Equity of access to reproductive health services among youths in resource-limited suburban communities of Mandalay City, Myanmar

Utilization of Sexual Reproductive Health Services Among Youths in Malaysia: A Cross-Sectional Study Applying Andersen's Behavioral Model of Healthcare Utilization

Background The sexual well-being of youths is crucial as it establishes the foundation for their sexual health throughout their lives. Malaysia's Ministry of Health (MOH) mainly delivers sexual reproductive health (SRH) services. Besides MOH, the National Population Family Development Board (NPFDB), under the purview of the Ministry of Women, Family and Community Development and Federation of Reproductive Health Association Malaysia, works closely with MOH to ensure the delivery of SRH information and services. Despite the availability of SRH services in Malaysia, it is uncertain whether youths are aware of and utilize these services. This study aims to identify factors that affect the utilization of SRH services among youths aged 18-24 years in Malaysia. Methodology This web-based, cross-sectional study was conducted from March 2022 to June 2022 using a self-administered pre-tested questionnaire. Andersen's Behavioral Model of Health Service Utilization was used to identify the variables included in the survey. Bivariate and multivariate logistic regression models were used to determine factors significantly associated with the utilization of SRH services. Adjusted odds ratio (AOR) and 95% confidence interval (CI) with a p-value <0.05 were considered to denote statistical significance. Results A total of 617 youths aged 18-24 years participated in the survey. Only 20.4% (n = 126) of youths had visited SRH services in their entire life, and only 8.4% (n = 52) of youths had visited SRH services in the past year. Predisposing factors such as age, marital status, exposure to SRH information from family and governmental agencies such as the NPFDB, enabling factors such as availability and comfort of SRH services, and need factors such as youths diagnosed with SRH-related diseases were significantly associated with SRH utilization. The older age group (20-24 years old) was more likely to utilize SRH services compared to the 18-19-year age group (AOR = 1.634, 95% CI = 1.041, 2.564, p = 0.033). Married participants were three times more likely to utilize SRH services than single participants (AOR = 2.910, 95% CI = 1.356, 6.249, p = 0.006). Participants who vaped had more odds of utilizing SRH services (AOR = 1.793, 95% CI = 1.014, 3.174, p = 0.045) The group of participants exposed to information on SRH from family had more odds of utilizing SRH service than those who did not receive information on SRH from the family (AOR = 1.964, 95% CI = 1.229, 3.138, p = 0.005). Likewise, participants who received SRH information from governmental agencies were more likely to utilize SRH services (AOR = 1.929, 95% CI = 1.202, 3.095, p = 0.006). Enabling factors that were associated with SRH utilization were the availability of services, described as self-buying medicine in pharmacies (AOR = 1.830, 95% CI = 1.184, 2.855, p = 0.007), and the comfortability of services (AOR = 1.928, 95% CI = 1.250, 2.974, p = 0.003). Youths who were diagnosed with SRH diseases (need factor) were four times more likely to utilize SRH services (AOR = 4.490, 95% CI = 1.935, 10.410, p < 0.001). Conclusions There is generally poor SRH service utilization and awareness among youths in Malaysia, which could be improved. The findings of this study can be used to influence SRH providers to offer a more age-targeted awareness program to meet the various SRH needs of youths.

Men's utilisation of sexual and reproductive health services in low- and middle-income countries: A narrative review

Background

Men have poor access to sexual and reproductive health (SRH) services globally, particularly in low- and middle-income countries (LMICs). Nevertheless, in LMIC and high-income countries (HICs), low SRH utilisation happens on account of several factors, such as individual, health system-related, and sociocultural factors. Identifying and addressing men's SRH service underutilisation remains essential to improving their sexual health and averting higher mortality and early morbidity associated with poor health seeking behaviour (HSB) among men.

Aim

This narrative review identifies factors influencing whether men do or do not utilise SRH services in LMICs.

Setting

We report on articles published in LMICs: Africa, Asia and South America.

Method

In this narrative review, we searched for quantitative and qualitative articles published between 2004 and 2021 from international databases, including Google Scholar, ScienceDirect, EBSCOhost, Scopus, PubMed, Medline, and reference lists of retrieved published articles.

Results

A total of 2219 articles were retrieved, from which 36 met the inclusion criteria. Factors contributing to poor uptake of SRH services by men included: a lack of access and availability of SRH services, poor health-seeking behaviour among men, and SRH facilities not being perceived as 'male-friendly spaces'. Furthermore, our review reveals that decreased use of SRH services is attributed to factors such as a lack of focus on men's SRH.

Conclusion

The current underutilised state of SRH services calls for urgent implementation of evidence-based interventions. Identifying men's SRH service inhibitors and enablers will assist programme managers and policymakers in designing SRH services tailored to their sexual health needs.

Contribution

Despite numerous global interventions to motivate men, the findings provide insight into the underutilisation of SRH services. The study also reveals the inadequate comprehensive investigation of men's SRH service utilisation, especially older men, to comprehend men's problems fully. Further research needs to be conducted on SRH issues, including vasectomy, mental health, and chronic conditions related to sexual and reproductive health. The analysis can assist SRH policymakers and program managers in strengthening the policies to motivate men to engage better with SRH services.

The hidden inequality: the disparities in the quality of daily use masks associated with family economic status

Wearing high-quality masks plays a critical role in reducing COVID-19 transmission. However, no study has investigated socioeconomic inequality in the quality of masks. Addressing this gap, this paper explored the relationships between mask's quality and family economic status. The cross-sectional survey was conducted in two Chinese universities by distributing structured questionnaires to assess participants' characteristics including family economic status, and meanwhile collecting their masks to evaluate the quality by measuring particle filtration efficiency. The valid responses were obtained from 912 students with mean age of 19.556 ± 1.453  years and were analyzed by using fractional or binary logistic regression. Three main findings were presented. First, inequality existed in the quality of masks. 36.07% of students were using unqualified masks with average filtration efficiency of 0.795 ± 0.119, which was much lower than China's national standard (0.9). Of those masks with identified production date, 11.43% were manufactured during COVID-19 outbreak when market was flooded with counterfeit production, and thus were of poor quality with average filtration efficiency of 0.819 ± 0.152. Second, better family economic status was associated with better masks' filtration efficiency and greater probability of using qualified masks. Third, students with better family economic status tend to use masks with individual packaging, and unique patterns and special designs, which may lead to inequality on a psychological level. Our analysis reveals the hidden socioeconomic inequality that exist behind cheap masks. In facing the challenges of future emerging infectious diseases, it is important to address the inequity to ensure equal access to affordable qualified personal protection equipment.

Sexual reproductive health service utilization and associated factors among undergraduate students of Addis Ababa University in Ethiopia

BACKGROUND

Making clinical services attractive to the younger generation has remained a challenge. Students in higher education continue to underutilize sexual and reproductive health services. This group is exposed to a very hostile environment and has a highly mobile and unprotected lifestyle, often resulting in an early sexual debut, physical and drug abuse, and sexually transmitted infections.

OBJECTIVE

The aim of this study was to assess sexual reproductive health services and associated factors among undergraduate students of Addis Ababa University 2022.

METHOD

An Institution-based cross-sectional study was been conducted among 419 randomly selected students and data were collected by using semi-structured and pre-tested questionnaire. Data were entered to Epi info data 7.0 and exported to SPSS version 21.0 for further analysis. Both binary and multiple logistic regression analysis was used to identify factors at P < 0.05 with 95% CI and AOR.

RESULTS

When queried, all 419 youths agreed to participate in the study, for a response rate of 100%. The mean age of the respondents was 22 years. The majority of respondents (371, 88.5%) were between the ages of 19 and 24, and 221 (52.7%) were female. More than half of those polled (273, or 65.2%) were third-year students, while 59, or 14.1%, were first-year students. About 206 (49.2%) of participants lived with their father and mother, but 138 (32.9%) had never discussed sexual and reproductive health. Finally, 205 respondents (or 48.9%) had ever used the Sexual and Reproductive Health Services. College of business (AOR (95% CI) 3.546 (1.62-7.79), respondents who live with only their mother (AOR (95% CI) 9.37 (2.78-31.51) and who live alone (AOR (95% CI) 5.75 (2.40-13.79), positive attitude toward SRHS (AOR (95% CI) 3.15 (1.71-5.80), good knowledge (AOR (95% CI) 4.16 (2.27-7.64), frequency of discussing SRHS(AOR (95% CI) 1.93 (1.12-3.346), Convenient location of youth RHs (AOR (95% CI) 8.31 (1.61-42.93), Fee of RH services (AOR (95% CI) 12.34 (6.48-23.49) and Satisfied to received RH services (AOR (95% CI) 4.59 (2.54-8.33) were independent predictors of utilized SRHS among undergraduate students.

CONCLUSION AND RECOMMENDATION

The prevalence of utilization of sexual and reproductive health services was determined to be low in this study, with identified factors increasing the likelihood of utilization being attitude, knowledge, satisfaction, discussion, fee for RH services, and location, in that order. On the other hand, poor knowledge and a negative attitude toward SRHS posed risks that contributed to reproductive health issues, so we worked on advocating for services that were available in a nearby location and raising awareness. Therefore, policymakers and health planners would be better off strengthening the urgent need to ensure adequate SRHS, knowledge, and attitude building among undergraduate students in higher education in Ethiopia.

Geographic barriers to care persist at the community healthcare level: Evidence from rural Madagascar

Geographic distance is a critical barrier to healthcare access, particularly for rural communities with poor transportation infrastructure who rely on non-motorized transportation. There is broad consensus on the importance of community health workers (CHWs) to reduce the effects of geographic isolation on healthcare access. Due to a lack of fine-scale spatial data and individual patient records, little is known about the precise effects of CHWs on removing geographic barriers at this level of the healthcare system. Relying on a high-quality, crowd-sourced dataset that includes all paths and buildings in the area, we explored the impact of geographic distance from CHWs on the use of CHW services for children under 5 years in the rural district of Ifanadiana, southeastern Madagascar from 2018-2021. We then used this analysis to determine key features of an optimal geographic design of the CHW system, specifically optimizing a single CHW location or installing additional CHW sites. We found that consultation rates by CHWs decreased with increasing distance patients travel to the CHW by approximately 28.1% per km. The optimization exercise revealed that the majority of CHW sites (50/80) were already in an optimal location or shared an optimal location with a primary health clinic. Relocating the remaining CHW sites based on a geographic optimum was predicted to increase consultation rates by only 7.4%. On the other hand, adding a second CHW site was predicted to increase consultation rates by 31.5%, with a larger effect in more geographically dispersed catchments. Geographic distance remains a barrier at the level of the CHW, but optimizing CHW site location based on geography alone will not result in large gains in consultation rates. Rather, alternative strategies, such as the creation of additional CHW sites or the implementation of proactive care, should be considered.

Individual and contextual factors affect the implementation fidelity of youth-friendly services, northwest Ethiopia: A multilevel analysis

BACKGROUND

The evaluation of all potential determinants of implementation fidelity of Youth-Friendly Services (YFS) is crucial for Ethiopia. Previous studies overlooked investigating the determinants at different levels. Therefore, this study aimed to assess the determinants of implementation fidelity of YFS considering individual and contextual levels.

METHODS

This study was conducted among 1,029 youths, from 11 health centers that are implementing the YFS in Central Gondar Zone. Data were collected by face to face interview and facility observation using a semi-structured questionnaire. A Bivariable multi-level mixed effect modelling was employed to assess the main determinants. Four separate models were fitted to reach the full model. The fitness of the model was assessed using Akaike Information Criterion (AIC) and level of significance was declared at p-values < 0.05. The results of fixed effects were presented as adjusted odds ratio (AOR) at their 95% CI.

RESULTS

Four hundred one (39.0%) of the respondents got the YFS with high level of fidelity. Had high level of involvement in the YFS provision (AOR = 1.35, 95% CI: 1.15, 1.57), knew any peer educator trained in YFS (AOR = 1.60, 95% CI: 1.36, 1.86), and involved as a peer educator (AOR = 1.46, 95% CI: 1.24, 1.71), were the individual level determinants. Whereas, got capacity building training; (AOR = 1.93, 95% CI (1.12, 3.48), got supportive supervision, (AOR 2.85, 95% CI (1.99, 6.37), had a separate waiting room (AOR = 9.84, 95%CI: 2.14, 17.79), and system in place to provide continuous support to staff (AOR = 2.81, 95%CI: 1.25, 6.34) were the contextual level determinants.

CONCLUSIONS

The level of implementation fidelity remains low. Both individual and contextual level determinants affect the implementation fidelity of YFS. Therefore, policy makers, planners, managers and YFS providers could consider both individual and contextual factors to improve the implementation fidelity.

Disparities in sexual and reproductive health services utilization among urban and rural adolescents in southern Ethiopia, 2020: a comparative cross-sectional study

BACKGROUND

Although studies on the uptake of Adolescent sexual and reproductive health (ASRH) services in Ethiopia have been conducted they have failed to show the disparity in service uptake among rural and urban settings. Once the extent and determinants of ASRH service uptake in urban and rural contexts are known, it will be crucial to provide evidence-based information and recommendations for potential interventions to reduce the burden of disease and disability among adolescents. This study aimed at determining the level of SRH service utilization among urban and rural adolescents in the Guraghe zone, Southern Ethiopia.

METHODS

A community-based comparative cross-sectional study was undertaken from November 1 -30, 2020. A multi-stage sampling technique was employed and a total of 1083 adolescents (361 from the urban and 722 from the rural areas) were selected randomly to take part in the study. Pre-tested, interviewer-administered, structured questionnaires were used to collect the data. The data were encoded and entered into Epi-Data version 3.1 and then exported to SPSS version 23 for analysis. χ2 test was computed to see a significant difference in SRH service utilization among urban and rural adolescents. In a bivariable logistic regression analysis, a variable with a p-value less than 0.25 has been selected for a multivariable logistic regression model. Variables with p-values less than 0.05 were declared statistically significant in multivariate logistic regression.

RESULTS

A total of 1,075 adolescents (358 from urban and 717 from rural) took part in the study, yielding a response rate of 99.3%. The overall SRH service utilization among the whole adolescents was 39.5% (95%CI: 36.5, 42.4). There was a significant difference in SRH service utilization between urban 56.9% (95%CI: 51.8, 62.1) and rural 30.8% (95%CI: 27.4, 34.2) adolescents (χ2 = 68.3, p < 0.001). Residence[AOR = 2.62; 95%CI:1.63,3.41], availability of youth clubs [AOR = 4.73; 95%CI:3.43,6.53], taking part in peer education [AOR = 2.06; 95%CI:1.48,3.88], having parental discussion [AOR = 3.29; 95%CI:1.73,3.33], and being knowledgeable on SRH issues [AOR = 2.01; 95%CI: 1.45,3.03] were identified as a significant determinants of SRH service uptake. Having parental discussion, geographical accessibility, and knowledge on SRH were significant predictors of SRH service uptake among rural adolescents.

CONCLUSION

Overall, ASRH service utilization in the study area was low, despite urban adolescent service uptake becoming higher than rural adolescents. Since the majority of adolescents were enrolled in schools, schools should be an area of intervention to improve adolescents' knowledge of SRH services through mass media, community networks, and interpersonal/group communication. Furthermore, promoting parent-adolescent discussions, as well as peer-to-peer discussions at the family and school level, should be emphasized. Stakeholders in the education and health sectors need to strengthen their efforts to establish youth clubs in places where they do not yet exist, especially in rural schools.

Key recommendations to strengthen public-private partnership for adolescent health in resource constrained settings: Formative qualitative inquiry in Mongolia, Myanmar and the Philippines

Background

Public health services can be inaccessible for adolescents. The private sector provides many services, but often in parallel to the public sector. This study aimed to understand current private sector engagement in adolescent health service delivery and develop recommendations to strengthen partnerships.

Methods

The study focussed on Mongolia, Myanmar and the Philippines. An initial participatory workshop in each country was followed by semi-structured key-informant interviews (32 in total) with public and private sector actors and adolescents to explore: perceptions of the public and private sectors, strengths and challenges, existing models of partnership, and insights for successful public-private partnership (PPP). Interview transcripts were analysed thematically, with findings and recommendations verified through a second workshop in Mongolia and the Philippines.

Findings

The private sector already plays a significant role in adolescent health care, and stakeholders reported a genuine willingness for partnership. Strengthened PPP was identified as necessary to improve service accessibility and quality for adolescents, unburden the public sector and introduce new technologies, with advantages for the private sector including improved access to training and resources, and an enhanced public image. Recommendations for strengthened PPP included the need to establish the foundations for partnership, clearly define roles and co-ordinate stakeholders, ensure capacity and sustainability, and monitor and evaluate efforts.

Interpretation

This is the first comprehensive study of public-private partnership for adolescent health in the Asia Pacific region. It identifies stakeholders are willing for stronger partnerships and the benefits this partnership will bring. We define eight key recommendations to enable this partnership across sectors.

Postpartum women's knowledge and planned use of contraception in Myanmar

BACKGROUND

Maternal mortality in Myanmar is one of the highest in the WHO South-East Asian region. Additionally, the country has a high unmet need for contraception and low rates of uptake of long-acting reversible contraceptive methods (LARCs) including intrauterine devices (IUDs) and implants. Engagement with health professionals around the time of a birth is an ideal opportunity for women to access contraception but immediate postpartum provision is not widely offered in Myanmar.

METHODS

We undertook a cross-sectional survey of women immediately postpartum at two hospitals in Yangon to investigate their knowledge, and past use of, contraceptive methods and their plans for postpartum contraception including perceptions of implants and IUDs. Four trained obstetrics staff collected data using electronic tablets between January 2017 and January 2018.

RESULTS

Of the 1755 participants, 55.1% had used pills and 42.2% injectables. In contrast, only 0.5% had used an IUD and 0.3% an implant. Few women (4.4%) anticipated starting contraception immediately postpartum and only a minority would consider future use of an implant (36.9%) or an IUD (13.0%). Fear of side effects was the major barrier to future implant and IUD uptake, reported by 64.5% and 62.5%, respectively.

CONCLUSIONS

Women in maternity care in Yangon have some awareness of IUDs and implants but many hold misconceptions about their side effects leading to reluctance to use. Reducing the unmet need for contraception and improving maternal outcomes in Myanmar could be achieved by improving education, policy and practice around immediate postpartum contraception provision, with a particular focus on LARC methods.

Assessment of access and utilization of adolescent and youth sexual and reproductive health services in western Ethiopia

BACKGROUND

Despite Ethiopia's enormous effort in youth-friendly service provision, little was investigated about the challenges of accessing sexual and reproductive health services in Western Ethiopia. Thus, this study aimed to assess factors associated with the utilization of adolescent and youth sexual and reproductive health services in this area.

METHODS

A community-based cross-sectional quantitative method mixed with the qualitative inquiry was conducted among 771 adolescents and youth aged 15 to 24 years from February 1 to 28, 2020. Data were collected through face-to-face interviews using pretested structured questionaries. Data were entered using EPI-INFO version 7.0 and analyzed by SPSS version 25. Descriptive analysis and logistic regressions were performed. The adjusted odds ratio with a 95% confidence interval was used and statistical significance was declared at P-value < 0.05. The qualitative inquiry was collected through in-depth interviews with service providers, focus group discussions, and observation checklists of service units in the study facilities. Data were analyzed thematically.

RESULTS

The mean age of participants was 18.99 years (SD ± 2.49). Two hundred seventeen (28.1%) of participants reported that they have ever heard about adolescents' and youth's reproductive health services. Only 66 (8.6%) have ever visited health facilities for sexual and reproductive health (SRH) services. Factors associated with the utilization of sexual and reproductive health service were age from 15 to 19 years (AOR = 0.36; 95%CI: 0.17, 0.76), history of having sexual intercourse(AOR = 5.34;95%CI: 2.53, 11.23), ever heard about sexual reproductive health service (AOR = 11.33; 95%CI: 5.59, 22.96), and visited a health facility for other health services (AOR = 5.12; 95%CI:1.72,15.24).

CONCLUSION

Sexual and reproductive health service utilization among adolescents and youth was found to be low. The factors associated with adolescents and youth sexual and reproductive health services utilization were age, history of ever having sexual intercourse, ever heard about SRH services, and visit the health facility for other services. Therefore, it is better if the concerned bodies work on improving awareness of adolescents and youth towards SRH services and integrating these services into other routine services.

Educational needs on safe motherhood from the perspective of suburban women: A qualitative study

Background

Maternal mortality resulting from pregnancy and delivery complications is a sensitive indicator of women's status in the society, access to care services, and sufficiency and quality of healthcare and is the major indicator of a country's developmental status. The present study aimed at determination of educational needs regarding safe motherhood from suburban women's perspective.

Method

This qualitative study with conventional content analysis approach was conducted in suburban healthcare centers of Alborz University of medical sciences from 23 October to 22 December 2019. The participants included 15 eligible Iranian suburban women who were selected through purposive sampling. The data were collected via in-depth semi-structured interviews and focus groups. Data were analyzes with MAXQDA10 software.

Results

Three main themes emerged from the analysis of the data (barriers against safe pregnancy, accountability multidimensional training, and threats and opportunities of distance learning), six categories, 11 subcategories and 547 codes.

Discussion

The results indicated that suburban women were less probable to be present in healthcare centers and receive the required information compared to their peers due to their conditions; provision of accessible training services appropriated to their conditions can greatly contribute to elimination of these problems.

Family planning awareness and service accessibility among women living with HIV in Myanmar

Background: Accessibility and availability of family planning services is critical for improvement in maternal health. There is limited information on awareness and accessibility to family planning services among women living with HIV in Myanmar. Methods: A mixed-methods cross-sectional descriptive study was conducted from Feb-March, 2018 at two antiretroviral therapy (ART) centers in Myanmar. Results: This study included 184 women living with HIV. The mean (SD) age was 38 (9) years. In total, 90 women (49%) were married, 10 (5%) were single. Among the respondents, 124 (67%) have never received health education on family planning, and 64 (35%) didn’t know any source of information for family planning services. In the last six months, 55 (30%) of them have used any type of contraception. Among married women, 16 (29%) intended to have a child. One-fourth of women with HIV responded that transmission of HIV from mother to child cannot be preventable. Perceived geographical accessibility to any type of family planning services was measured, and only 7% had high accessibility. The main barriers to accessing family planning information and services among women living with HIV were also explored. Most participants responded that they had poor knowledge and received insufficient information on the family planning services. Some of them mentioned they had financial constraints to access modern contraceptive methods. Key informant interviews with public service providers revealed that there was the lack of referral system, and poor linkage between ART teams and maternal and reproductive health teams for women living with HIV to provide the quality family planning services. Conclusions: This study highlighted the need for awareness raising among women living with HIV about family planning, and effective referral system between maternal and reproductive health unit, and HIV/AIDS care unit in Myanmar.

Disparity in utilization and expectation of community-based maternal health care services among women in Myanmar: a cross-sectional study

BACKGROUND

Aim of this study is to assess women's utilization and expectation of community-based antenatal and delivery care services in Myanmar and determine associated factors for disparity of services received with services women expected to receive.

METHODS

A cross-sectional survey was conducted among 6-month postpartum women in three townships of Myanmar during May-September 2016. Associated factors for the services with disparity were identified using multinomial logistic regression models.

RESULTS

Of 1743 women, the percentages of antenatal care (ANC) attended by a skilled provider, at least four ANC visits, and early ANC were 89, 60 and 36%, respectively. The percentage of non-facility delivery was 65%. Many ANC services received and services expected to receive had lower than 80% coverage. Services with significant disparity included blood hemoglobin and urinary protein testing, and iron supplementation. Low access to ANC, women's socio-economic status, pregnancy and delivery complications, and out-of-pocket cost were associated with disparity of these services.

CONCLUSION

Utilization and expectation of community-based ANC services and facility delivery is low in Myanmar. Disparities of the services received with the services women expected to receive were common in ANC. Improving women's expectations on essential services during pregnancy is needed as well as strengthening community participation.

Reproductive health services utilization and its associated factors among adolescents in Debre Berhan town, Central Ethiopia: a community-based cross-sectional study

BACKGROUND

Utilization of reproductive health services is an important component in preventing adolescents from different sexual and reproductive health problems. As a result, the extent of their service utilization should be determined before implementing any kind of interventions. Therefore, this study was aimed at assessing the level of reproductive health services utilization and its associated factors among adolescents who live in Debre Berhan town.

METHODS

A community-based cross-sectional method was employed in this study from April 5-May 1, 2016. A multi-stage systematic sampling technique was applied to select a total of 648 adolescents living in 5 randomly selected kebeles of Debre Berhan town. Moreover, a logistic regression was done to identify independent predictors of reproductive health service utilization.

RESULTS

Accordingly, the major findings of this study reveals that about one-third (33.8%) of adolescents utilized at least one of reproductive health services. Adolescents who had discussed sexual and reproductive health issues with their sexual partner and peers were two times more likely to use reproductive health services than their counter parts (AOR = 2.368, 95% CI: 1.168-4.802 and AOR = 2.360, 95% CI: 1.155-4.820 respectively). Adolescents who weren't co-resided with both their parents were also about two times more likely to utilize reproductive health service than those who were living together (AOR = 2.570, 95% CI = 1.155-4.820). Positive perception of oneself towards acquisition of Human Immunodeficiency Virus urged the adolescents to use RH services twice than those who didn't perceive themselves as risky (AOR = 2.231, 95%CI: 1.001-4.975).

CONCLUSION

Succinctly speaking, the analysis of the major finding suggests that the utilization of reproductive health services among adolescents in the study area was low. Discussion with sexual partner and peers, risk perception of oneself towards the acquisition of human immune-deficiency virus was among the predictors of reproductive health services usage.

Sexual and Reproductive Health Services Use, Perceptions, and Barriers among Young People in Southwest Oromia, Ethiopia

Background

Utilizations of sexual and reproductive health (SRH) services among young people is vital in reducing sexual and reproductive health problems. This study investigated young people's perceptions and barriers towards the use of sexual and reproductive health services in Southwest Ethiopia.

Methods

A cross sectional study was employed to collect data from 1,262 in-school youths. Simple random sampling technique was used to select schools and study participants. Fifteen focus group discussions and 22 key informant interviews were conducted. Multiple logistic regression analyses were conducted. P value ≤ 0.05 was set to determine statistical significance. Data were analyzed using SPSS v16. Qualitative data were triangulated with quantitative findings and also presented in themes.

Results

Four hundred sixty (36.5%) of the respondents had utilized sexual and reproductive health services. Advice on sexual and reproductive health was the major (67.2%) service sought followed by seeking-treatments (23.3%). Health centers were the major (65.0%) source of SRH services. Being married, being sexually active, father-child communication, religion and place of residence were significantly associated with use of sexual and reproductive health services (p<0.05). Lack of information about SRH, poor perceptions about SRH, feeling of shame, fear of being seen by others, restrictive cultural norms, lack of privacy, confidentiality and unavailability of services were deterring use of sexual and reproductive health services.

Conclusions

Only a small proportion of young people used sexual and reproductive health services. Hence, in addition to behavioral modification interventions, it is essential to consider multi-level and culturally sensitive interventions in a holistic approach.

Social mobilization for safe transition from adolescence: a qualitative research in Iran

Introduction Until now, the services provided to Iranian youth have been prepared based on authorities' perspectives and according to the resources and reports from other countries and international agencies. Using youth perspectives to provide health, however, helps in continuing the process of providing health services, and most young people will receive these services. Objective To explain perception of youth and key individuals to improve health programs for safe transition in Iran. Methodology This study is a qualitative research with a grounded theory approach. Data were collected using semi-structured in-depth interviews and group discussions. Participants were first selected by purposive sampling and then by theoretical sampling. Overall, 67 adolescents aged 14-18 years, eight youths aged 19-24 years, 12 parents and important persons involved in providing health services joined the study. Young participants and their parents were selected from different training areas of Tehran and the key individuals were from the Ministry of Health and Medical Education and the Education Department. Collecting samples were continued to saturation. The Strauss and Corbin (2008) method was used for data analysis. Result In this study, the phenomenon of adolescents' confusion to manage puberty emerged. This process, with appropriate strategies, such as the mobilization of available resources in the community and comprehensive programming to provide health services by policymakers, could have provided youth empowerment as an impact to self-care. Conclusion Current services provided by health centers cannot guarantee the health of adolescents, but it does require proper planning and management in families, schools and societies.

Maternal and child health voucher scheme in Myanmar: a review of early stage implementation

BACKGROUND

The Maternal and Child Health Voucher Scheme (MCHVS) was introduced in Myanmar to address the high rate of maternal and infant mortalities. It aimed to increase access to maternal and child health (MCH) services by skilled birth attendants (SBAs) and improve the health of pregnant women and their babies. A study to pilot a voucher scheme was implemented in May 2013 in Yedarshey Township. This paper provides a report on a mid-term review of the programme after 7 months of implementation to determine the outcomes of the programme and its impediments.

METHODS

Quantitative and qualitative approaches were used. Secondary quantitative data were analysed in order to measure the coverage and utilisation of the programme. Semi-structured interviews were conducted in groups and individually with 79 key informants to explore qualitative information on voucher communication, beneficiary's identification, voucher distribution, and challenges for beneficiaries and providers under the MCHVS.

RESULTS

The results showed that 63 % of eligible pregnant women who registered to the programme received voucher booklets, while the utilisation of most of the MCH services increased over time; in particular, delivery by SBAs increased significantly (P < 0.01) after implementing MCHVS. Overall, the programme was implemented well in terms of promoting and communicating the programme to people in Yedarshey Township. Although a number of targeted poor pregnant women were included in the programme, some beneficiaries were overlooked for a variety of reasons. Nevertheless, both providers and beneficiaries who experienced the MCHVS service utilisation were satisfied with the programme. The evaluation indicated several programme challenges, i.e. external and internal programme communication, voluntary voucher distributor recruitment, incentive and support for voucher distributors, beneficiary screening criteria, and approaches to increase access of services for pregnant women living in remote areas.

CONCLUSIONS

Generally, the MCHVS pilot programme is a promising initiative to increase access to and utilisation of the MCH services for pregnant women and their babies in Myanmar. However, increasing coverage of the programme and overcoming the barriers should be considered as high-priority issues that need to be addressed.

Family planning knowledge, attitudes and practices in refugee and migrant pregnant and post-partum women on the Thailand-Myanmar border - a mixed methods study

Background

Lack of data in marginalized populations on knowledge, attitudes and practices (KAP) hampers efforts to improve modern contraceptive practice. A mixed methods study to better understand family planning KAP amongst refugee and migrant women on the Thailand-Myanmar border was conducted as part of an ongoing effort to improve reproductive health, particularly maternal mortality, through Shoklo Malaria Research Unit (SMRU) antenatal and birthing services.

Methods

Cross-sectional surveys and focus group discussions (FGDs) in currently pregnant women; and in-depth interviews (IDIs) in selected post-partum women with three children or more; were conducted. Quantitative data were described with medians and proportions and compared using standard statistical tests. Risk factors associated with high parity (>3) were identified using logistic regression analysis. Qualitative data were coded and grouped and discussed using identified themes.

Results

In January-March 2015, 978 women participated in cross-sectional studies, 120 in FGD and 21 in IDI. Major positive findings were: > 90 % of women knew about contraceptives for birth spacing, >60 % of women in the FGD and IDI reported use of family planning (FP) in the past and nearly all women knew where they could obtain FP supplies. Major gaps identified included: low uptake of long acting contraception (LAC), lack of awareness of emergency contraception (>90 % of women), unreliable estimates of when child bearing years end, and misconceptions surrounding female sterilization. Three was identified as the ideal number of children in the cross-sectional survey but less than half of the women with this parity or higher in the IDI actually adopted LAC leaving them at risk for unintended pregnancy. Discussing basic female anatomy using a simple diagram was well received in FGD and IDIs. LAC uptake has increased particularly the IUD from 2013–2015.

Conclusion

Definitive contextual issues were identified during this study and a significant range of action points have been implemented in FP services at SMRU as a result, particularly in regard to the IUD. The importance of the role and attitudes of husbands were acknowledged by women and studies to investigate male perspectives in future may enhance FP practice in this area.

Electronic supplementary material

The online version of this article (doi:10.1186/s12978-016-0212-2) contains supplementary material, which is available to authorized users.

Level of Young People Sexual and Reproductive Health Service Utilization and Its Associated Factors among Young People in Awabel District, Northwest Ethiopia

Background

Currently in Ethiopia, young people’s sexual and reproductive health services are limited and there is a growing issue of confidentiality and affordability of these health services. Moreover, the available services provided are not sensitive to the special needs of young people. Therefore, this study was aimed to assess young people’s sexual and reproductive health service utilization and its associated factors in Awabel district, Northwest Ethiopia.

Methods

A community based cross-sectional study was conducted among 781 randomly selected young people using a pre-tested structured questionnaires in Awabel district, Northwest Ethiopia. Data were entered into Epi data version 3.1 and analyzed using SPSS version 16.0 software.

Results

The mean age of respondents were 17.80 (+ 2.65) years. About 41% of young people had utilized sexual and reproductive health services. Young people from families of higher family expenditure, lived with mothers, participated in peer education and lived near to a Health Center were more likely to utilize sexual and reproductive health services. Furthermore, those who had a parental discussion on sexual and reproductive health (AOR (95% C.I): 2.23 (1.43, 3.46)) and ever had sexual intercourse (AOR (95% C.I): 1.88 (1.30, 2.71)) were more likely to utilize the service than their counterparts. On the other hand, those young people lived with their father and had a primary level of educational attainment was less likely to utilize the service.

Conclusion

Utilization of sexual and reproductive health services is low which needs a great attention where; if not intervened, young people might engage in risky sexual activities. Therefore, it needs a concerted effort from all the concerned bodies to improve their service utilization and thereby reduce the burden of young people’s disease and disabilities associated with sexual and reproductive health.

Gender differences in exposure to SRH information and risky sexual debut among poor Myanmar youths

BACKGROUND

Globally, the proportion of youths has been steadily increasing, especially in Asia. This vulnerable population has limited exposure to sexual and reproductive health (SRH) information leading to various reproductive health (RH) problems including risky sexual debut, unwanted pregnancy, unsafe abortion as well as STI/HIV infections. Among known social variations which influence youth's RH, gender differences are critical for planning necessary gender appropriate interventions. This study aimed to identify gender differences in exposure to SRH information and risky sexual debut as well as associated factors among Myanmar youths in poor suburban communities of Mandalay City.

METHODS

A total of 444 randomly selected youths (aged 15-24 years) from all poor, suburban communities in Mandalay City took part in our survey. Gender differences in exposure to SRH information and risky sexual debut were assessed by bivariate analysis. Multivariate logistic regression was used to confirm gender differences and identify independent factors associated with main outcomes separately for males and females as well as for both.

RESULTS

Of 444 youths interviewed, 215 were males and 229 were females. Gender differences were seen in both exposures to SRH information (p = 0.013) and risky sexual debut (p = 0.003). These gender differences were confirmed by multivariate analysis even after adjusting for other risk factors. For exposure to SRH information, only age group and schooling status were significant factors for females. As well as those two factors, media exposure and parental guardianship were significant factors among males. Only positive norm of premarital sex increased the likelihood of risky sexual debut among males. In contrast, unwillingness at sexual debut was a risk factor and a higher education level was a protective factor for risky sexual debut among females.

CONCLUSIONS

Limited exposure to SRH information and high risky sexual debut among poor youths were found. There were different influential factors for RH behaviors between males and females. Policy makers as well as local RH care providers should be aware of these differences. Dissemination of reliable SRH information among youths through possible mass media, especially among males, is an urgent issue.