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Sileo KM, Muhumuza C, Wanyenze RK, Kershaw TS, Ellerbe B, Muñoz S, Sekamatte S, Lule H, Kiene SM. Effects of a community-based, multi-level family planning intervention on theoretically grounded intermediate outcomes for couples in rural Uganda: Results from a mixed methods pilot evaluation. Br J Health Psychol 2024; 29:551-575. [PMID: 38242837 PMCID: PMC11258211 DOI: 10.1111/bjhp.12713] [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: 04/10/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVES This study tested the theoretically grounded conceptual model of a multi-level intervention, Family Health = Family Wealth (FH = FW), by examining FH = FW's effect on intermediate outcomes among couples in rural Uganda. FH = FW is grounded in the social-ecological model and the social psychological theory of transformative communication. DESIGN A pilot quasi-experimental controlled trial. METHODS Two matched clusters (communities) were randomly allocated to receive the FH = FW intervention or an attention/time-matched water, sanitation and hygiene intervention (N = 140, 35 couples per arm). Quantitative outcomes were collected through interviewer-administered questionnaires at baseline, 7-months and 10-months follow-up. Focus group discussions (n = 39) and semi-structured interviews (n = 27) were conducted with subsets of FH = FW participants after data collection. Generalized estimated equations tested intervention effects on quantitative outcomes, and qualitative data were analysed through thematic analysis-these data were mixed and are presented by level of the social-ecological model. RESULTS The findings demonstrated an intervention effect on family planning determinants across social-ecological levels. Improved individual-level family planning knowledge, attitudes and intentions, and reduced inequitable gender attitudes, were observed in intervention versus comparator, corroborated by the qualitative findings. Interpersonal-level changes included improved communication, shared decision-making and equitable relationship dynamics. At the community level, FH = FW increased perceived acceptance of family planning among others (norms), and the qualitative findings highlighted how FH = FW's transformative communication approach reshaped definitions of a successful family to better align with family planning. CONCLUSIONS This mixed methods pilot evaluation supports FH = FW's theoretically grounded conceptual model and ability to affect multi-level drivers of a high unmet need for family planning.
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Affiliation(s)
- Katelyn M Sileo
- Department of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Christine Muhumuza
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Trace S Kershaw
- Department of Social and Behavior Science, Yale School of Public Health, New Haven, Connecticut, USA
| | - Brooke Ellerbe
- Department of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Suyapa Muñoz
- Department of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA
| | | | - Haruna Lule
- Global Centre of Excellence in Health (GLoCEH), Kampala, Uganda
| | - Susan M Kiene
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
- Division of Epidemiology and Biostatistics, San Diego State University (SDSU) School of Public Health, San Diego, California, USA
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Wambete SN, Serwaa D, Dzantor EK, Baru A, Poku-Agyemang E, Kukeba MW, Bashiru Y, Olayemi OO. Determinants for male involvement in family planning and contraception in Nakawa Division, Kampala, Uganda; An urban slum qualitative study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003207. [PMID: 38820444 PMCID: PMC11142587 DOI: 10.1371/journal.pgph.0003207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 04/15/2024] [Indexed: 06/02/2024]
Abstract
Current evidence shows that male involvement in family planning (FP) is crucial to women's contraceptive use decisions. This study explored the reasons for male involvement in FP and contraception in slum areas in Nakawa Division, Kampala, Uganda. A qualitative study was conducted among sexually active males in a slum area in Nakawa Division, Kampala. A purposive sampling technique was utilised to recruit 40 men for a Focus Group Discussion (FGDs), and 2 key informants (KI) for critical perspective interviews. A semi-structured FGDs and interview guides were used to collect the data. The FGDs were conducted in both English and the local language, Luganda. All interviews were recorded and transcribed verbatim. Transcripts for both FGDs and KI interviews were imported into the NVivo Qualitative Data Analysis Software version 10 application, and thematic data analysis was conducted. The findings show that males' involvement in FP and its decisions were minimal. The findings also show that several factors emerged as contributing to male's participation in FP and utilisation of contraceptives. Inadequate understanding of FP and contraceptives, lack of clarity on males' role in FP, unfriendly healthcare environment and community members' perceptions of male involvement in FP were reported as reasons contributing to male participation in FP and contraction. There is limited involvement of males in FP. There is a need for renewed efforts that will positively alter the factors that impact male involvement favourably. Promotion and education about FP for males will significantly address issues of limited understanding and clarity of males' role in FP services.
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Affiliation(s)
- Sarah Namee Wambete
- Faculty of Public Health, Department of Public Health, Nursing and Midwifery, Save The Mothers East Africa, Uganda Christian University, Mukono, Uganda
- Slum and Rural Health Initiative Network/Uganda, Kampala, Uganda
| | - Dorcas Serwaa
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, Australia
| | - Edem Kojo Dzantor
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- Research and Innovation Unit, College of Nursing and Midwifery, Nalerigu, North-East Region, Ghana
| | - Ararso Baru
- College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia
- Slum and Rural Health Initiative Network/Ethiopia, Addis Ababa, Ethiopia
| | - Evelyn Poku-Agyemang
- Department of Nursing and Midwifery, Methodist Health Training Institute, Afosu, Eastern Region, Ghana
| | - Margaret Wekem Kukeba
- Department of Nursing, School of Nursing and Midwifery, CKT-University of Technology and Applied Sciences, Navrongo, Upper-East Region, Ghana
| | - Yussif Bashiru
- Department of Nursing and Midwifery, Methodist Health Training Institute, Afosu, Eastern Region, Ghana
| | - Oladapo O. Olayemi
- Faculty of Clinical Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Omona K, Mahoro RM. Factors associated with men’s participation in postpartum family planning: a study of Kiswa Health Centre III, Kampala, Uganda. J OBSTET GYNAECOL 2023; 43. [DOI: https:/doi.org/10.1080/01443615.2022.2158321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/09/2022] [Indexed: 02/17/2024]
Affiliation(s)
- Kizito Omona
- Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda
| | - Rose Mary Mahoro
- Department of Communication and Policy, Marie Stopes Uganda, Kampala, Uganda
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Omona K, Mahoro RM. Factors associated with men's participation in postpartum family planning: a study of Kiswa Health Centre III, Kampala, Uganda. J OBSTET GYNAECOL 2023; 43:2158321. [PMID: 36606701 DOI: 10.1080/01443615.2022.2158321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Low uptake of family planning among women is predominantly attributed to low participation of men in postpartum family planning. In order to improve maternal health, strengthening male participation in family planning is an important public health initiative. This study aimed to assess factors associated with participation of men in postpartum care at Kiswa Health Centre III, Nakawa division, Kampala. An analytical cross-sectional study design involving collection of quantitative data was used. Systematic random sampling was used to select study participants. Data was collected using semi-structured questionnaires. Data entry and cleaning was performed using EpiData version 12 and analysed using Stata version 14. 80.0% of respondents participated in postpartum family planning. Approval of family planning use, knowledge on family planning and information source were significantly associated with male involvement in postpartum family planning. Respondents who approved family planning use at home were 15.5 times more likely to get involved in family planning services as compared to those who didn't approve family planning. Conclusively, there was a generally high level of male involvement in postpartum family planning in comparison with the national levels. Approval of family planning at home increased the likelihood of men's participation in family planning.IMPACT STATEMENTWhat is already known on this subject? Evidence has it that short birth intervals of less than 15 months have been found to be associated with adverse pregnancy outcomes including induced abortions, miscarriages, preterm births, neonatal and child mortalities, still births and maternal depletion syndrome. In Africa, generally, low family uptake among women is also attributed to low men participation in postpartum family planning.What do the results of this study add? Approval of family planning use, knowledge on family planning and information source were associated with male involvement in postpartum family planning. Respondents who approved family planning use at home were 15.5 times more likely to get involved in postpartum family planning services as compared to those who didn't approve family planning.What are the implications of these findings for clinical practice and/or further research? In this study, the involvement of men was relatively high, but more studies are needed in other locations to compare with this finding. Otherwise, consolidation of such high involvement is highly needed, as this can be a starting point for further improvement.
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Affiliation(s)
- Kizito Omona
- Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda
| | - Rose Mary Mahoro
- Department of Communication and Policy, Marie Stopes Uganda, Kampala, Uganda
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Sileo KM, Muhumuza C, Wanyenze RK, Kershaw TS, Sekamatte S, Lule H, Kiene SM. A pilot quasi-experimental controlled trial of a community-based, multilevel family planning intervention for couples in rural Uganda: evidence of feasibility, acceptability, and effect on contraceptive uptake among those with an unmet need for family planning. Contraception 2023; 125:110096. [PMID: 37355086 PMCID: PMC10966983 DOI: 10.1016/j.contraception.2023.110096] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVES Effective interventions to reduce the unmet need for family planning in low-income settings are limited. This study aimed to establish the feasibility, acceptability, and preliminary effects of Family Health=Family Wealth (FH=FW), a multilevel intervention aimed to increase high-efficacy contraceptive uptake among couples wanting to delay pregnancy. STUDY DESIGN A pilot quasi-experimental controlled trial was conducted in rural Uganda, with 70 couples wanting to delay pregnancy but not using contraceptives (n = 140). Two matched clusters (communities) were randomly allocated to receive FH=FW or a comparator intervention via coin toss. FH=FW included health system strengthening elements and four facilitated group sessions. Interviewer-administered questionnaires were conducted at baseline and at ∼7-month and ∼10-month follow-up, and process data gathered feasibility/acceptability outcomes. RESULTS Of 121 households visited in the intervention community, 63 couples were screened, and 35 enrolled. In the comparator, 61 households were visited, 45 couples screened, and 35 enrolled. Intervention attendance was 99%, fidelity was 96%, and 100% of participants reported being satisfied with the intervention. From no use at baseline, there was 31% more high efficacy contraceptive uptake at 7 months and 40% more at 10 months in intervention versus comparator couples (adjusted odds ratio = 1.68, 95% confidence interval = 0.78-3.62, p = 0.19). A decline in fertility desires was observed in intervention versus comparator participants from baseline (Wald χ2 = 9.87, p = 0.007; Cohen's d: 7 months, 0.06; 10 months, 0.49). CONCLUSIONS FH=FW is a feasible and acceptable intervention with strong promise in its effect on contraceptive uptake to be established in a future trial. IMPLICATIONS The FH=FW intervention addresses multilevel family planning barriers through four group dialogs with couples paired with efforts to reduce health system barriers. A quasi-experimental controlled trial provides preliminary support for its feasibility, acceptability, contraceptive uptake and fertility desire effects, and success in engaging both women and men.
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Affiliation(s)
- Katelyn M Sileo
- Department of Public Health, The University of Texas at San Antonio, San Antonio, TX, United States.
| | - Christine Muhumuza
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Mulago Kampala, Uganda.
| | - Trace S Kershaw
- Department of Social and Behavior Science, Yale School of Public Health, New Haven, CT, United States.
| | | | - Haruna Lule
- Global Center of Health Excellency (GloCHE), Kampala, Uganda.
| | - Susan M Kiene
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Mulago Kampala, Uganda; Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, CA, United States.
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Sileo KM, Muhumuza C, Helal T, Olfers A, Lule H, Sekamatte S, Kershaw TS, Wanyenze RK, Kiene SM. Exploring the effects of COVID-19 on family planning: results from a qualitative study in rural Uganda following COVID-19 lockdown. Reprod Health 2023; 20:31. [PMID: 36759838 PMCID: PMC9910252 DOI: 10.1186/s12978-023-01566-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/06/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has likely affected the already high unmet need for family planning in low- and middle-income countries. This qualitative study used Andersen's Behavioral Model of Health Service Use as a theoretical framework to explore the possible ways in which the COVID-19 pandemic, including the impact of a 3-month government mandated lockdown, might affect family planning outcomes in rural Uganda. A secondary aim was to elicit recommendations to improve family planning service delivery in the context of COVID-19. METHODS Between June and October 2020, we conducted four focus group discussions with men and women separately (N = 26) who had an unmet need for family planning, and 15 key-informant interviews with community leaders and family planning stakeholders. Data were analyzed using thematic analysis. RESULTS We identified a significant disruption to the delivery of family planning services due to COVID-19, with potential negative effects on contraceptive use and risk for unintended pregnancy. COVID-19 had a negative effect on individual enabling factors such as family income, affecting service access, and on community enabling factors, such as transportation barriers and the disruption of community-based family planning delivery through village health teams and mobile clinics. Participants felt COVID-19 lockdown restrictions exacerbated existing contextual predisposing factors related to poverty and gender inequity, such as intimate partner violence and power inequities that diminish women's ability to refuse sex with their husband and their autonomy to use contraceptives. Recommendations to improve family planning service delivery in the context of COVID-19 centered on emergency preparedness, strengthening community health systems, and creating new ways to safely deliver contractive methods directly to communities during future COVID-19 lockdowns. CONCLUSIONS This study highlights the consequences of COVID-19 lockdown on family planning distribution, as well as the exacerbation of gender inequities that limit women's autonomy in pregnancy prevention measures. To improve family planning service uptake in the context of COVID-19, there is a need to strengthen emergency preparedness and response, utilize community structures for contraceptive delivery, and address the underlying gender inequities that affect care seeking and service utilization.
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Affiliation(s)
- Katelyn M. Sileo
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX USA
| | | | - Teddy Helal
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX USA
| | - Allison Olfers
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX USA
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Amuzie CI, Nwamoh UN, Ukegbu A, Umeokonkwo CD, Azuogu BN, Okedo-Alex IN, Kalu KU, Izuka M, Odini F. Urban-rural differences in health service-related factors associated with male involvement in family planning services in Abia State, Southeastern Nigeria. Ghana Med J 2022; 56:105-114. [PMID: 38322738 PMCID: PMC10630032 DOI: 10.4314/gmj.v56i3s.12] [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] [Indexed: 02/08/2024] Open
Abstract
Objective To identify and compare the health service-related factors associated with male involvement in family planning services among the rural and urban areas in Abia State, Nigeria. Design A community-based cross-sectional study. Setting Twelve communities (six urban and six rural) in Abia State, Nigeria. Participants Five hundred and eighty-eight (588) men aged 15-59 years and resident in the study area 6 months before the study were recruited. Main outcome measure Male involvement in family planning services. Results The mean ages of the respondents were 41.8±8.0 years and 43.1±8.0 years in the urban and rural areas, respectively. Active male involvement in family planning services was significantly higher in urban areas (62.6%, 95%CI: 56.8%-68.1%) compared to the rural areas (47.6%, 95%CI: 41.5%-53.2%. p<0.001). The predictors of male involvement included gender preference of healthcare workers (aOR=1.75, 95%CI:1.01-3.03) and attitude of the healthcare workers (aOR=2.07, 95%CI:1.17-3.67) among the urban participants, compared to occupational status of the respondents (aOR=2.50, 95% CI: 1.16-5.56) and the availability of male-friendly clinics (aOR=2.27, 95%CI:1.25-4.15) among the rural participants. Conclusion Health service-related factors associated with male involvement varied between the urban and rural settings. Stakeholders should target addressing health service-related factors by types of settlement while designing family planning programs targeting men. Funding No funding was obtained for this study.
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Affiliation(s)
- Chidinma I Amuzie
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
| | - Uche N Nwamoh
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
| | - Andrew Ukegbu
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
| | - Chukwuma D Umeokonkwo
- Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Benedict N Azuogu
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Ijeoma N Okedo-Alex
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
- African Institute for Health Policy and Health Systems, Ebonyi State University Abakaliki, Ebonyi State, Nigeria
| | - Kalu U Kalu
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
| | - Michael Izuka
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
| | - Franklin Odini
- Department of Community Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
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Namasivayam A, Schluter PJ, Namutamba S, Lovell S. Understanding the contextual and cultural influences on women's modern contraceptive use in East Uganda: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000545. [PMID: 36962757 PMCID: PMC10022157 DOI: 10.1371/journal.pgph.0000545] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022]
Abstract
Unmet need for contraception, defined as the percentage of women who are sexually active and want to avoid, space or limit pregnancies, but are not using a method of contraception, stands at 28.4% of all married women in Uganda. An understanding of women's contraceptive behaviours, and the motivations that drive these, are key to tackling unmet need, by way of designing, implementing and improving family planning programs to effectively meet the needs of different population groups. This qualitative study sought to understand women's contraceptive use and identify strategies to strengthen contraceptive uptake among women in the Busoga region of east Uganda (chosen due to its low contraceptive prevalence of 31.3% and high unmet need of 36.5% among married women of reproductive age). Six focus group discussions were conducted with single and married women across different age groups (18-24, 25-34, and ≥ 35 years), living in three urban and three rural districts. Thematic analyses of the data highlighted three major themes pertaining to the complex, multi-level nature of contributors to unmet need and women's use of contraception in the Busoga region. Within a largely patriarchal society, women had to navigate many obstacles. Some of these included: fears about contraceptive side effects; partner opposition, community beliefs and stigma that dissuaded contraceptive use; traditional gender and socio-cultural norms that dictated women's fertility choices; and service delivery limitations. Changing community narratives about family planning through testimonies from satisfied users, increasing male acceptance of contraception, and encouraging joint-decision making on matters of reproductive health are strategic focal areas for family planning initiatives to effectively tackle the problem of unmet need among women, and make contraceptives more accessible to women in Uganda.
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Affiliation(s)
- Amrita Namasivayam
- School of Health Sciences, University of Canterbury-Te Whare Wānanga o Waitaha, Christchurch, New Zealand
| | - Philip J Schluter
- School of Health Sciences, University of Canterbury-Te Whare Wānanga o Waitaha, Christchurch, New Zealand
- Medical School-General Practice Clinical Unit, The University of Queensland, Brisbane, Australia
| | - Sarah Namutamba
- Institute of Public Health, Makerere University, Kampala, Uganda
| | - Sarah Lovell
- School of Health Sciences, University of Canterbury-Te Whare Wānanga o Waitaha, Christchurch, New Zealand
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Mwendwa P, Karani C, Kamolo E, Kroll T, De Brún A, McAuliffe E. What contextual factors and mechanisms facilitate male involvement in women's sexual and reproductive health in Sub-Saharan Africa? A rapid realist review protocol. HRB Open Res 2021; 3:55. [PMID: 33665545 PMCID: PMC7907758 DOI: 10.12688/hrbopenres.13113.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Sexual and reproductive health (SRH) outcomes of women within low resource contexts continue to be of concern to policymakers. Notably, sub-Saharan Africa (SSA) continues to lag behind other regions of the world in improving SRH outcomes for women in the region. A key suggested strategy is male involvement through interventions that respect, promote and facilitate women in taking care of themselves and their new-borns. However, factors such as social-cultural barriers may preclude men's involvement in these programmes. There is a need for a context-specific understanding of gender dynamics and interaction and the mechanisms that enhance or impede men's involvement. Methods: We will employ a rapid realist review (RRR) methodology to examine what mechanisms and contextual factors are essential to facilitate the involvement of men in women's SRH programmes in SSA. In keeping with the realist literature we will follow six steps, which will include: (1) developing a theory, (2) developing a search strategy, (3) selecting and appraising documents, (4) extracting data, (5) analysing data and synthesising the evidence, and (6) presenting and disseminating a revised theory. We will also engage with key stakeholders who will provide local contextual insights and with experts in the subject area. The review findings will be shared with relevant stakeholders using a variety of avenues including through publications, at conferences and on social media platforms. Discussion: This review will identify the mechanisms and contextual factors that facilitate or hinder men's involvement in women's SRH programmes in SSA. The rationale for adopting an RRR approach is to help gather the information within a relatively short period to ensure relevance of findings to policymakers in SSA. Results from this work also have the potential to be adapted to the other contexts, for example, Ireland and the UK, which have a growing population of people from SSA.
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Affiliation(s)
- Purity Mwendwa
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland, Ireland
| | - Caroline Karani
- School of Nursing, Meru University of Science and Technology, Meru, Kenya
| | - Elizabeth Kamolo
- School of Nursing, Meru University of Science and Technology, Meru, Kenya
| | - Thilo Kroll
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland, Ireland
| | - Eilish McAuliffe
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland, Ireland
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10
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Nyondo-Mipando AL, Kapesa LS, Salimu S, Kazuma T, Mwapasa V. "Dispense antiretrovirals daily!" restructuring the delivery of HIV services to optimize antiretroviral initiation among men in Malawi. PLoS One 2021; 16:e0247409. [PMID: 33617561 PMCID: PMC7899340 DOI: 10.1371/journal.pone.0247409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 02/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Gender disparities exist in the scale-up and uptake of HIV services with men being disproportionately under-represented in the services. In Eastern and Southern Africa, of the people living with HIV infection, more adult women than men were on treatment highlighting the disparities in HIV services. Delayed initiation of antiretroviral treatment creates a missed opportunity to prevent transmission of HIV while increasing HIV and AIDS-associated morbidity and mortality. The main objective of this study was to assess the strategies that men prefer for Antiretroviral Therapy (ART) initiation in Blantyre, Malawi. METHODS This was a qualitative study conducted in 7 Health facilities in Blantyre from January to July 2017. We selected participants following purposive sampling. We conducted 20 in-depth interviews (IDIs) with men of different HIV statuses, 17 interviews with health care workers (HCWs), and 14 focus group discussions (FGDs) among men of varying HIV statuses. We digitally recorded all the data, transcribed verbatim, managed using NVivo, and analysed it thematically. RESULTS Restructuring the delivery of antiretroviral (ARVs) treatment and conduct of ART clinics is key to optimizing early initiation of treatment among heterosexual men in Blantyre. The areas requiring restructuring included: Clinic days by offering ARVs daily; Clinic hours to accommodate schedules of men; Clinic layout and flow that preserves privacy and establishment of male-specific clinics; ARV dispensing procedures where clients receive more pills to last them longer than 3 months. Additionally there is need to improve the packaging of ARVs, invent ARVs with less dosing frequency, and dispense ARVs from the main pharmacy. It was further suggested that the test-and-treat strategy be implemented with fidelity and revising the content in counseling sessions with an emphasis on the benefits of ARVs. CONCLUSION The success in ART initiation among men will require a restructuring of the current ART services to make them accessible and available for men to initiate treatment. The inclusion of people-centered approaches will ensure that individual preferences are incorporated into the initiation of ARVs. The type, frequency, distribution, and packaging of ARVs should be aligned with other medicines readily available within a health facility to minimize stigma.
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Affiliation(s)
- Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, Blantyre, Malawi
| | - Leticia Suwedi Kapesa
- Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, Blantyre, Malawi
| | - Sangwani Salimu
- Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, Blantyre, Malawi
| | - Thokozani Kazuma
- Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, Blantyre, Malawi
| | - Victor Mwapasa
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, Blantyre, Malawi
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11
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Mwendwa P, Karani C, Kamolo E, Kroll T, De Brún A, McAuliffe E. What contextual factors and mechanisms facilitate male involvement in women's sexual and reproductive health in Sub-Saharan Africa? A rapid realist review protocol. HRB Open Res 2021; 3:55. [PMID: 33665545 PMCID: PMC7907758 DOI: 10.12688/hrbopenres.13113.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 10/01/2023] Open
Abstract
Background: Sexual and reproductive health (SRH) outcomes of women within low resource contexts continue to be of concern to policymakers. Notably, sub-Saharan Africa (SSA) continues to lag behind other regions of the world in improving SRH outcomes for women in the region. A key suggested strategy is male involvement through interventions that respect, promote and facilitate women in taking care of themselves and their new-borns. However, factors such as social-cultural barriers may preclude men's involvement in these programmes. There is a need for a context-specific understanding of gender dynamics and interaction and the mechanisms that enhance or impede men's involvement. Methods: We will employ a rapid realist review (RRR) methodology to examine what mechanisms and contextual factors are essential to facilitate the involvement of men in women's SRH programmes in SSA. In keeping with the realist literature we will follow six steps, which will include: (1) developing a theory, (2) developing a search strategy, (3) selecting and appraising documents, (4) extracting data, (5) analysing data and synthesising the evidence, and (6) presenting and disseminating a revised theory. We will also engage with key stakeholders who will provide local contextual insights and with experts in the subject area. The review findings will be shared with relevant stakeholders using a variety of avenues including through publications, at conferences and on social media platforms. Discussion: This review will identify the mechanisms and contextual factors that facilitate or hinder men's involvement in women's SRH programmes in SSA. The rationale for adopting an RRR approach is to help gather the information within a relatively short period to ensure relevance of findings to policymakers in SSA. Results from this work also have the potential to be adapted to the other contexts, for example, Ireland and the UK, which have a growing population of people from SSA.
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Affiliation(s)
- Purity Mwendwa
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland, Ireland
| | - Caroline Karani
- School of Nursing, Meru University of Science and Technology, Meru, Kenya
| | - Elizabeth Kamolo
- School of Nursing, Meru University of Science and Technology, Meru, Kenya
| | - Thilo Kroll
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland, Ireland
| | - Eilish McAuliffe
- UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (UCD IRIS Centre), School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland, Ireland
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Clark J, Sweet L, Nyoni S, Ward PR. Improving male involvement in antenatal care in low and middle-income countries to prevent mother to child transmission of HIV: A realist review. PLoS One 2020; 15:e0240087. [PMID: 33057353 PMCID: PMC7561142 DOI: 10.1371/journal.pone.0240087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/21/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Childhood Human Immunodeficiency Virus (HIV) infection occurs almost exclusively via mother to child transmission (MTCT) during pregnancy, birth, or through breastfeeding. Recent studies have shown that male involvement (MI) in antenatal care (ANC) and HIV testing, including couples voluntary counselling and testing (CVCT), increases the likelihood that women will adhere to prevention advice and comply with HIV treatment if required during their pregnancy; hence reducing the rates of MTCT of HIV. This realist review investigates how, why, when, and for whom MI in ANC works best to provide contextual advice on how MI in ANC can be best used for prevention of mother to child transmission (PMTCT) of HIV. METHODS A realist review of existing evidence was conducted. Realist review seeks to explain how and why an intervention works, or does not work, in a given context. This was completed through the five stages of realist synthesis; Eliciting the program theory, search strategy, study selection criteria, data extraction, and data analysis and synthesis. Findings are presented as context-mechanism-outcome (CMO) configurations outlining the mechanisms that work in given contexts to give an outcome. RESULTS Three CMO configurations were developed. These describe that 1) Couples in monogamous relationships have higher levels of trust, commitment and security leading to increased uptake of PMTCT programs together; 2) ANC spaces that make 'male friendly' adaptions promote normalisation of MI in PMTCT and are more welcoming, leading to increased willingness of male partners to participate in ANC; and 3) couples and communities with higher health literacy encourage increased informed decision making, ownership, and responsibility and thus increased participation in PMTCT of HIV. CONCLUSIONS The CMOs developed in this review give contextual advice on how one might improve ANC services to increase MI and help reduce MTCT of HIV. We propose that MI in ANC works best where couples are monogamous and trusting, where ANC spaces actively promote being a 'male friendly space' and where there are high levels of community education programs around MTCT.
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Affiliation(s)
- Jacinta Clark
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University and Western Health Partnership, Burwood, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Simangaliso Nyoni
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Paul R. Ward
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Gopal P, Fisher D, Seruwagi G, Taddese HB. Male involvement in reproductive, maternal, newborn, and child health: evaluating gaps between policy and practice in Uganda. Reprod Health 2020; 17:114. [PMID: 32718357 PMCID: PMC7385888 DOI: 10.1186/s12978-020-00961-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/08/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Male involvement in maternal and child health is a practice wherein fathers and male community members actively participate in caring for women and supporting their family to access better health services. There is positive association between male involvement and better maternal and child health outcomes. However, the practice is not always practiced optimally, especially in low- and middle-income countries, where women may not have access to economic resources and decision-making power. AIM This study investigates how key stakeholders within the health system in Uganda engage with the 'male involvement' agenda and implement related policies. We also analyzed men's perceptions of male involvement initiatives, and how these are influenced by different political, economic, and organizational factors. METHODOLOGY This is a qualitative study utilizing data from 17 in-depth interviews and two focus group discussions conducted in Kasese and Kampala, Uganda. Study participants included men involved in a maternal health project, their wives, and individuals and organizations working to improve male involvement; all purposively selected. RESULT Through thematic analysis, four major themes were identified: 'gaps between policy and practice', 'resources and skills', 'inadequate participation by key actors', and 'types of dissemination'. These themes represent the barriers to effective implementation of male involvement policies. Most health workers interviewed have not been adequately trained to provide male-friendly services or to mobilize men. Interventions are highly dependent on external aid and support, which in turn renders them unsustainable. Furthermore, community and religious leaders, and men themselves, are often left out of the design and management of male involvement interventions. Finally, communication and feedback mechanisms were found to be inadequate. CONCLUSION To enable sustainable behavior change, we suggest a 'bottom-up' approach to male involvement that emphasizes solutions developed by or in tandem with community members, specifically, fathers and community leaders who are privy to the social norms, structures, and challenges of the community.
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Affiliation(s)
- Prerna Gopal
- School of Public Health, Imperial College London, Medical School Building, Norfolk Place, London, W2 1PG, UK
| | - Duncan Fisher
- Family Included, Upper House Farm, Crickhowell, NP8 1BZ, UK
| | - Gloria Seruwagi
- Makerere University School of Public Health, University Rd, Kampala, Uganda
| | - Henock B Taddese
- School of Public Health, Imperial College London, Medical School Building, Norfolk Place, London, W2 1PG, UK.
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Krakowiak D, Makabong'o P, Goyette M, Kinuthia J, Osoti AO, Asila V, Gone MA, Mark J, Farquhar C. Reaching hard-to-reach men through home-based couple HIV testing among pregnant women and their male partners in western Kenya: a qualitative study. BMC Public Health 2020; 20:724. [PMID: 32429879 PMCID: PMC7236963 DOI: 10.1186/s12889-020-08878-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/10/2020] [Indexed: 11/12/2022] Open
Abstract
Background Globally only 79% of adults living with HIV (human immunodeficiency virus) know their status and men in sub-Saharan Africa are considered a particularly hard-to-reach population for HIV testing. Home-based HIV couple testing during the antenatal period is a safe and effective method that has been used to test male partners of pregnant women. The goal of this qualitative study was to identify elements that made couple testing successful and describe important characteristics of this home-based intervention from couples’ perspectives. Methods Couples who received scheduled home-based couple testing during pregnancy in Kisumu, Kenya, were purposively sampled based on HIV status from January to May 2015. An interviewer administered all of the in-depth interviews and two coders were directly involved in the data analysis and reconciled codes several times in the process. Results Twenty-one couples were enrolled: 9 concordant HIV-negative couples, 8 HIV discordant couples, 3 HIV concordant HIV-positive couples, and 1 whose concordance status was unknown. Median age at the time of home-based couple testing was 24 and 28 years for women and men, respectively. Median relationship duration was 3 years and couples had a median of two pregnancies. The major themes that emerged were that home-based couple testing 1) removed the female burden of requesting couple testing, 2) overcame logistical barriers associated with clinic-based testing, 3) encouraged participants to overcome their fear of testing and disclosure, 4) provided privacy in the home, and 5) provided quality time with the health advisors. Importantly, some women appreciated individual testing at the clinic before couple testing and some couples preferred skilled, anonymous health advisors delivering the intervention rather than known community health workers. Conclusions The results of this qualitative study suggest that home-based couple testing during pregnancy overcame many of the barriers that limit men’s access to and uptake of clinic-based testing. It encouraged participants to overcome their fear of testing and disclosure through a setting that afforded privacy and quality time with skilled health advisors. These qualitative results may help design effective partner and couple HIV testing programs in the antenatal setting and alongside or within other assisted partner notification services. Trial Registration Clinicaltrials.gov registry: NCT01784783. Registered prospectively on June 15, 2012.
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Affiliation(s)
- Daisy Krakowiak
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.
| | - Pamela Makabong'o
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Marielle Goyette
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.,Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya.,Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Alfred Onyango Osoti
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya.,Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - Victor Asila
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Molly Ann Gone
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Jennifer Mark
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Carey Farquhar
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA.,Department of Global Health, University of Washington, Seattle, Washington, USA
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15
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Pollahan A, Thinkhamrop J, Kongwattanakul K, Chaiyarach S, Sutthasri N, Lao-Unka K. Rate of Couple HIV Testing in a Prenatal Care Clinic and Factors Associated with Refusal of Testing Among Male Partners. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2019; 11:369-375. [PMID: 32021479 PMCID: PMC6942528 DOI: 10.2147/hiv.s232191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/11/2019] [Indexed: 11/23/2022]
Abstract
Objective To determine the rate of HIV testing in couples during pregnancy and the reasons and risk factors related to male partners refusing to be tested. Materials and methods This was a cross-sectional study conducted in pregnant women undergoing prenatal care after receiving information about HIV testing on their first visit. After 20 weeks of gestation, they were approached to participate in the study, which consisted of an interview and examination of their medical records. Data collection included the women’s socioeconomic status, obstetric condition and serological test results together with their partner information. If relevant, the partner’s reasons for refusing to undergo HIV testing. Results A total of 400 pregnant women were recruited between February and August 2018, 150 (37.5%) of whose male partners underwent HIV testing. There were five couples in which one or both members were found to be positive for HIV: 1 seroconcordant couple, 1 serodiscordant couple in which the pregnant woman was positive, and 3 serodiscordant couples in which the male partners were positive. The most common reason for male partners refusing to take the test was their already having been tested once before. The women having had other sexual partners prior to their current partners was a significant risk factor for the partners refusing to be tested. Conclusion There was a low rate of couple HIV testing and a substantial portion of discordant infection among positive couples. Routine couples counseling and testing should be encouraged to reduce the vertical transmission and the number of new cases of HIV infection.
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Affiliation(s)
- Achara Pollahan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Jadsada Thinkhamrop
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Kiattisak Kongwattanakul
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Sukanya Chaiyarach
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Nutwara Sutthasri
- Nursing Department, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Kesorn Lao-Unka
- Nursing Department, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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16
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Lyatuu GW, Naburi H, Urrio R, Mwashemele SZ, Mdingi S, Panga R, Koda H, Chende Y, Tsere M, Mhalu A, Siril H, Lema IA, Aris E, Muya AN, Galanti MR, Biberfeld G, Kilewo C, Ekström AM. Engaging community leaders to improve male partner participation in the prevention of mother-to-child transmission of HIV in Dar es Salaam, Tanzania. PLoS One 2018; 13:e0207986. [PMID: 30540794 PMCID: PMC6291081 DOI: 10.1371/journal.pone.0207986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 11/11/2018] [Indexed: 11/19/2022] Open
Abstract
Background Male partner participation improves uptake, retention and outcomes of prevention of mother-to-child transmission of HIV (PMTCT) services. However, in patriarchal settings few men accompany their partners to antenatal care (ANC) and PMTCT services. We explored whether community leaders can improve male partner participation in ANC and PMTCT. Methods We integrated initiatives to increase male partner participation in routine ANC care in six health facilities (attending about 4,500 new pregnant women per quarter) in Dar es Salaam, Tanzania in 2015/16. These initiatives were adapted from a best performing health facility, on male partner participation in ANC and PMTCT, referred to as the “best practice site”. At the six purposively selected intervention sites, we sensitized and garnered commitment from healthcare providers to provide couple friendly services. We then worked with the providers to sensitize and engage community leaders to integrate and promote male partner participation initiatives in their routine community activities. We assessed change in male partner participation in ANC and PMTCT using the proportion of women testing for HIV together with their partners (i.e. couple HIV testing) by quarter. We used 203 ANC facilities (attending about 31,000 new pregnant women per quarter) in the same area as control sites. Results After one year, couple HIV testing in the six intervention sites had tripled from 11.9% at baseline to 36.0% (p<0.001) while there was very little change (from 17.7% to 18.3%) in the 203 control sites (p = 0.07). Statistically significant improvements in couple testing were observed in four of the six intervention sites (6.7% to 19.1%; 9.3% to 74.6%; 46.2% to 95.2%; and 4.7% to 15.1% respectively. p<0.001 for all sites). Two of these four sites, located in the same administrative district as the best practice site, achieved remarkably high couple HIV testing (95.2% and 74.6%). This may be attributable to the greater engagement and active participation of the community leaders in these two sites compared to the other four. Conclusion Effective engagement and functional partnerships between healthcare providers and community leaders can contribute to improve male partner participation in ANC and PMTCT services. PMTCT programs should capitalize on community leaders, in addressing low male partner participation in ANC and PMTCT, in order to improve effective uptake, retention and outcomes of HIV prevention and treatment services among pregnant and breastfeeding women, their partners, infants and families.
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Affiliation(s)
- Goodluck Willey Lyatuu
- Management and Development for Health, Dar es Salaam, Tanzania
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Helga Naburi
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Roseline Urrio
- Management and Development for Health, Dar es Salaam, Tanzania
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Sarah Mdingi
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Rehema Panga
- Ubungo Municipal Council, Dar es Salaam, Tanzania
| | - Happiness Koda
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Yusuph Chende
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Martha Tsere
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Aisa Mhalu
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Helen Siril
- Management and Development for Health, Dar es Salaam, Tanzania
| | | | - Eric Aris
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Aisa Nkya Muya
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Maria Rosaria Galanti
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
| | - Gunnel Biberfeld
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
| | - Charles Kilewo
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anna Mia Ekström
- Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Disease, Karolinska university hospital, Stockholm, Sweden
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Dougherty A, Kayongo A, Deans S, Mundaka J, Nassali F, Sewanyana J, Migadde E, Kiyemba R, Katali E, Holcombe SJ, Heil SH, Kalyesubula R. Knowledge and use of family planning among men in rural Uganda. BMC Public Health 2018; 18:1294. [PMID: 30477477 PMCID: PMC6258500 DOI: 10.1186/s12889-018-6173-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unmet need for family planning exceeds 33% in Uganda. One approach to decreasing unmet need is promoting male involvement in family planning. Male disapproval of use of family planning by their female partners and misconceptions about side effects are barriers to family planning globally and in Uganda in particular. Researchers have conducted a number of qualitative studies in recent years to examine different aspects of family planning among Ugandan men. The present study aimed to quantify men's knowledge of family planning in rural Uganda to understand how better to involve men in couples' contraceptive decision-making, particularly in low-resource settings. METHODS Data were derived from in-person, researcher-administered surveys of men in a rural agrarian district in Uganda (N = 178). Participant demographics and knowledge of family planning methods, side effects, and use were queried. Descriptive statistics were used for analysis. RESULTS Men were 34 years of age on average (range 18-71) and about half (56%) had a primary school education or less. Ninety-eight percent reported any knowledge of family planning, with 73% of men reporting obtaining information via radio and only 43% from health workers. The most common method known by men was the male condom (72%), but more than half also knew of injections (54%) and pills (52%). Relatively few men reported knowing about the most effective reversible contraceptive methods, intrauterine devices and implants (both 16%). Men identified many common contraceptive side-effects, such as vaginal bleeding (31%), and misconceptions about side effects, such as increased risk of infertility and birth defects, were relatively uncommon (both < 10%). About half of all men reported ever using a family planning method (53%), and 40% reported current use. CONCLUSIONS This study's quantitative results build on those of recent qualitative studies and provide information about the types of family planning information men are lacking and avenues for getting this information to them.
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Affiliation(s)
- Anne Dougherty
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont, Burlington, VT, USA
| | - Alex Kayongo
- Department of Medicine, Makerere College of Health Sciences, Kampala, Uganda.,African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Samantha Deans
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont, Burlington, VT, USA
| | - John Mundaka
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda.,Department of Obstetrics and Gynecology, Makerere College of Health Sciences, Kampala, Uganda
| | - Faith Nassali
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - James Sewanyana
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Eric Migadde
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Ronald Kiyemba
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Estherloy Katali
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda.,Makerere University Business School, Kampala, Uganda
| | - Sarah Jane Holcombe
- Bixby Center for Population, Health, and Sustainability, University of California, Berkeley, USA
| | - Sarah H Heil
- Departments of Psychiatry and Psychological Science, University of Vermont, Burlington, VT, USA
| | - Robert Kalyesubula
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda. .,Departments of Medicine and Physiology, Makerere College of Health Sciences, P.O Box 7072, Kampala, Uganda.
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18
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Mwije S. Men and maternal health: The dilemma of short-lived male involvement strategies in Uganda. Health Care Women Int 2018; 39:1221-1233. [PMID: 29693503 DOI: 10.1080/07399332.2018.1466887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This article has been written to call for further attention to the importance of involving males in efforts to reduce maternal mortality. Since the 1995 International Conference on Population and Development [ICPD], institutional and community arrangements have been implemented in developing countries to engage males in maternal and child health promotions. The government of Uganda - in partnership with other health promotion institutions such as the United Nations agencies - has in the past decade formulated and implemented national and local strategies for male involvement in Sexual and Reproductive Health and Rights (SRHR). Nevertheless, strategies are such as Male Action Groups (MAGs) have been short-lived because the strategies within cannot by themselves work without 'genuine' acceptance at community levels where implementation takes place. Even acceptance alone is also not enough. Majority of males have more interest in economic than social endeavors. They have less interest to engage in maternal health promotion initiatives. Cultural based perceptions and behaviors associated with patriarchal tendencies remain the greatest challenge. Therefore, relevancy, functionality, adaptability, and sustainability in relation to the effectiveness of male involvement initiatives must be assessed before these interventions are initiated in such culturally diverse communities with different informal institutional arrangements. The individual, interpersonal and institutional contexts in which interventions operate matters. The article identifies relevant stakeholders and suggests, though not discussed in detail, strategies for improving stakeholders' interests to respond to male involvement as a core issue in maternal health.
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Affiliation(s)
- Solomon Mwije
- a Institute of Development Policy, University of Antwerp , Antwerp , Belgium.,b Department of Development Studies , Uganda Christian University , Mukono , Uganda
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19
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Hoang A, Nguyen CQ, Duong CD. Youth experiences in accessing sexual healthcare services in Vietnam. CULTURE, HEALTH & SEXUALITY 2018; 20:545-559. [PMID: 28866956 DOI: 10.1080/13691058.2017.1360945] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Poor sexual and reproductive health outcomes among youth are reflective of the many barriers members of this group face in accessing health services. This study provides an in-depth account of the unique challenges that young people face in accessing sexual healthcare services in Vietnam. We surveyed 130 men and women aged 18-24 years at two major reproductive health sites in Ho Chi Minh City. We identified and explored seven domains: health insurance status, modern contraception use, HIV/STI testing, cervical cancer screening, unintended pregnancy, reproductive coercion and the patient-provider relationship. Attitudes towards the national health insurance system suggest that it does not facilitate access to healthcare. Despite widespread and affordable services, fears, fallacies and fixed social mores created formidable barriers for unmarried youth to access sexual and reproductive health services in Vietnam.
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Affiliation(s)
- Anh Hoang
- a Yale University , New Haven , USA
- d School of Medicine , University of California San Francisco , USA
| | - Chinh Quoc Nguyen
- b Reproductive Healthcare Centre of Ho Chi Minh City , Ho Chi Minh City , Vietnam
| | - Cong Dinh Duong
- c Department of Community Health , Pham Ngoc Thach University of Medicine , Ho Chi Minh City , Vietnam
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20
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How Do We Get Partners to Test for HIV?: Predictors of Uptake of Partner HIV Testing Following Individual Outpatient Provider Initiated HIV Testing in Rural Uganda. AIDS Behav 2017; 21:2497-2508. [PMID: 28585100 DOI: 10.1007/s10461-017-1817-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In a sample of outpatients (152 females, 152 males) receiving individual provider-initiated HIV testing and counselling (PITC) we aimed to identify factors associated with subsequent uptake of partner HIV testing. Purposively sampled outpatients receiving PITC at a Ugandan hospital completed a questionnaire immediately prior to testing for HIV, and then at 3 and 6 months post-test. By 6-month follow-up 96% of participants reported disclosing their HIV test results to their partner and 96.4% reported asking their partner to test. 38.8% of women and 78.9% of men reported that their partner tested and they knew their results. Recent (men AOR 5.84, 95.0% CI 1.90-17.99; women AOR 6.19, 95.0% CI 2.74-13.59) or any previous testing by the partner (women AOR 4.01, 95% CI 1.06-15.10) predicted uptake of partner testing by the 6-month follow-up. Among women, perceiving greater social support from their partner, which perhaps reflects better relationship quality, was predictive of their male partner testing for HIV (AOR 2.37, 95% CI 1.22-4.58). Notably intimate partner violence showed no negative association with partner testing. Our findings demonstrate that women are at a disadvantage compared to men in their ability to influence their partner to test for HIV, and that improving social support in intimate relationships should be a focus of HIV partner testing interventions. However, more research on interventions to improve partner testing is needed, particularly in identifying effective ways to support women in engaging their partners to test.
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