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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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Alidou S, Dahourou LD, Dah TTE, Sogo A, Kenao TS, Yehadji D, Meda N, Ekouevi DK. Unmet needs for modern contraceptive methods among sexually active adolescents and young women in Togo: a nationwide cross-sectional study. Front Public Health 2023; 11:1169180. [PMID: 37575119 PMCID: PMC10412928 DOI: 10.3389/fpubh.2023.1169180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/05/2023] [Indexed: 08/15/2023] Open
Abstract
Background The unmet need for modern contraceptives among sexually active adolescent and young women (AYW) in Africa contributes to high morbidity and mortality. To investigate the prevalence of unmet need for modern contraceptives and its associated factors among AYW in Togo, we performed a secondary analysis of data from the MICS-62017 survey. Method We extracted data from sexually active AYW aged 15-24 years for the analysis and used multi-level logistic regression models to identify factors associated with unmet need for modern contraceptives. Results Among the AYW, the median age was 20 years. The prevalence of unmet need for modern contraceptives was 27.02%. Factors that increased the likelihood of having unmet need for contraceptives included being in the "Poor" or "Middle" quintile of household wealth, aged 20-24 years, and completing primary or secondary education. Living in a household headed by a woman and having a household head aged 19-38, 39-58, or greater than 78 years decreased the likelihood of unmet need for modern contraceptives. Conclusion The study highlights the high-unmet need for modern contraceptives among sexually active AYW in Togo and emphasizes the importance of addressing individual and household/community factors to improve their sexual and reproductive health. Interventions such as increasing AYW awareness, providing social marketing campaigns in schools, and targeting men-headed households could help promote modern contraceptive use and improve the sexual and reproductive health of AYW in Togo.
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Affiliation(s)
- Smaila Alidou
- Département de Santé Publique, Unité de Formation et de Recherche en Sciences de la Santé, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
- Ministère de la Santé, Hygiène Publique et de l’Accès Universel aux Soins, Lomé, Togo
| | - Lucien Désiré Dahourou
- Institut de Recherche en Sciences de la Santé (IRSS/CNRST), Ouagadougou, Burkina Faso
- Institut National de la Santé et de la Recherche Médicale (INSERM, UMR1295), Centre d’épidémiologie et de Recherche en Santé des Populations (CERPOP), Université de Toulouse, Toulouse, France
| | - Ter Tiero Elias Dah
- Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouahigouya, Ouahigouya, Burkina Faso
| | - Armel Sogo
- Institut de Recherche en Sciences de la Santé (IRSS/CNRST), Ouagadougou, Burkina Faso
| | - Tchasso Serge Kenao
- Département de Promotion de la Santé, Institut Régionale de Santé Publique, Université d’Abomey-Calavi, Cotonou, Benin
| | - Dègninou Yehadji
- Ministère de la Santé, Hygiène Publique et de l’Accès Universel aux Soins, Lomé, Togo
| | - Nicolas Meda
- Département de Santé Publique, Unité de Formation et de Recherche en Sciences de la Santé, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Didier Koumavi Ekouevi
- Département de Santé Publique, Faculté des Sciences de la Santé (FSS), Université de Lomé, Lomé, Togo
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Arije O, Madan J, Hlungwani T. Validation of the Adolescent Health Quality of Care (AHQOC) index for mystery client studies. PLoS One 2023; 18:e0285888. [PMID: 37319188 PMCID: PMC10270626 DOI: 10.1371/journal.pone.0285888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/29/2023] [Indexed: 06/17/2023] Open
Abstract
The Adolescent Health Quality of Care (AHQOC) index is a tool designed to evaluate the quality of facility-based adolescent sexual and reproductive health (ASRH) services. This descriptive cross-sectional study aimed to validate the AHQOC index in 27 primary and secondary public health facilities located in a rural and an urban local government area (LGA) of Ogun State, Nigeria. To conduct the study, 12 mystery clients (MCs) were recruited and performed 144 visits to the health facilities. The MCs were young males and females who were seeking information on premarital sex, pregnancy prevention, sexually transmitted infections (STIs), and contraception. The validity, and reliability of the AHQOC index were evaluated using exploratory factor analysis, Cronbach's Alpha, and intra-class correlation coefficient tests. The Kaiser-Meyer-Olkin test result for the initial 37-item pool was 0.7169, and the final tool retained 27 items with a Cronbach's Alpha of 0.80. Two subscales of the index had Cronbach's Alpha of 0.76 and 0.85. The intra-rater consistency assessed by the intra-class correlation coefficient was 0.66 (0.10-0.92) p = 0.001 for the urban LGA and 0.72 (0.37-0.91) p = 0.001 for the rural LGA. Positive and statistically significant relationships were observed between the full scales and subscales and the validity item (MC ranking of health worker on proficiency from 1 to 10). The results of this study demonstrate that the validated AHQOC index is a valuable tool for assessing the quality of ASRH services in public health facilities.
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Affiliation(s)
- Olujide Arije
- Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Jason Madan
- Warwick Medical School, University of Warwick, Warwick, United Kingdom
| | - Tintswalo Hlungwani
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Arije O, Madan J, Hlungwani T. Quality of sexual and reproductive health services for adolescents and young people in public health facilities in Southwest Nigeria: a mystery client study. Glob Health Action 2022; 15:2145690. [PMID: 36458886 PMCID: PMC9721434 DOI: 10.1080/16549716.2022.2145690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND To support the policy drive for the promotion of sexual and reproductive health (SRH) of adolescents and young people (AYP), it is necessary to understand the characteristics of the existing SRH services available to them. OBJECTIVE To assess the provision and experiences of care in SRH services for AYP in a Nigerian setting. METHODS Twelve male and female mystery clients (MCs) conducted 144 visits at 27 selected primary and secondary health facilities in two Local Government Areas (LGA) in Ogun State, Nigeria. A 27-item adolescent quality of care (AHQOC) index with a Cronbach's Alpha of 0.7 was used to obtain a quality-of-care score for each clinic visit. Linear panel-data random-effects regression models using the generalised least square estimator were used to assess quality associated factors. Sentiment analysis was done on the qualitative narrative summaries provided by MCs after each visit. RESULTS There was an absence of the use of educational materials during the 60.4% of the visits. The MCs' medical history (90.3%), social record (63.9%), sexual/reproductive history (53.5%), and contraceptive experience (66.0%) were not obtained in most of the visits. Female MC visits had a lower AHQOC index rating on average compared to males (β=-0.3, CI -1.6 - 1.0 p = 0.687), rural health facilities had a lower AHQOC index rating on average compared to urban (β=-2.7, CI -5.1 - -0.2, p = 0.031), and a higher ranking of the health worker on the scale of 1-10 corresponded to a higher AHQOC index of the MC visit (β = 1.9, CI 1.6-2.1, p < 0.001). There were more positive than negative sentiments about the clinic encounters. CONCLUSION This study found gaps in the competencies of the health workers, non-usage of educational materials in clinic encounters with young people, as well as the differential perception of quality of care by male and female AYP.
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Affiliation(s)
- Olujide Arije
- Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria,School of Public Health, University of Witwatersrand, Johannesburg, South Africa,CONTACT Olujide Arije Institute of Public Health, Obafemi Awolowo University, P.M.B. 13, Ile-Ife, Nigeria
| | - Jason Madan
- Warwick Medical School, University of Warwick, Warwick, UK
| | - Tintswalo Hlungwani
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Schwandt H, Boulware A, Corey J, Herrera A, Hudler E, Imbabazi C, King I, Linus J, Manzi I, Merritt M, Mezier L, Miller A, Morris H, Musemakweli D, Musekura U, Mutuyimana D, Ntakarutimana C, Patel N, Scanteianu A, Shemeza BE, Sterling-Donaldson G, Umutoni C, Uwera L, Zeiler M, Feinberg S. “She is courageous because she does not care what people think about her…”: attitudes toward adolescent contraception use among Rwandan family planning providers and adult female modern contraceptive users. Reprod Health 2022; 19:204. [PMID: 36333785 PMCID: PMC9636625 DOI: 10.1186/s12978-022-01517-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction In Rwanda, only 20% of sexually active unmarried young women use family planning as compared to 64% of married women. Adolescence is an important time of growth and development that often includes the initiation of sexual activity. Sexually active adolescents need support in accessing contraceptive services to prevent negative health outcomes. In sub-Saharan Africa, the adolescent population represents a large share of the total population and that proportion is predicted to expand over time. Adolescent contraceptive needs have largely been unmet, and with growing numbers, there is increased potential for negative health sequelae. Due to the low use of contraception by adolescents in Rwanda, and the growing population of adolescents, this study aims to explore the perspectives of family planning providers and adult modern contraceptive users on adolescent contraceptive use. Inclusion of adult community members in the study is a unique contribution, as research on adolescent contraceptive use in sub-Saharan Africa relies primarily on perspectives from adolescents and family planning providers. Methods This qualitative study in 2018 utilized 32 in-depth interviews with modern contraceptive users and eight focus group discussions with family planning providers. Respondents were from Musanze and Nyamasheke districts in Rwanda, the districts with the highest and lowest modern contraceptive use among married women, respectively. Coding was conducted in Atlas.ti. Results Stigma regarding premarital sex results in barriers to adolescent access to contraceptive services. Family planning providers do provide services to adolescents; however, they often recommend secondary abstinence, offer a limited method selection, and accentuate risks associated with sexual activity and contraceptive use. Providers support adolescent clients by emphasizing the need for privacy, confidentiality, and expedient services, particularly through youth corners, which are spaces within health facilities designed to meet youth needs specifically. Modern contraceptive-using adult female community members advocate for youth access to contraception, however mothers have mixed comfort discussing sexual health with their own youth. Conclusion To destigmatize premarital sexual activity, government efforts to initiate communication about this topic must occur at national and community levels with the goal of continued conversation within the family. The government should also train family planning providers and all health personnel interacting with youth on adolescent-friendly health services. Dialogue between community members and family planning providers about adolescent access to contraceptive services could also reduce barriers for adolescents due to community members’ generally supportive views on adolescent contraceptive use. Efforts to engage adolescent caregivers in how to talk to youth about sex could also contribute to expanded use. In Rwanda, youth who are having sex use family planning less than married women. This study involved asking family planning providers and adults what they think about youth using family planning. Data for this study was collected in 2018, and included 32 interviews with adult family planning users and eight group discussions with family planning providers in two areas of Rwanda. The findings show that Rwandans believe youth should not have sex before they are married. Family planning providers do provide youth with services; however, they often push stopping sexual activity, offer a smaller selection of family planning methods, and exaggerate risks associated with sex and family planning use. Family planning providers support youth by honoring their need for privacy, keeping their secrets, and providing fast services so fewer people see them at the clinic. Providers like to help adolescents in youth corners, which are special spaces within health facilities just for youth. Importantly, adult women who use family planning want youth in their community to be able to use family planning, too. In order to respond to the issues raised, the Rwandan government can start conversations in villages and more broadly about the need for youth to have access to family planning. The government should also teach family planning providers and anyone who comes into contact with youth to offer helpful and friendly services. Setting up spaces for adults to talk with family planning providers about youth access to family planning could also contribute to fewer barriers to services for adolescents.
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Affiliation(s)
- Hilary Schwandt
- grid.281386.60000 0001 2165 7413Western Washington University, Bellingham, WA USA
| | - Angel Boulware
- grid.263934.90000 0001 2215 2150Spelman College, Atlanta, USA
| | - Julia Corey
- grid.422659.e0000 0000 9111 4134Wheaton College, Norton, USA
| | - Ana Herrera
- Northwest Vista Community College, San Antonio, USA
| | - Ethan Hudler
- grid.422656.10000 0000 9839 7069Whatcom Community College, Bellingham, USA
| | | | - Ilia King
- grid.268355.f0000 0000 9679 3586Xavier University, New Orleans, USA
| | - Jessica Linus
- grid.266673.00000 0001 2177 1144University of Maryland Baltimore County, Baltimore, USA
| | | | - Madelyn Merritt
- grid.281386.60000 0001 2165 7413Western Washington University, Bellingham, WA USA
| | - Lyn Mezier
- grid.264273.60000 0000 8999 307XSUNY Oswego, Oswego, USA
| | - Abigail Miller
- grid.281386.60000 0001 2165 7413Western Washington University, Bellingham, WA USA
| | - Haley Morris
- grid.268194.00000 0000 8547 0132Western Oregon University, Monmouth, USA
| | | | - Uwase Musekura
- grid.255407.10000 0001 0579 3386Eastern Oregon University, La Grande, USA
| | | | | | - Nirali Patel
- grid.252353.00000 0001 0583 8943Arcadia University, Glenside, USA
| | | | | | | | | | - Lyse Uwera
- grid.442742.30000 0004 0435 552XINES, Ruhengeri, Rwanda
| | - Madeleine Zeiler
- grid.281386.60000 0001 2165 7413Western Washington University, Bellingham, WA USA
| | - Seth Feinberg
- grid.281386.60000 0001 2165 7413Western Washington University, Bellingham, WA USA
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Corley AG, Sprockett A, Montagu D, Chakraborty NM. Exploring and Monitoring Privacy, Confidentiality, and Provider Bias in Sexual and Reproductive Health Service Provision to Young People: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116576. [PMID: 35682160 PMCID: PMC9180733 DOI: 10.3390/ijerph19116576] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/13/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023]
Abstract
Purpose: Poor privacy and confidentiality practices and provider bias are believed to compromise adolescent and young adult sexual and reproductive health service quality. The results of focus group discussions with global youth leaders and sexual and reproductive health implementing organizations indicated that poor privacy and confidentiality practices and provider bias serve as key barriers to care access for the youth. Methods: A narrative review was conducted to describe how poor privacy and confidentiality practices and provider bias impose barriers on young people seeking sexual and reproductive health services and to examine how point of service evaluations have assessed these factors. Results: 4544 peer-reviewed publications were screened, of which 95 met the inclusion criteria. To these articles, another 16 grey literature documents were included, resulting in a total of 111 documents included in the review. Conclusion: Poor privacy and confidentiality practices and provider bias represent significant barriers for young people seeking sexual and reproductive health services across diverse geographic and sociocultural contexts. The authors found that present evaluation methods do not appropriately account for the importance of these factors and that new performance improvement indicators are needed.
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Elnakib S, Elsallab M, Wanis MA, Elshiwy S, Krishnapalan NP, Naja NA. Understanding the impacts of child marriage on the health and well-being of adolescent girls and young women residing in urban areas in Egypt. Reprod Health 2022; 19:8. [PMID: 35033114 PMCID: PMC8761304 DOI: 10.1186/s12978-021-01315-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Egypt has made progress in delaying age at marriage, but child marriage continues to be practiced in many places across the country. This study investigates the impacts of child marriage on the health and wellbeing of girls residing in urban Egypt using a multi-method approach. METHODS The quantitative component leveraged data from the 2014 Egypt Demographic and Health Survey and focused on (1) reproductive health, (2) maternal health and (3) social outcomes among a subsample of ever-married urban women ages 20-24 (N = 1041). Simple and multivariable logistic regressions were used to estimate prevalence odds ratios and 95% confidence intervals for associations between child marriage and the three sets of outcomes. The qualitative component drew from 11 focus groups, 23 in-depth interviews, and 13 key informant interviews conducted in three urban sites in Egypt. The data was thematically analyzed using a combination of inductive and deductive coding. RESULTS The prevalence of marriage under age 18 was 13.22%. Child marriage was significantly associated with ever use of contraception (Adjusted Odds Ratio (AOR) 2.95 95% CI 1.67-5.19), multiple births (AOR 12.93 95% CI 5.45-30.72), rapid repeat childbirth (AOR 2.20 95% CI 1.34-3.63), and pregnancy termination (AOR 1.89 95% CI 1.11-3.23). Many of these associations disappeared after adjusting for marriage duration. Girls married under age 18 had larger spousal age gaps (AOR 2.06; 95% CI 1.24-3.41) and higher odds of FGM (AOR 2.14; 95% CI 1.11-4.13). They were significantly more likely to report receiving no ANC care (AOR 0.39; 95% CI 0.19-0.80), and less likely to deliver through C-section (AOR: 0.53; 95% CI 0.34-0.83). Consequences emerging from the qualitative data centered around five themes: (1) Access to and use of sexual and reproductive health services; (2) exposure to FGM; (3) marriage and birth registration; (4) marital relations; and (5) relationship with in-laws. CONCLUSION Findings provide important insights into the practice of child marriage in urban areas in Egypt and illustrate a range of adverse consequences associated with the practice.
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Affiliation(s)
- Shatha Elnakib
- Johns Hopkins Bloomberg School of Public Health, Maryland, USA.
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Disrespectful care in family planning services among youth and adult simulated clients in public sector facilities in Malawi. BMC Health Serv Res 2021; 21:336. [PMID: 33853581 PMCID: PMC8045277 DOI: 10.1186/s12913-021-06353-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background Provision of high-quality family planning (FP) services improves access to contraceptives. Negative experiences in maternal health have been documented worldwide and likely occur in other services including FP. This study aims to quantify disrespectful care for adult and adolescent women accessing FP in Malawi. Methods We used simulated clients (SCs) to measure disrespectful care in a census of public facilities in six districts of Malawi in 2018. SCs visited one provider in each of the 112 facilities: two SCs visits (one adult and one adolescent case scenario) or 224 SC visits total. We measured disrespectful care using a quantitative tool and field notes and report the prevalence and 95% confidence intervals for the indicators and by SC case scenarios contextualized with quotes from the field notes. Results Some SCs (12%) were refused care mostly because they did not agree to receive a HIV test or vaccination, or less commonly because the clinic was closed during operating hours. Over half (59%) of the visits did not have privacy. The SCs were not asked their contraceptive preference in 57% of the visits, 28% reported they were not greeted respectfully, and 20% reported interruptions. In 18% of the visits the SCs reported humiliation such as verbal abuse. Adults SCs received poorer counseling compared to the adolescent SCs with no other differences found. Conclusions We documented instances of refusal of care, lack of privacy, poor client centered care and humiliating treatment by providers. We recommend continued effort to improve quality of care with an emphasis on client treatment, regular quality assessments that include measurement of disrespectful care, and more research on practices to reduce it. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06353-z.
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Kalyesubula R, Pardo JM, Yeh S, Munana R, Weswa I, Adducci J, Nassali F, Tefferi M, Mundaka J, Burrowes S. Youths' perceptions of community health workers' delivery of family planning services: a cross-sectional, mixed-methods study in Nakaseke District, Uganda. BMC Public Health 2021; 21:666. [PMID: 33827502 PMCID: PMC8028711 DOI: 10.1186/s12889-021-10695-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 03/23/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND High rates of unintended adolescent pregnancy are a significant health problem in Uganda. To improve access to family planning (FP) services, community-based Village Health Teams (VHTs) are widely employed in Uganda to deliver education and services. However, evaluations of FP programs suggest that mainly older, married women use VHT FP services. METHODS To better understand youth reluctance to use VHTs, we collected quantitative FP and contraceptive-seeking behavior data from a survey of 250 youths aged 15-25 in randomly selected households in Nakaseke District, which we triangulated with data from 3 focus group discussions (FGDs) (n = 15). RESULTS Most respondents received FP services from the formal health sector, not VHTs. Only half had talked to a VHT, but 65% knew that VHTs provide free FP services, and most (82%) felt comfortable talking to VHTs about FP. The main reasons for discomfort were fear that VHTs would violate privacy (mentioned by 60% of those not comfortable), that VHTs would talk to parents (33%), shyness (mentioned by 42% of those ≤18), and fear of being judged (14%). Concern about side effects was the most common reason for not using FP methods. Survey respondents said having VHTs of the same sex was important, particularly those in the youngest age group (OR = 4.45; 95%CI: 1.24, 16.00) and those who were unmarried (OR = 5.02; 95%CI: 2.42, 10.39). However, FGD participants (who were older than survey respondents on average) often preferred older VHTs of the opposite sex, whom they viewed as more professional and trustworthy. Respondents said the primary deciding factors for using VHTs were whether privacy would be respected, the proximity of care, and the respectfulness of care. CONCLUSIONS VHTs are a known source of FP services but not widely used by youth due to privacy and quality of care concerns. VHT messaging and training should increase focus on ensuring privacy, protecting confidentiality, providing respectful care, and addressing concerns about contraceptive side effects. Preferences for VHTs of similar age and sex may be more important for younger adolescents than older youths for whom quality concerns predominate.
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Affiliation(s)
- Robert Kalyesubula
- African Community Center for Social Sustainability, Nakaseke, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Richard Munana
- African Community Center for Social Sustainability, Nakaseke, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Ivan Weswa
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | | | - Faith Nassali
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | | | - John Mundaka
- African Community Center for Social Sustainability, Nakaseke, Uganda
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Otim J. Contraceptive nonuse among women in Uganda: a comparative assessment of predictors across regions. BMC Womens Health 2020; 20:275. [PMID: 33334342 PMCID: PMC7745472 DOI: 10.1186/s12905-020-01148-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Contraceptive nonuse has diverse effects on women, such as unintended pregnancies and births that result in high fertility and poor maternal health outcomes. In Uganda, knowledge on contraceptive use is high, amidst undesirably high contraceptive nonuse and scarce literature on predictors of contraceptive nonuse across regions. This study assessed factors associated with contraceptive nonuse among women of reproductive age across regions in Uganda. METHOD This study used data from a cross-sectional 2016 Uganda demographic and heath survey that had 18,506 women of reproductive age. The relationship between contraceptive nonuse and socio-economic and demographic factors across regions were assessed using a binary multivariable logistic regression model. RESULTS In Uganda, contraceptive nonuse is estimated at 40%. Northern region (55%) had the highest prevalence of contraceptive nonuse compared to Central region (35%) with the lowest. Across regions, wealth index, number of living children, educational level, and children born in the last 5 years prior to the demographic survey differently predicted contraceptive nonuse. Conversely, age, religion, age at first marriage, sexual autonomy, age at first birth, desire for children, listening to radio, and employment status were only predictors of contraceptive nonuse in particular regions amidst variations. Residence, perception of distance to health facility, watching television, and reading newspapers or magazines did not predict contraceptive nonuse. CONCLUSIONS The study findings propose the need to appreciate regional-variations in effect of contraceptive nonuse predictors and therefore, efforts should be directed towards addressing regional-variations so as to attain high contraceptive usage across regions, and thus reduce on unwanted pregnancies and births.
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Affiliation(s)
- Jude Otim
- Department of Sociology and Social Administration, Kyambogo University, P.O. Box 1, Kyambogo, Kampala, Uganda.
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11
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Boydell V, Nulu N, Hardee K, Gay J. Implementing social accountability for contraceptive services: lessons from Uganda. BMC Womens Health 2020; 20:228. [PMID: 33046065 PMCID: PMC7549211 DOI: 10.1186/s12905-020-01072-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/10/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Growing evidence shows that social accountability contributes to improving health care services, with much promise for addressing women's barriers in contraceptive care. Yet little is known about how social accountability works in the often-complex context of sexual and reproductive health, particularly as sex and reproduction can be sensitive topics in the open and public formats typical of social accountability. This paper explores how social accountability operates in the highly gendered and complex context of contraceptive care. METHODS This exploratory research uses a case study approach to provide a more grounded understanding of how social accountability processes operate in the context of contraceptive information and services. We observed two social accountability projects that predominantly focused on contraceptive care in Uganda over a year. Five instruments were used to capture information from different source materials and multiple respondents. In total, one hundred and twenty-eight interviews were conducted and over 1000 pages of project documents were collected. Data were analyzed and compiled into four case studies that provide a thick description of how these two projects operated. RESULTS The case studies show the critical role of information, dialogue and negotiation in social accountability in the context of contraceptive care. Improved community and health system relationships, community empowerment, provider and health system responsiveness and enhanced availability and access to services were reported in both projects. There were also changes in how different actors related to themselves and to each other, and contraceptive care, a previously taboo topic, became a legitimate area for public dialogue. CONCLUSION The study found that while social accountability in the context of contraceptive services is indeed sensitive, it can be a powerful tool to dissolving resistance to family planning and facilitating a more productive discourse on the topic.
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Affiliation(s)
- Victoria Boydell
- Global Health Centre, Geneva Graduate Institute, Chemin Rigot 2, 1202, Geneva, Switzerland.
| | - Nanono Nulu
- Department of Population Studies, Makerere University, Kampala, Uganda
| | | | - Jill Gay
- MIA, What Works Association, Washington, DC, USA
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Chandra-Mouli V, Lenz C, Adebayo E, Lang Lundgren I, Gomez Garbero L, Chatteriee S. A systematic review of the use of adolescent mystery clients in assessing the adolescent friendliness of health services in high, middle, and low-income countries. Glob Health Action 2019; 11:1536412. [PMID: 30482103 PMCID: PMC6282470 DOI: 10.1080/16549716.2018.1536412] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Mystery client methodology is a form of participatory research that provides a unique opportunity to monitor and evaluate the performance of health care providers or health facilities from the perspective of the service user. However, there are no systematic reviews that analyse the use of mystery clients in adolescent sexual and reproductive health (ASRH) research and monitoring and evaluation of programmes. Objective: To assess the use of adolescent mystery clients in examining health care provider and facility performance in providing ASRH services in high, middle, and low-income countries. Methods: We carried out a systematic review of published journal articles and reports from the grey literature on this topic from 2000 to 2017 (inclusive). Thirty research evaluations/studies were identified and included in the analysis. We identified common themes through thematic analysis. Results: The findings reveal that researchers and evaluators used mystery client methodology to observe client-provider relationships, and to reduce observation bias, in government or private health facilities, NGOs, and pharmacies. The mystery clients in the evaluations/studies were young people who played varying roles; in most cases, they were trained for these roles. Most reported good experiences and friendly providers; however, some reported lack of privacy and confidentiality, lack of sufficient written/verbal information, and unfavourable experiences such as sexual harassment and judgmental comments. Female mystery clients were more likely than males to report unfavourable experiences. Generally, the methodology was considered useful in monitoring and evaluating the attitudes of health service providers and ASRH service provision. Conclusions: The research evaluations/studies in this review highlight the usefulness of mystery clients as a method to gain insight, from an adolescent perspective, on the quality of ASRH services for research and monitoring and evaluation of programmes.
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Affiliation(s)
- Venkatraman Chandra-Mouli
- a Department of Reproductive Health and Research, Human Reproduction Programme , World Health Organization , Geneva , Switzerland
| | - Cosima Lenz
- b UCLA Fielding School of Public Health , Los Angeles , USA
| | - Emmanuel Adebayo
- c Adolescent Health Unit, Institute of Child Health , University of Ibadan , Ibadan , Nigeria
| | - Iliana Lang Lundgren
- d Department of Health Policy and Management , Globa lGiving Foundation, Georgetown University - Women's and Gender Studies
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Brooks MI, Johns NE, Quinn AK, Boyce SC, Fatouma IA, Oumarou AO, Sani A, Silverman JG. Can community health workers increase modern contraceptive use among young married women? A cross-sectional study in rural Niger. Reprod Health 2019; 16:38. [PMID: 30909942 PMCID: PMC6434879 DOI: 10.1186/s12978-019-0701-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 03/19/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Republic of Niger has the highest rate of early marriage and adolescent fertility in the world. Recent global health initiatives, such as Family Planning 2020, have reinvigorated investments in family planning in low- and middle-income countries (LMICs). As part of this initiative, Niger has implemented ambitious plans to increase contraceptive prevalence through policies designed to increase coverage and access to family planning services. One strategy involves the deployment of volunteer community health workers (relais communautaires) in rural settings to improve access to family planning services, especially among adolescents and youth. The objective of this article is to determine if visits by relais are associated with increased use of modern contraception among young married women in rural Niger. METHODS Cross-sectional data from a household survey were collected from young married women between the ages of 13 and 19 in three rural districts in the region of Dosso, Niger from May to August 2016. Multivariate logistic regression was conducted to assess the odds of married female youth reporting current use of modern contraceptive methods based on being visited by a relais in the past three months. RESULTS A total of 956 young married women were included in the final analysis. Among study participants, 9.3% reported a relais visit to discuss health issues in the past three months and 11.4% reported currently using a modern method of contraception. Controlling for socio-demographic variables, the odds of current use of modern contraceptive methods were higher among young married women who were visited by a relais in the last three months compared to those not visited by a relais during this period (AOR = 1.94[95% CI 1.07-3.51]). In this study setting, relais were less likely to visit nulliparous women and women that worked in the past 12 months. CONCLUSION Young married women visited by relais were more likely to use modern contraceptive methods compared to those not visited by a relais. These results are consistent with similar family planning studies from sub-Saharan Africa and suggest that relais in Niger may be able to provide access to essential family planning services in rural and hard-to-reach areas. Additional efforts to understand the contraceptive barriers faced by nulliparous women and working women should be a key research priority in Niger. TRIAL REGISTRATION Clinical trial registration number 2016-1430 ; registered on October 7, 2016 (retrospectively registered).
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Affiliation(s)
| | - Nicole E. Johns
- Center on Gender Equity and Health, University of California, San Diego, La Jolla, CA 92093 USA
| | - Anne K. Quinn
- Center on Gender Equity and Health, University of California, San Diego, La Jolla, CA 92093 USA
| | - Sabrina C. Boyce
- Center on Gender Equity and Health, University of California, San Diego, La Jolla, CA 92093 USA
| | | | | | | | - Jay G. Silverman
- Center on Gender Equity and Health, University of California, San Diego, La Jolla, CA 92093 USA
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Mutumba M, Wekesa E, Stephenson R. Community influences on modern contraceptive use among young women in low and middle-income countries: a cross-sectional multi-country analysis. BMC Public Health 2018; 18:430. [PMID: 29609567 PMCID: PMC5879615 DOI: 10.1186/s12889-018-5331-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/18/2018] [Indexed: 11/24/2022] Open
Abstract
Background Despite investment in family planning programs and education, unmet need for family planning remains high among young women (aged 15–24) in low and middle-income countries, increasing the risk for unwanted pregnancies and adverse social and reproductive health outcomes. There is a dearth of cross-national research that identifies the differential impact of community level factors among youth in low and middle-income countries (LMICs), which is imperative for the design of structural level interventions aimed at increasing family planning use. Methods Grounded in the socio-ecological framework, this paper utilizes Demographic and Health Survey (DHS) from 52 LMICs to examine the influence of community level reproductive, gender, fertility, literacy and economic indicators on modern contraceptive use among female youth. Analyses are conducted using multi-level logistic regressions with random community-level effects. Results Our findings highlight the positive influence of community level education attainment and negative influence of gender and fertility related norms on young women’s contraceptive use. Additionally, increased exposure to mass media did not positively influence young women’s uptake of modern contraceptive methods. Conclusions Taken together, findings indicate that young women’s contraceptive decision-making is greatly shaped by their social contexts. The commonalities and regional variations in community level influences provide support for both structural level interventions and tailored regional approaches to family planning interventions.
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Affiliation(s)
- Massy Mutumba
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 3177, 400 N.Ingalls Bldg, Ann Arbor, MI, 48109-5482, USA.
| | - Eliud Wekesa
- Department of Humanities and Social Sciences, South Eastern Kenya University, Kitui, Kenya
| | - Rob Stephenson
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 3177, 400 N.Ingalls Bldg, Ann Arbor, MI, 48109-5482, USA
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de Castro F, Barrientos-Gutierrez T, Braverman-Bronstein A, Santelli J, Place JM, Eternod-Arámburu M, Hernández-Avila M. Adolescent Access to Information on Contraceptives: A Mystery Client Study in Mexico. J Adolesc Health 2018; 62:265-272. [PMID: 29055646 DOI: 10.1016/j.jadohealth.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE We aimed to evaluate adolescent access to contraceptive information and quality of care in a sample of primary care clinics and pharmacies in Mexico and their association with health facility and adolescent characteristics. METHODS We selected a random sample of pharmacies (n = 434) and public-sector, primary care clinics (n = 327) in Mexico City to be visited by young women posing as "mystery clients" looking for contraception or emergency contraception. Access to contraception information was measured as the percent of times that women received the information they requested. To assess quality of care, we built an "adolescent-friendly services" (AFS) score based on the World Health Organization framework. Regression models were fitted to evaluate the associations between outcomes and health facility and client characteristics. RESULTS Twenty percent of women did not receive the information they requested. Clients seeking emergency contraception information had higher odds of obtaining it than clients seeking information on contraception (odds ratio 3.08 95% confidence interval 2.03, 4.67). AFS scores were low, although higher in clinics than in pharmacies (5/9 in clinics vs. 3/9 in pharmacies). Younger age and indigenous appearance were associated with lower quality as measured by the AFS score. CONCLUSIONS Access to information about contraception in pharmacies and clinics is high, but efforts must be made to provide 100% coverage to adolescents. The quality of contraception services in pharmacies and clinics is poor and nonequitable, favoring older and nonindigenous adolescents. Clinics and pharmacies must strive to comply with international AFS guidelines.
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Affiliation(s)
- Filipa de Castro
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | | | - John Santelli
- Mailman School of Public Health, Columbia University, New York, New York
| | - Jean Marie Place
- Department of Nutrition and Health Science, Ball State University, Muncie, Indiana
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Dennis ML, Radovich E, Wong KLM, Owolabi O, Cavallaro FL, Mbizvo MT, Binagwaho A, Waiswa P, Lynch CA, Benova L. Pathways to increased coverage: an analysis of time trends in contraceptive need and use among adolescents and young women in Kenya, Rwanda, Tanzania, and Uganda. Reprod Health 2017; 14:130. [PMID: 29041936 PMCID: PMC5645984 DOI: 10.1186/s12978-017-0393-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/06/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Despite efforts to make contraceptive services more "youth friendly," unmet need for contraception among young women in sub-Saharan Africa remains high. For health systems to effectively respond to the reproductive health needs of a growing youth population, it is imperative to understand their contraceptive needs and service seeking practices. This paper describes changes over time in contraceptive need, use, and sources of care among young women in four East African countries. METHODS We used three rounds of DHS data from Kenya, Rwanda, Tanzania, and Uganda to examine time trends from 1999 to 2015 in met need for modern contraception, method mix, and source of care by sector (public or private) and type of provider among young women aged 15-24 years. We assessed disparities in contraceptive coverage improvements over time between younger (15-24 years) and older women (25-49 years) using a difference-in-differences approach. RESULTS Met need for contraception among women aged 15-24 years increased over time, ranging from a 20% increase in Tanzania to more than a 5-fold increase in Rwanda. Improvements in met need were greater among older women compared to younger women in Rwanda and Uganda, and higher among younger women in Kenya. Injectables have become the most popular contraceptive choice among young women, with more than 50% of modern contraceptive users aged 15-24 years currently using the method in all countries except for Tanzania, where condoms and injectables are used by 38% and 35% of young users, respectively. More than half of young women in Tanzania and Uganda receive contraceptives from the private sector; however, while the private sector played an important role in meeting the growing contraceptive needs among young women in Tanzania, increased use of public sector services drove expanded access in Kenya, Rwanda, and Uganda. CONCLUSIONS Our study shows that contraceptive use increased among young East African women, yet, unmet need remains high. As youth populations continue to grow, governments must develop more targeted strategies for expanding access to reproductive health services for young women. Engaging the private sector and task-shifting to lower-level providers offer promising approaches; however, additional research is needed to identify the key facilitators and barriers to the success of these strategies in different contexts.
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Affiliation(s)
- Mardieh L. Dennis
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Emma Radovich
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Kerry L. M. Wong
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Onikepe Owolabi
- Guttmacher Institute, 125 Maiden Lane 7th Floor, New York, NY 10038 USA
| | - Francesca L. Cavallaro
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | | | - Agnes Binagwaho
- Department of Global Health and Social Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA
- Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Rd, Hanover, NH 03755 USA
- University of Global Health Equity, Kigali Heights, Plot, 772 Kigali, Rwanda
| | - Peter Waiswa
- Makerere University School of Public Health, New Mulago Hill Road, Kampala, Uganda
| | - Caroline A. Lynch
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Lenka Benova
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Schwandt HM, Speizer IS, Corroon M. Contraceptive service provider imposed restrictions to contraceptive access in Urban Nigeria. BMC Health Serv Res 2017. [PMCID: PMC5393003 DOI: 10.1186/s12913-017-2223-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Schwandt HM, Speizer IS, Corroon M. Contraceptive service provider imposed restrictions to contraceptive access in urban Nigeria. BMC Health Serv Res 2017; 17:268. [PMID: 28403858 PMCID: PMC5389090 DOI: 10.1186/s12913-017-2233-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/06/2017] [Indexed: 11/28/2022] Open
Abstract
Background Health service providers can restrict access to contraceptives through their own imposed biases about method appropriateness. In this study, provider biases toward contraceptive service provision among urban Nigerian providers was assessed. Methods Health providers working in health facilities, as well as pharmacists and patent medical vendors (PMV), in Abuja, Benin City, Ibadan, Ilorin, Kaduna, and Zaria, were surveyed in 2011 concerning their self-reported biases in service provision based on age, parity, and marital status. Results Minimum age bias was the most common bias while minimum parity was the least common bias reported by providers. Condoms were consistently provided with the least amount of bias, followed by provision of emergency contraception (EC), pills, injectables, and IUDs. Experience of in-service training for health facility providers was associated with decreased prevalence of marital status bias for the pill, injectable, and IUD; however, training experience did not, or had the opposite effect on, pharmacists and PMV operator’s reports of service provision bias. Conclusions Provider imposed eligibility barriers in urban study sites in Nigeria were pervasive - the most prevalent restriction across method and provider type was minimum age. Given the large and growing adolescent population - interventions aimed at increasing supportive provision of contraceptives to youth in this context are urgently needed. The results show that the effect of in-service training on provider biases was limited. Future efforts to address provider biases in contraceptive service provision, among all provider types, must find creative ways to address this critical barrier to increased contraceptive use. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2233-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hilary M Schwandt
- Johns Hopkins University Center for Communication Programs, Baltimore, MD, USA. .,Fairhaven College, Western Washington University, Bellingham, WA, USA.
| | - Ilene S Speizer
- Carolina Population Center at The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Maternal and Child Health, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Meghan Corroon
- Carolina Population Center at The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Nalwadda G, Mirembe F, Byamugisha J, Tumwesigye NM, Faxelid E. Young peoples' interface with providers of contraceptive care: a simulated client study in two Ugandan districts. Contracept Reprod Med 2016; 1:15. [PMID: 29201404 PMCID: PMC5693527 DOI: 10.1186/s40834-016-0027-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 06/16/2016] [Indexed: 12/04/2022] Open
Abstract
Background Young people in Uganda have a large unmet need for modern contraception, and the reasons are unclear. This study describes young peoples’ experiences of contraceptive care, client-provider interactions and its aftermath on choice, access and satisfaction. Methods Simulated client method, with 128 encounters with providers in public and private health care facilities was used. Semi-structured narrative debriefing and a structured questionnaire were used to collect data. Content analysis, descriptive and inferential statistics were applied. Results Both qualitative and quantitative results highlight favorable reception, provider bias, low client satisfaction and reservations about contraceptive methods. Two thirds of the providers choose a contraceptive method for the client. The clients reported satisfaction with contraceptive services in 29 % of the consultations. Privacy was reported to be observed in 42 % and clients felt respectfully treated in 50 % of the consultations. However, most clients would not recommend the visited facility to others. Client-provider interactions revealed contradictory views on methods to use, whether to first have children, and whether to use contraceptives at all. Younger clients seemed to be treated differently than older clients; contraceptives were provided after a prolonged debate. Inaccurate information about contraceptives was provided and costs were high. Providers conveyed potential adverse effects of contraceptives to young people in a way that indicated providers own fears and doubts. Conclusion Young people are not able to exercise their rights to choose, obtain and use contraceptives when needed. Overall satisfaction with the services was rated low and client- provider interactions were often unfavorable.
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Affiliation(s)
- Gorrette Nalwadda
- Department of Nursing, College of Health Sciences Makerere University, P.O Box 7072, Kampala, Uganda.,Department of Obstetrics and Gynecology, College of Health Sciences Makerere University, P.O Box 7072, Kampala, Uganda.,Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Nobels vag 9, 171 76 Stockholm, Sweden
| | - Florence Mirembe
- Department of Obstetrics and Gynecology, College of Health Sciences Makerere University, P.O Box 7072, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynecology, College of Health Sciences Makerere University, P.O Box 7072, Kampala, Uganda
| | - Nazarius M Tumwesigye
- Department of Epidemiology and Biostatistics, School of Public Health, College Health Sciences Makerere University, Kampala, Uganda
| | - Elisabeth Faxelid
- Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Nobels vag 9, 171 76 Stockholm, Sweden
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Paul M, Näsström SB, Klingberg-Allvin M, Kiggundu C, Larsson EC. Healthcare providers balancing norms and practice: challenges and opportunities in providing contraceptive counselling to young people in Uganda - a qualitative study. Glob Health Action 2016; 9:30283. [PMID: 27174861 PMCID: PMC4865766 DOI: 10.3402/gha.v9.30283] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/18/2016] [Accepted: 03/18/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pregnancies among young women force girls to compromise education, resulting in low educational attainment with subsequent poverty and vulnerability. A pronounced focus is needed on contraceptive use, pregnancy, and unsafe abortion among young women. OBJECTIVE This study aims to explore healthcare providers' (HCPs) perceptions and practices regarding contraceptive counselling to young people. DESIGN We conducted 27 in-depth interviews with doctors and midwives working in seven health facilities in central Uganda. Interviews were open-ended and allowed the participant to speak freely on certain topics. We used a topic guide to cover areas topics of interest focusing on post-abortion care (PAC) but also covering contraceptive counselling. Transcripts were transcribed verbatim and data were analysed using thematic analysis. RESULTS The main theme, HCPs' ambivalence to providing contraceptive counselling to sexually active young people is based on two sub-themes describing the challenges of contraceptive counselling: A) HCPs echo the societal norms regarding sexual practice among young people, while at the same time our findings B) highlights the opportunities resulting from providers pragmatic approach to contraceptive counselling to young women. Providers expressed a self-identified lack of skill, limited resources, and inadequate support from the health system to successfully provide appropriate services to young people. They felt frustrated with the consultations, especially when meeting young women seeking PAC. CONCLUSIONS Despite existing policies for young people's sexual and reproductive health in Uganda, HCPs are not sufficiently equipped to provide adequate contraceptive counselling to young people. Instead, HCPs are left in between the negative influence of social norms and their pragmatic approach to address the needs of young people, especially those seeking PAC. We argue that a clear policy supported by a clear strategy with practical guidelines should be implemented alongside in-service training including value clarification and attitude transformation to equip providers to be able to better cater to young people seeking sexual and reproductive health advice.
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Affiliation(s)
- Mandira Paul
- Department of Women's and Children's Health/IMCH, Uppsala University, Uppsala, Sweden
| | - Sara B Näsström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Marie Klingberg-Allvin
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Charles Kiggundu
- Department of Obstetrics and Gynaecology, Mulago Hospital, Kampala, Uganda
| | - Elin C Larsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden;
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Kibira SPS, Muhumuza C, Bukenya JN, Atuyambe LM. "I Spent a Full Month Bleeding, I Thought I Was Going to Die…" A Qualitative Study of Experiences of Women Using Modern Contraception in Wakiso District, Uganda. PLoS One 2015; 10:e0141998. [PMID: 26524603 PMCID: PMC4629884 DOI: 10.1371/journal.pone.0141998] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 10/15/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction There is high unmet need for family planning (FP) in Uganda as well as high contraceptive discontinuation rates. These contribute to the high fertility rates that in part are due to unplanned pregnancies. There are gaps in knowledge about experiences that couples go through while using contraceptives in their lives. This study explored women’s experiences during the course of their contraceptive use. Methods We conducted a qualitative study involving 30 women who had used modern contraception for at least one year in Wakiso district, central Uganda. We used in-depth interviews to obtain their personal accounts. Index women were approached through health officers at four health centres in the district. All ethical approvals and informed consent were obtained. We used conventional content analysis; identifying codes through open coding, on which basis categories were developed and grouped into overarching themes. Results Women’s accounts were summarised in the following themes: negative experiences with modern contraceptive use, motivation to continue using FP in spite of these negative experiences, the role of influential people, and discontinuation of use. Negative accounts dominated the experiences of most women but they expressed strong desire to continue using modern contraception even amidst all challenges. Health workers emerged as the most influential people that played a vital role in women’s decisions. Conclusion Varied negative experiences with modern contraception and misperceptions exist amidst a determination to continue use. Partner engagement, health service strengthening to improve side effects management and health worker skills, and engaging older women that have successfully used contraception as community champions, are potential strategies to support women’s contraceptive decisions.
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Affiliation(s)
- Simon P. S. Kibira
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Centre for International Health, Department of Global Public Health and Primary care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- * E-mail:
| | - Christine Muhumuza
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Justine N. Bukenya
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Lynn M. Atuyambe
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Koni P, Chishinga N, Nyirenda L, Kasonde P, Nsakanya R, Welsh M. Health Facility Graduation from Donor-Supported Intensive Technical Assistance and Associated Factors in Zambia. PLoS One 2015; 10:e0131084. [PMID: 26098555 PMCID: PMC4476711 DOI: 10.1371/journal.pone.0131084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 05/28/2015] [Indexed: 12/03/2022] Open
Abstract
Introduction The FHI360-led Zambia Prevention Care and Treatment partnership II (ZPCT II) with funding from United States Agency for International Development, supports the Zambian Ministry of Health in scaling up HIV/AIDS services. To improve the quality of HIV/AIDS services, ZPCT II provides technical assistance until desired standards are met and districts are weaned-off intensive technical support, a process referred to as district graduation. This study describes the graduation process and determines performance domains associated with district graduation. Methods Data were collected from 275 health facilities in 39 districts in 5 provinces of Zambia between 2008 and 2012. Performance in technical capacity, commodity management, data management and human resources domains were assessed in the following services areas: HIV counselling and testing and prevention of mother to child transmission, antiretroviral therapy/clinical care, pharmacy and laboratory. The overall mean percentage score was calculated by obtaining the mean of mean percentage scores for the four domains. Logistic regression models were used to obtain odds ratios (OR) and 95% confidence intervals (CI) for the domain mean percentage scores in graduated versus non-graduated districts; according to rural-urban, and province strata. Results 24 districts out of 39 graduated from intensive donor supported technical assistance while 15 districts did not graduate. The overall mean percentage score for all four domains was statistically significantly higher in graduated than non-graduated districts (93.2% versus 91.2%, OR = 1.34, 95%CI:1.20–1.49); including rural settings (92.4% versus 89.4%, OR = 1.43,95%CI:1.24–1.65). The mean percentage score in human resource domain was statistically significantly higher in graduated than non-graduated districts (93.6% versus 71.6%, OR = 5.81, 95%CI: 4.29–7.86) and in both rural and urban settings. Conclusions QA/QI tools can be used to assess performance at health facilities and determine readiness for district graduation. Human resources management domain was found to be an important factor associated with district graduation.
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Omondi Aduda DS, Ouma C, Onyango R, Onyango M, Bertrand J. Voluntary medical male circumcision scale-up in Nyanza, Kenya: evaluating technical efficiency and productivity of service delivery. PLoS One 2015; 10:e0118152. [PMID: 25706119 PMCID: PMC4338032 DOI: 10.1371/journal.pone.0118152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 01/08/2015] [Indexed: 12/02/2022] Open
Abstract
Background Voluntary medical male circumcision (VMMC) service delivery is complex and resource-intensive. In Kenya’s context there is still paucity of information on resource use vis-à-vis outputs as programs scale up. Knowledge of technical efficiency, productivity and potential sources of constraints is desirable to improve decision-making. Objective To evaluate technical efficiency and productivity of VMMC service delivery in Nyanza in 2011/2012 using data envelopment analysis. Design Comparative process evaluation of facilities providing VMMC in Nyanza in 2011/2012 using output orientated data envelopment analysis. Results Twenty one facilities were evaluated. Only 1 of 7 variables considered (total elapsed operation time) significantly improved from 32.8 minutes (SD 8.8) in 2011 to 30 minutes (SD 6.6) in 2012 (95%CI = 0.0350–5.2488; p = 0.047). Mean scale technical efficiency significantly improved from 91% (SD 19.8) in 2011 to 99% (SD 4.0) in 2012 particularly among outreach compared to fixed service delivery facilities (CI -31.47959–4.698508; p = 0.005). Increase in mean VRS technical efficiency from 84% (SD 25.3) in 2011 and 89% (SD 25.1) in 2012 was not statistically significant. Benchmark facilities were #119 and #125 in 2011 and #103 in 2012. Malmquist Productivity Index (MPI) at fixed facilities declined by 2.5% but gained by 4.9% at outreach ones by 2012. Total factor productivity improved by 83% (p = 0.032) in 2012, largely due to progress in technological efficiency by 79% (p = 0.008). Conclusions Significant improvement in scale technical efficiency among outreach facilities in 2012 was attributable to accelerated activities. However, ongoing pure technical inefficiency requires concerted attention. Technological progress was the key driver of service productivity growth in Nyanza. Incorporating service-quality dimensions and using stepwise-multiple criteria in performance evaluation enhances comprehensiveness and validity. These findings highlight site-level resource use and sources of variations in VMMC service productivity, which are important for program planning.
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Affiliation(s)
| | - Collins Ouma
- Department of Biomedical Sciences and Technology, Maseno University, Maseno, Kenya
| | - Rosebella Onyango
- Department of Public Health and Community Development, Maseno University, Maseno, Kenya
| | - Mathews Onyango
- Male Circumcision Consortium, FHI360, Kisumu Office, Kisumu, Kenya
| | - Jane Bertrand
- Department of Global Health Systems and Development, Tulane University. New Orleans, LA, 70112, United States of America
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Geary RS, Webb EL, Clarke L, Norris SA. Evaluating youth-friendly health services: young people's perspectives from a simulated client study in urban South Africa. Glob Health Action 2015; 8:26080. [PMID: 25623610 PMCID: PMC4306747 DOI: 10.3402/gha.v8.26080] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 11/14/2014] [Accepted: 12/08/2014] [Indexed: 11/14/2022] Open
Abstract
Background Few youth-friendly health services worldwide have been scaled up or evaluated from young people’s perspectives. South Africa’s Youth Friendly Services (YFS) programme is one of the few to have been scaled up. This study investigated young people’s experiences of using sexual and reproductive health services at clinics providing the YFS programme, compared to those that did not, using the simulated client method. Design Fifteen primary healthcare clinics in Soweto were randomly sampled: seven provided the YFS programme. Simulated clients conducted 58 visits; young men requested information on condom reliability and young women on contraceptive methods. There were two outcome measures: a single measure of the overall clinic experience (clinic visit score) and whether or not simulated clients would recommend a clinic to their peers. The clinic visit score was based on variables relating to the simulated clients’ interactions with staff, details of their consultation, privacy, confidentiality, the healthcare workers’ characteristics, and the clinic environment. A larger score corresponds to a worse experience than a smaller one. Multilevel regression models and framework analysis were used to investigate young people’s experiences. Results Health facilities providing the YFS programme did not deliver a more positive experience to young people than those not providing the programme (mean difference in clinic visit score: −0.18, 95% CI: −0.95, 0.60, p=0.656). They were also no more likely to be recommended by simulated clients to their peers (odds ratio: 0.48, 95% CI: 0.11, 2.10, p=0.331). More positive experiences were characterised by young people as those where healthcare workers were friendly, respectful, knew how to talk to young people, and appeared to value them seeking health information. Less positive experiences were characterised by having to show soiled sanitary products to obtain contraceptives, healthcare workers expressing negative opinions about young people seeking information, lack of privacy, and inadequate information. Conclusions The provision and impact of the YFS programme are limited. Future research should explore implementation. Regular training and monitoring could enable healthcare workers to address young people’s needs.
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Affiliation(s)
- Rebecca S Geary
- Department of Infection and Population Health, University College London, London, UK; Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK;
| | - Emily L Webb
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Lynda Clarke
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Shane A Norris
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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