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Jaya ZN, Mapanga W, Mashamba-Thompson TP. Understanding the preferences of young women in self-sampling interventions for sexually transmitted infection diagnosis: a discrete choice experimental protocol. BMJ Open 2024; 14:e082981. [PMID: 39317498 PMCID: PMC11423747 DOI: 10.1136/bmjopen-2023-082981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2024] Open
Abstract
INTRODUCTION Sexually transmitted infections (STIs) are a significant public health concern globally, particularly affecting young women. Early diagnosis and treatment are essential to reducing or stopping the continuous spread of infections and the development of associated complications. Syndromic management, which is commonly used for STIs, presents several barriers, particularly for young women. This protocol is for a study that aims to understand young women's preferences for a self-sampling intervention for STI diagnosis by using a discrete choice experiment (DCE). The DCE will be conducted among young women residing in underserved urban communities in eThekwini Metropolitan Municipality in KwaZulu-Natal, South Africa. METHODS AND ANALYSIS The following attributes of a self-sampling intervention were identified through a Nominal Group Technique: accessibility, education, confidentiality, self-sampling method, youth-friendliness and cost. A pilot study involving 20 participants was conducted to refine the DCE questionnaire. A total of 196 young women from underserved communities will be recruited. The participants will be sampled from communities, stratified by settlement type and socioeconomic status. Data will be analysed using the multinomial logit model and mixed logit model to assess preferences and heterogeneity. ETHICS AND DISSEMINATION The study was approved by the Faculty of Health Sciences Research Ethics Committee of the University of Pretoria. The study findings have the potential to inform policies for STI treatment and management to align healthcare services with user preferences. This can improve STI healthcare access for young women in underserved communities. Ethical approval was obtained, and results will be disseminated through peer-reviewed journals and health conferences.
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Affiliation(s)
- Ziningi Nobuhle Jaya
- School of Health Systems and Public Health, University of Pretoria, Pretoria, Gauteng, South Africa
- Biomedical Sciences, Mangosuthu University of Technology, Durban, KwaZulu-Natal, South Africa
| | - Witness Mapanga
- School of Health Systems and Public Health, University of Pretoria, Pretoria, Gauteng, South Africa
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John R, Mohd Salleh NA, Nik Farid ND. Utilization of Sexual Reproductive Health Services Among Youths in Malaysia: A Cross-Sectional Study Applying Andersen's Behavioral Model of Healthcare Utilization. Cureus 2024; 16:e60230. [PMID: 38751405 PMCID: PMC11093695 DOI: 10.7759/cureus.60230] [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] [Accepted: 05/13/2024] [Indexed: 05/18/2024] Open
Abstract
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.
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Affiliation(s)
- Rowena John
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Nur Afiqah Mohd Salleh
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
| | - Nik Daliana Nik Farid
- Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MYS
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Komasawa M, Sato M, Ssekitoleko R, Waiswa P, Gitta S, Nabugoomu J, Honda S, Saito K, Aung MN. Study protocol for a type-II hybrid effectiveness-implementation trial to reach teenagers using mobile money shops to reduce unintended pregnancies in Uganda. BMJ Open 2024; 14:e084539. [PMID: 38582537 PMCID: PMC11002355 DOI: 10.1136/bmjopen-2024-084539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/22/2024] [Indexed: 04/08/2024] Open
Abstract
INTRODUCTION Unintended teenage pregnancies have become a global public health challenge, particularly in sub-Saharan Africa. There is a notably high prevalence of unintended pregnancies among unmarried teenagers in Uganda. This study will develop an intervention programme using mobile money shops (vendors) as a platform to deliver sexual and reproductive health and rights (SRHR) services to teenagers and assess its effectiveness and scalability in Uganda. METHODS AND ANALYSES This hybrid study comprises two integral components: an intervention study to assess the effectiveness of vendor-mediated intervention and implementation research to evaluate the implementation process. 30 vendors will be recruited for both intervention and control arms in 2 municipalities in Eastern Uganda, which have a high unintended pregnancy prevalence rate among unmarried teens aged 15-19 years. A preintervention and postintervention repeated survey involving 600 participants for each arm will be conducted over 4 months. The primary outcome is the rate of condom users among teenage vendor users. The secondary outcomes include the rate of preference for receiving SRHR services at vendors and knowledge regarding SRHR. A difference-in-differences analysis will be used to determine the effectiveness of the intervention. The Bowen model will be employed to evaluate the implementation design. ETHICS AND DISSEMINATION Ethical approval was obtained from the Ethics Review Committee of Uganda Christen University and JICA Ogata Sadako Research Institute for Peace and Development in Japan. The findings will be widely disseminated. This study was registered with the University Hospital Medical Information Network in Japan (UMIN000053332) on 12 January 2024. TRIAL REGISTRATION NUMBER UMIN000053332.
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Affiliation(s)
- Makiko Komasawa
- Ogata Sadako Research Institute for Peace and Development, Japan International Cooperation Agency, Shinjuku-ku, Japan
- Department of Global Health Research, Juntendo University, Bunkyo-ku, Japan
| | - Miho Sato
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | - Peter Waiswa
- School of Public Health, Makerere University, Kampala, Uganda
- Busoga Health Forum, Jinja, Uganda
| | - Sheba Gitta
- School of Public Health, Uganda and Busoga Health Forum, Jinja, Uganda
- Makerere University, Kampala, Uganda
| | | | - Sumihisa Honda
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Kiyoko Saito
- Ogata Sadako Research Institute for Peace and Development, Japan International Cooperation Agency, Shinjuku-ku, Japan
| | - Myo Nyein Aung
- Department of Global Health Research, Juntendo University, Bunkyo-ku, Japan
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Prabhakar P, Singh NS, Sulaiman M, King J, Saddique Z, Mounier-Jack S, Asinde B, Namakula S, Namatovu J, Kapiti R, Kasiri J, Borghi J. Sexual and reproductive healthcare utilisation and affordability for South Sudanese refugees and host populations in Northern Uganda: A mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002351. [PMID: 37672542 PMCID: PMC10482223 DOI: 10.1371/journal.pgph.0002351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023]
Abstract
Given Uganda's increasing refugee population, the health financing burden on refugee and host populations is likely to increase because Uganda's integrated health system caters to both populations. We used sexual, reproductive, and maternal health (SRMH) as a lens to assess the utilisation and user cost of health services in Northern Uganda to identify potential gaps in SRMH services and their financing. We conducted a cross-sectional survey among 2,533 refugee and host women and girls in Arua and Kiryandongo districts. We conducted 35 focus group discussions and 131 in-depth interviews with host and South Sudanese refugees, community members, health workers, NGO and governmental actors. Qualitative data were analysed thematically using a framework approach. Quantitative data were analysed using t-test, chi-square tests, multivariate logistical regression, and a two-part model. We found high levels of access to maternal care services among refugee and host communities in Northern Uganda, but lower levels of met need for family planning (FP). Refugees had higher uptake of delivery care than host communities due to better-resourced refugee facilities, but incurred higher costs for delivery kits and food and less for transport due to facilities being closer. FP uptake was low for both groups due to perceived risks, cultural and religious beliefs, and lack of agency for most women. Host communities lack access to essential maternal healthcare services relative to refugees, especially for delivery care. Greater investment is needed to increase the number of host facilities, improve the quality of SRMH services provided, and further enhance delivery care access among host communities. Ongoing funding of delivery kits across all communities is needed and new financing mechanisms should be developed to support non-medical costs for deliveries, which our study found to be substantial in our study. All populations must be engaged in co-designing improved strategies to meet their FP needs.
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Affiliation(s)
- Pallavi Prabhakar
- Independent Evaluation and Research Cell, BRAC Uganda, Kampala, Uganda
| | - Neha S. Singh
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Munshi Sulaiman
- Independent Evaluation and Research Cell, BRAC Uganda, Kampala, Uganda
| | - Jessica King
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Zia Saddique
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sandra Mounier-Jack
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Barbara Asinde
- Independent Evaluation and Research Cell, BRAC Uganda, Kampala, Uganda
| | | | | | | | | | - Josephine Borghi
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Chao M, Menon C, Elgendi M. Menstrual cycles during COVID-19 lockdowns: A systematic review and meta-analysis. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:949365. [PMID: 36303682 PMCID: PMC9580671 DOI: 10.3389/frph.2022.949365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/21/2022] [Indexed: 12/03/2022] Open
Abstract
Coronavirus disease 2019 lockdowns produced psychological and lifestyle consequences for women of reproductive age and changes in their menstrual cycles. To our knowledge, this is the first systematic review to characterize changes in menstrual cycle length associated with lockdowns compared to non-lockdown periods. A search on 5 May 2022 retrieved articles published between 1 December 2019, and 1 May 2022, from Medline, Embase, and Web of Science. The included articles were peer-reviewed observational studies with full texts in English, that reported menstrual cycle lengths during lockdowns and non-lockdowns. Cross-sectional and cohort studies were appraised using the Appraisal tool for Cross-Sectional Studies and the Cochrane Risk of Bias Tool for Cohort Studies, respectively. Review Manager was used to generate a forest plot with odds ratios (OR) at the 95% confidence interval (CI), finding a significant association between lockdown and menstrual cycle length changes for 21,729 women of reproductive age (OR = 9.14, CI: 3.16-26.50) with a significant overall effect of the mean (Z = 4.08, p < 0.0001). High heterogeneity with significant dispersion of values was observed (I 2 = 99%, τ = 1.40, χ2 = 583.78, p < 0.0001). This review was limited by the availability of published articles that favored high-income countries. The results have implications for adequately preparing women and assisting them with menstrual concerns during lockdown periods.
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Affiliation(s)
- Melissa Chao
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Carlo Menon
- Biomedical and Mobile Health Technology Laboratory, Department of Health Sciences and Technology, Zurich, Switzerland
| | - Mohamed Elgendi
- Biomedical and Mobile Health Technology Laboratory, Department of Health Sciences and Technology, Zurich, Switzerland
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