPT). Methods: Embedded within a Phase I randomized, placebo-controlled trial, we examined acceptability of continuous versus interrupted use of a 90-day MPT IVR among 47 low-risk women in Norfolk, Virginia and the Dominican Republic. A baseline survey assessed menstruation attitudes, risk perceptions and trial-related motivations. Follow-up surveys (M1/M3) examined user experiences with and preferences for IVR attributes; 18 women also participated in two in-depth interviews. Results: Most women rated the IVR's flexibility and smoothness (86%) and ease of insertion/removal (76%) as very acceptable. Fewer women similarly rated the IVR size (57%) and changes in color from menstruation (52%). Most participants experienced no changes or less bleeding. Those reporting more/heavier bleeding (20% M1, 15% M3) disliked the change. Overall, women preferred a 3-month (75%) to a 1-month IVR (7.5%) or a bimonthly injectable (10%). In qualitative interviews, women were willing to continuously use an IVR for 6–12 months, providing it did not “degrade” inside the body. Reasons for trial participation and prevention preferences, menstrual attitudes, and perceived IVR benefits and doubts varied by site. Conclusions: Findings provide strong evidence of demand for an MPT IVR that protects from pregnancy and HIV/STIs, lasts longer than 1 month, minimally disrupts menstrual bleeding, and is in women's control. numberClinicalTrials.gov: #NCT03279120.
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Affiliation(s)
- Elizabeth E Tolley
- Behavioral, Epidemiological & Clinical Sciences, FHI 360, Durham, North Carolina, USA
| | - Seth Zissette
- Rollins School of Public Health, Emory University, Department of Epidemiology (PhD Student), Atlanta, GA, USA
| | - Jamilah Taylor
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Homaira Hanif
- CONRAD, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Susan Ju
- CONRAD, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Jill Schwarz
- CONRAD, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Andrea Thurman
- CONRAD, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Smith-Greenaway E, Yeatman S, Chilungo A. Life After Loss: A Prospective Analysis of Mortality Exposure and Unintended Fertility. Demography 2022; 59:563-585. [PMID: 35262689 PMCID: PMC9122690 DOI: 10.1215/00703370-9807961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The relationship between mortality and fertility is a key component of demographic transition theory, placing it at the center of extensive inquiry. Among other linkages, mortality in women's communities and social networks influences their subsequent fertility. Existing demographic research assumes this is principally due to volitional mechanisms, implying that exposure to mortality consolidates women's desire to become pregnant, leading to intended fertility. Yet, insights from other disciplines suggest that mortality exposure could also increase women's unintended fertility through psychological, relational, and behavioral mechanisms. This study examines the relationships between network mortality exposure and women's hazard of pregnancy, and of unintended pregnancy specifically. We analyze two years (2009-2011) of closely spaced panel data on young Malawian women (N=1,272) enrolled in the Tsogolo la Thanzi study. Our data include information on funeral attendance and fertility desires measured weeks before conception, which is confirmed through frequent pregnancy testing. Hazard models show that the number of funerals women attend corresponds with a higher hazard of pregnancy and of unintended pregnancy specifically. These findings make clear that mortality exposure can influence fertility not by shaping women's desires but by disrupting the realization of those desires.
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Affiliation(s)
- Emily Smith-Greenaway
- Department of Sociology, USC Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, CA, USA
| | - Sara Yeatman
- Department of Health and Behavioral Sciences, College of Liberal Arts and Sciences, University of Colorado Denver, Denver, CO, USA
- CU Population Center, University of Colorado Boulder, Boulder, CO, USA
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Tanko RF, Bunjun R, Dabee S, Jaumdally SZ, Onono M, Nair G, Palanee-Phillips T, Harryparsad R, Happel AU, Gamieldien H, Qumbelo Y, Sinkala M, Scoville CW, Heller K, Baeten JM, Bosinger SE, Burgener A, Heffron R, Jaspan HB, Passmore JAS. The Effect Of Contraception On Genital Cytokines In Women Randomized To Copper Intrauterine Device, Intramuscular Depot Medroxyprogesterone Acetate Or Levonorgestrel Implant. J Infect Dis 2022; 226:907-919. [PMID: 35263421 PMCID: PMC9470113 DOI: 10.1093/infdis/jiac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The ECHO Trial randomized women to intramuscular depot medroxyprogesterone acetate (DMPA-IM), levonorgestrel implant (LNG-implant), or copper intrauterine device (Cu-IUD). In a sub-study of the ECHO Trial, we tested the hypothesis that contraceptives influence genital inflammation by comparing cervicovaginal cytokine changes following contraception initiation. In addition, we compared cytokine profiles in women who acquired HIV (cases) versus those remaining HIV-negative (controls). METHODS Women (n=251) from South Africa and Kenya were included. Twenty-seven cervicovaginal cytokines were measured by Luminex at baseline, 1- and 6-month post-contraceptive initiation. In addition, cytokines were measured pre-seroconversion in HIV cases (n=25) and controls (n=100). RESULTS At 6-months post-contraceptive initiation, women using Cu-IUD had increased concentrations of 25/27 cytokines compared to their respective baseline concentrations. In contrast, women initiating DMPA-IM and LNG-implant did not experience changes in cervicovaginal cytokines. Pre-seroconversion concentrations of IL-1β, IL-6, and TNF-α, previously associated with HIV risk, correlated with increased HIV risk in a logistic regression analysis, although not significantly after correcting for multiple comparisons. Adjusting for contraceptive arm did not alter these results. CONCLUSION Although Cu-IUD use broadly increased cervicovaginal cytokine concentrations at 6-months post-insertion, these inflammatory changes were found not to be a significant driver of HIV risk.
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Affiliation(s)
- Ramla F Tanko
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa.,The Medical Research Centre, Institute of Medical Research and Medicinal Plant Studies (IMPM), Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
| | - Rubina Bunjun
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | | | - Shameem Z Jaumdally
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | | | | | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Rushil Harryparsad
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | - Anna-Ursula Happel
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | - Hoyam Gamieldien
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | - Yamkela Qumbelo
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | - Musalula Sinkala
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | | | | | - Jared M Baeten
- University of Washington, Seattle, USA.,Gilead Sciences, Foster City, USA
| | - Steven E Bosinger
- Emory University, Atlanta, USA.,Yerkes National Primate Research Center, Atlanta, USA
| | - Adam Burgener
- Center for Global Health and Diseases, Case Western Reserve University, Ohio, USA.,Department of Obstetrics & Gynecology and Medical Microbiology, University of Manitoba, Canada.,Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Heather B Jaspan
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa.,Seattle Children's Research Institute, Seattle, USA
| | - Jo-Ann S Passmore
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa.,NRF-DST CAPRISA Centre of Excellence in HIV Prevention, Durban, South Africa.,National Health Laboratory Service, Cape Town, South Africa
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Gaobotse G, Mbunge E, Batani J, Muchemwa B. The future of smart implants towards personalized and pervasive healthcare in Sub-Saharan Africa: Opportunities, barriers and policy recommendations. SENSORS INTERNATIONAL 2022. [DOI: 10.1016/j.sintl.2022.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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