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Anglewicz P, Cardona C, Akinlose T, Gichangi P, OlaOlorun F, Omoluabi E, Thiongo M, Akilimali P, Tsui A, Kayembe P. Service delivery point and individual characteristics associated with the adoption of modern contraceptive: A multi-country longitudinal analysis. PLoS One 2021; 16:e0254775. [PMID: 34403428 PMCID: PMC8370635 DOI: 10.1371/journal.pone.0254775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background Women who start using contraception (“adopters”) are a key population for family planning goals, but little is known about characteristics that predict the adoption of contraception as opposed to current use. We used prospective data from women and facilities for five countries, (Democratic Republic of Congo, India, Kenya, Nigeria, and Burkina Faso) and identified baseline characteristics that predicted adoption of modern contraception in the short term. Methods We used data from the Performance Monitoring for Action (PMA) Agile Project. PMA Agile administered service delivery point (SDP) client exit interview (CEI) surveys in urban sites of these five countries. Female clients responding to the CEI were asked for phone numbers that were used for a phone follow-up survey approximately four months later. For our analysis, we used data from the SDP and CEI baseline surveys, and the phone follow up to compare women who start using contraception during this period with those who remain non-users. We used characteristics of the facility and the woman at baseline to predict her contraception adoption in the future. Results Discussing FP with a partner at baseline was associated with greater odds of adoption in DRC (OR 2.34; 95% CI 0.97–5.66), India (OR 2.27; 95% CI 1.05–4.93), and Kenya (OR 1.65; 95% CI 1.16–2.35). Women who discussed family planning with any staff member at the health facility had 1.72 greater odds (95% CI 1.13–2.67) of becoming an adopter in Nigeria. The odds of adoption were lower in Nigerian facilities that had a stockout (OR 0.66 95% CI 0.44–1.00) at baseline. Other characteristics associated with contraception adoption across settings were education, age, wealth, parity, and marital status. Conclusions Characteristics of both the woman and the health facility were associated with adoption of modern contraception in the future. Some characteristics, like discussing family planning with a spouse, education, and parity, were associated with contraceptive adoption across settings. Other characteristics that predict contraceptive use, such as health facility measures, varied across countries.
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Affiliation(s)
- Philip Anglewicz
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Carolina Cardona
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Titilope Akinlose
- Research Triangle Institute International, Health Care Financing and Payment, Research Triangle Park, North Carolina, United States of America
| | - Peter Gichangi
- International Centre for Reproductive Health Kenya, Nairobi, Kenya
| | | | | | - Mary Thiongo
- International Centre for Reproductive Health Kenya, Nairobi, Kenya
| | - Pierre Akilimali
- University of Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Amy Tsui
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Patrick Kayembe
- University of Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
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Kalbarczyk A, Rodriguez DC, Mahendradhata Y, Sarker M, Seme A, Majumdar P, Akinyemi OO, Kayembe P, Alonge OO. Barriers and facilitators to knowledge translation activities within academic institutions in low- and middle-income countries. Health Policy Plan 2021; 36:728-739. [PMID: 33661285 PMCID: PMC8173595 DOI: 10.1093/heapol/czaa188] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 11/13/2022] Open
Abstract
The barriers and facilitators of conducting knowledge translation (KT) activities are well-established but less is known about the institutional forces that drive these barriers, particularly in low resource settings. Understanding organizational readiness has been used to assess and address such barriers but the employment of readiness assessments has largely been done in high-income countries. We conducted a qualitative study to describe the institutional needs and barriers in KT specific to academic institutions in low- and middle-income countries. We conducted a review of the grey and published literature to identify country health priorities and established barriers and facilitators for KT. Key-informant interviews (KII) were conducted to elicit perceptions of institutional readiness to conduct KT, including experiences with KT, and views on motivation and capacity building. Participants included representatives from academic institutions and Ministries of Health in six countries (Bangladesh, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria). We conducted 18 KIIs, 11 with members of academic institutions and 7 with policymakers. KIIs were analysed using a deductive and inductive coding approach. Our findings support many well-documented barriers including lack of time, skills and institutional support to conduct KT. Three additional institutional drivers emerged around soft skills and the complexity of the policy process, alignment of incentives and institutional missions, and the role of networks. Participants reflected on often-lacking soft-skills needed by researchers to engage policy makers. Continuous engagement was viewed as a challenge given competing demands for time (both researchers and policy makers) and lack of institutional incentives to conduct KT. Strong networks, both within the institution and between institutions, were described as important for conducting KT but difficult to establish and maintain. Attention to the cross-cutting themes representing barriers and facilitators for both individuals and institutions can inform the development of capacity building strategies that meet readiness needs.
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Affiliation(s)
- Anna Kalbarczyk
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Yodi Mahendradhata
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Bulaksumur Yogyakarta, Indonesia
| | - Malabika Sarker
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh.,Heidelberg Global Institute of Health (HIGH), Heidelberg University, Heidelberg, Germany
| | - Assefa Seme
- Addis Ababa University School of Public Health, Ethiopia
| | - Piyusha Majumdar
- Indian Institute of Health Management Research, Bengaluru, India
| | - Oluwaseun O Akinyemi
- Department of Health Policy and Management, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Patrick Kayembe
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Akilimali PZ, Nzuka HE, LaNasa KH, Wumba AM, Kayembe P, Wisniewski J, Bertrand JT. The gap in contraceptive knowledge and use between the military and non-military populations of Kinshasa, DRC, 2016-2019. PLoS One 2021; 16:e0254915. [PMID: 34314439 PMCID: PMC8315532 DOI: 10.1371/journal.pone.0254915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/06/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction The objective of this study is to assess change over time in the modern contraceptive prevalence rate (MCPR) and related variables among married women of reproductive age (15–49 years) in the military population in Kinshasa, Democratic Republic of Congo, compared to women in the non-military population, based on cross-sectional surveys in 2016 and 2019. Methods Data among women living in military camps were collected as a special study of contraceptive knowledge, use, and exposure to FP messaging, for comparison to women in the non-military population from the annual PMA2020 survey. Both used a two-stage cluster sampling design to randomly select participants. This analysis is limited to women married or in union. Bivariate and multivariate analysis was used to compare the military and non-military populations. Results The socio-demographic profile of women in the military camps differed between 2016 and 2019, which may reflect the more mobile nature of this population. In both populations, knowledge of modern contraceptive methods increased significantly. Similarly, use of a modern contraceptive method also increased significantly in both, though by 2019 women in the military camps were less likely to use modern contraception (24.9%) than their non-military counterparts (29.7%). Multivariate analysis showed no significant difference in the amount of increase in MCPR for the two populations. Among contraceptive users in both populations, the implant was the leading method. Potential effects of FP programming were evident in the military population: exposure to FP messaging increased (in comparison to a decrease among the non-military population). Moreover, women who had lived in the camps for 4+ years had a higher MCPR than those living in the camps for less than four years. Conclusions This study demonstrates the feasibility and importance of collecting data in military camps for better understanding contraceptive dynamics among this specialized population.
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Affiliation(s)
- Pierre Z. Akilimali
- Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, The Democratic Republic of the Congo
| | - Henri Engale Nzuka
- Medical Division, Congolese Armed Forces, Kinshasa, The Democratic Republic of the Congo
| | - Katherine H. LaNasa
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- * E-mail:
| | - Angéle Mavinga Wumba
- Medical Division, Congolese Armed Forces, Kinshasa, The Democratic Republic of the Congo
| | - Patrick Kayembe
- Kinshasa School of Public Health, Université de Kinshasa, Kinshasa, The Democratic Republic of the Congo
| | - Janna Wisniewski
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
| | - Jane T. Bertrand
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
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Cislaghi B, Bhatia A, Li M, Lian Q, Baird S, Kayembe P, Chipeta E, Moreau C. Changes in the Sexual Double Standard Associated With Sociodevelopmental Factors Among Young Adolescents in Kinshasa. J Adolesc Health 2021; 69:S23-S30. [PMID: 34217455 DOI: 10.1016/j.jadohealth.2020.07.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to describe the changes in adolescents' perceptions of a sexual double standard (SDS) over time and to examine the developmental and social factors associated with these changing perceptions. METHODS The sample includes 2,163 10- to 14-year-old adolescents from Kinshasa, interviewed at two time points (T0 and T1), 1 year apart. We examined associations between SDS and pubertal onset, family interactions, peer interactions, and media exposure. We conducted sex-stratified generalized estimation equation models to test associations between changes in SDS and sociodevelopmental factors at T0 as well as with changes in sociodevelopmental factors between T0 and T1. RESULTS At T0, the SDS score was 4.15/5 among boys and 4.43/5 among girls, signaling highly gender unequal perceptions. SDS scores increased over time, shifting toward greater inequality. Adolescents who were prepubertal at T0 experienced greater increases in SDS scores than those who were pubertal at T0. The greatest increase in SDS scores was observed among girls who transitioned through puberty between T0 and T1. High parental monitoring of boys mitigated the increase in SDS as did boys' increased exposure to social media between T0 and T1. Girls who had mixed-sex friendships also experienced less change in SDS perceptions compared with those who socialized in same-sex groups. CONCLUSIONS Puberty was associated with changes in SDS perceptions for all adolescents, whereas family interactions and media exposure affected changes in SDS perceptions for boys and peer interactions affected changes in SDS perceptions for girls.
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Affiliation(s)
- Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Amiya Bhatia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Mengmeng Li
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Qiguo Lian
- NHC Key Lab. of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, People's Republic of China
| | - Sarah Baird
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Patrick Kayembe
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Effie Chipeta
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Centre for Reproductive Health (CRH), University of Malawi, College of Medicine, Blantyre, Malawi
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Soins Primaires et Prévention, Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Paris, France
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Mmari K, Cooper D, Moreau C, Koenig L, Martinez M, Mafuta E, Kayembe P, De Meyer S, Michielson K, Yu C, Zuo X, Blum RW. The Social Context of Early Adolescents in the Global Early Adolescent Study. J Adolesc Health 2021; 69:S5-S15. [PMID: 34217460 DOI: 10.1016/j.jadohealth.2021.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/25/2020] [Accepted: 01/22/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This paper used data from the Global Early Adolescent Study (GEAS) to provide a descriptive analysis of how early adolescents' social environments vary by sex across diverse cultural settings. METHODS The analyses were based on baseline data among 10-14-year old adolescents living in disadvantaged urban areas in seven sites: Kinshasa (DRC), Shanghai (China), Cuenca (Ecuador), Lampung, Semarang and Denpasar (Indonesia), and Flanders (Belgium). Except in Kinshasa where face-to face interviews were used, data were collected using self-administered surveys on mobile tablets. Social environments were measured by examining factors within five main domains, including the household and family, school, peers, neighborhoods, and the media. Site-specific descriptive analyses were performed, using Chi square tests and Student T-tests to identify sex-differences in each site. RESULTS The majority of early adolescents lived in two-parent households, perceived their parents/guardians cared and monitored them, had at least one friend, reported high educational aspirations, and perceived their neighborhoods as safe, socially cohesive, with a high level of social control. Yet, large gender and site differences were also observed. More girls reported same-sex friends and high levels of parental monitoring, while boys were more likely to have mixed-sex friends and spend greater amounts of time with friends. Adolescents in Kinshasa and Semarang watched the most TV per day, while higher proportions of adolescents in Flanders used social media on a daily basis. Significant gender differences in media use were also observed but varied according to site. CONCLUSIONS Understanding how social contexts differ between boys and girls across sites has relevance for how we might examine gender attitude formations and subsequent health behaviors. Given the increased attention on the importance of early adolescence for shaping gender attitudes and norms, implementing approaches that consider the differences in boys' and girls' lives may hold the most promise for creating sustained and improve change.
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Affiliation(s)
- Kristin Mmari
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, Maryland.
| | - Diane Cooper
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, Maryland; Soins Primaires et Prévention, Inserm U1018, Center for research in Epidemiology and Population Health (CESP), Villejuif, France
| | - Leah Koenig
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, Maryland
| | - Michelle Martinez
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, Maryland
| | - Eric Mafuta
- Health Systems Management and Policy Department, Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Patrick Kayembe
- Health Systems Management and Policy Department, Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Sara De Meyer
- International Centre for Reproductive Health, University of Ghent, Ghent, Belgium
| | - Kristien Michielson
- International Centre for Reproductive Health, University of Ghent, Ghent, Belgium
| | - Chunyan Yu
- China NHC Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, People's Republic of China
| | - Xiayun Zuo
- China NHC Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, People's Republic of China
| | - Robert Wm Blum
- Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, Maryland
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Zimmerman LA, Koenig LR, Pulerwitz J, Kayembe P, Maddeleno M, Moreau C. The Intersection of Power and Gender: Examining the Relationship of Empowerment and Gender-Unequal Norms Among Young Adolescents in Kinshasa, DRC. J Adolesc Health 2021; 69:S64-S71. [PMID: 34217462 DOI: 10.1016/j.jadohealth.2021.03.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To examine how perceptions of gender norms and expressions of empowerment are related among disadvantaged young adolescent boys and girls in Kinshasa, DRC. METHODS We included data from 2,610 adolescent boys and girls between 10 and 14 years old. We examined correlations between three dimensions of perceived gender norms (a sexual double standard, gender stereotypical roles, and gender stereotypical traits) and two domains of agency (voice and decision-making), overall and by sex. We conducted sex-stratified simple and multivariable linear regression models to assess these associations, adjusting for sociodemographic factors. We also tested for differences in the association between gender norm perceptions and agency by sex. RESULTS Correlations between gender norm perceptions and agency scores were low (under 0.15). Among boys, greater perception of a sexual double standard was related to more voice (p=0.001) and more decision-making power (p=0.008). Similar patterns were observed among girls for the relationship between sexual double standard and voice (p≤.001), but not for decision-making. Increased perceptions of gender stereotypical traits were related to more voice among girls (p≤.001), while conversely girls who perceived greater gender stereotypical roles had less decision-making power (p=0.010). CONCLUSIONS This study demonstrated that gender norm perceptions and agency are distinct but related constructs. Interventions aimed to promote gender equality must consider gender unequal norms and gender-unequal divisions of power as important but different dynamics.
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Affiliation(s)
- Linnea A Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Leah R Koenig
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Julie Pulerwitz
- HIV/AIDS Program, Population Council, Washington, District of Columbia
| | - Patrick Kayembe
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Gender, Sexual and Reproductive Health, CESP Centre for Research in Epidemiology and Population Health U1018, Inserm, Villejuif, France
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Deressa W, Kayembe P, Neel AH, Mafuta E, Seme A, Alonge O. Lessons learned from the polio eradication initiative in the Democratic Republic of Congo and Ethiopia: analysis of implementation barriers and strategies. BMC Public Health 2020; 20:1807. [PMID: 33339529 PMCID: PMC7747367 DOI: 10.1186/s12889-020-09879-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Since its inception in 1988, the Global Polio Eradication Initiative (GPEI) has partnered with 200 countries to vaccinate over 2.5 billion children against poliomyelitis. The polio eradication approach has adapted to emerging challenges and diverse contexts. Knowledge assets gained from these experiences can inform implementation of future health programs, but only if efforts are made to systematically map barriers, identify strategies to overcome them, identify unintended consequences, and compare experiences across country contexts. METHODS A sequential explanatory mixed methods design, including an online survey followed by key informant interviews (KIIs), was utilized to map tacit knowledge derived from the polio eradication experience from 1988 to 2019. The survey and KIIs were conducted between September 2018 and March 2019. A cross-case comparison was conducted of two study countries, the Democratic Republic of Congo (DRC) and Ethiopia, which fit similar epidemiological profiles for polio. The variables of interest (implementation barriers, strategies, unintended consequences) were compared for consistencies and inconsistencies within and across the two country cases. RESULTS Surveys were conducted with 499 and 101 respondents, followed by 23 and 30 KIIs in the DRC and Ethiopia, respectively. Common implementation barriers included accessibility issues caused by political insecurity, population movement, and geography; gaps in human resources, supply chain, finance and governance; and community hesitancy. Strategies for addressing these barriers included adapting service delivery approaches, investing in health systems capacity, establishing mechanisms for planning and accountability, and social mobilization. These investments improved system infrastructure and service delivery; however, resources were often focused on the polio program rather than strengthening routine services, causing community mistrust and limiting sustainability. CONCLUSIONS The polio program investments in the DRC and Ethiopia facilitated program implementation despite environmental, system, and community-level barriers. There were, however, missed opportunities for integration. Remaining pockets of low immunization coverage and gaps in surveillance must be addressed in order to prevent importation of wild poliovirus and minimize circulating vaccine-derived poliovirus. Studying these implementation processes is critical for informing future health programs, including identifying implementation tools, strategies, and principles which can be adopted from polio eradication to ensure health service delivery among hard-to-reach populations. Future disease control or eradication programs should also consider strategies which reduce parallel structures and define a clear transition strategy to limit long-term external dependency.
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Affiliation(s)
- Wakgari Deressa
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Patrick Kayembe
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Abigail H Neel
- International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
| | - Eric Mafuta
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Assefa Seme
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Olakunle Alonge
- International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
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Glover AL, Kayembe P, Kaba D, Babakazo P. Assessing Readiness to Provide Comprehensive Abortion Care in the Democratic Republic of the Congo After Passage of the Maputo Protocol. Int Perspect Sex Reprod Health 2020; 46:3-12. [PMID: 33326395 DOI: 10.1363/46e0420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CONTEXT The Democratic Republic of the Congo (DRC) decriminalized abortion under certain circumstances in 2018 through the Maputo Protocol. However, little is known about the readiness of the country's health facilities to provide comprehensive abortion care. METHODS Data on 1,380 health facilities from the 2017-2018 DRC Service Provision Assessment (SPA) inventory survey were used to assess readiness to provide abortion care in four domains: termination of pregnancy, basic treatment of postabortion complications, comprehensive treatment of postabortion complications and postabortion contraceptive care. Analyses used a modified application of the emergency obstetric care signal function approach; criteria for readiness were based on World Health Organization guidelines. RESULTS Thirty-one percent of DRC facilities met the criteria for readiness to provide abortions. The proportion of facilities classified as ready was higher among urban facilities than rural ones (50% vs. 26%), and among hospitals than health centers or reference health centers (72% vs. 25% and 45%, respectively). Few facilities were ready to provide either basic or comprehensive treatment of postabortion complications (4% and 1%); readiness to provide these services was greatest among hospitals (14% and 11%). Only a third of facilities displayed readiness to provide postabortion contraceptive care. Inadequate supplies of medication (e.g., misoprostol, antibiotics, contraceptives) and equipment were the greatest barrier to readiness. CONCLUSIONS Most DRC facilities were not ready to provide comprehensive abortion care. Improving supplies of vital health commodities will improve readiness, and has the potential to reduce the prevalence of unplanned pregnancies and future demand for abortions.
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Affiliation(s)
- Annie L Glover
- Postdoctoral fellow, Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA,
| | - Patrick Kayembe
- Professor and head, Department of Epidemiology and Biostatistics, School of Public Health, University of Kinshasa, Democratic Republic of the Congo
| | - Didine Kaba
- Professor, Department of Epidemiology and Biostatistics, School of Public Health, University of Kinshasa, Democratic Republic of the Congo
| | - Pélagie Babakazo
- Professor, Department of Epidemiology and Biostatistics, School of Public Health, University of Kinshasa, Democratic Republic of the Congo
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Koenig LR, Li M, Zimmerman LA, Kayembe P, Lou C, Mafuta E, Ortiz J, Moreau C. Associations Between Agency and Sexual and Reproductive Health Communication in Early Adolescence: A Cross-cultural, Cross-sectional Study. J Adolesc Health 2020; 67:416-424. [PMID: 32331930 PMCID: PMC7456790 DOI: 10.1016/j.jadohealth.2020.02.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/08/2020] [Accepted: 02/16/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the extent to which adolescents aged 10-14 have communicated about sexual relationships, pregnancy, and contraception and how agency in the form of voice and decision-making along with an enabling socioecological environment are associated with sexual and reproductive health (SRH) communication. METHODS Using data from the Global Early Adolescent Study, we included 1,367, 697, and 1,424 adolescents in Kinshasa, Cuenca, and Shanghai, respectively. Patterns of SRH communication and agency levels were described by site and sex. Multivariable logistic regressions assessed odds of SRH communication first in relation to socioecological characteristics and second with levels of agency, after adjustment for social environmental factors. Interaction terms tested sex differences in associations. RESULTS Experiences of SRH communication ranged from one in ten in Kinshasa to about half in Cuenca. Pregnancy was the most discussed SRH topic. Socioecological factors consistently related to SRH communication included older age and pubertal onset, while others varied by context. In multivariable analyses, voice was linked to all forms of SRH communication in Kinshasa and Cuenca with adjusted odds ratios ranging from 1.6 to 2.2, but not in Shanghai. In Cuenca, decision-making was associated with a 50% and 60% increase in odds of communication about pregnancy and contraception, respectively. In Kinshasa, a stronger association between voice and pregnancy discussions was observed for girls than boys. CONCLUSIONS Developmental characteristics and voice were linked to communication about SRH among young adolescents across two contexts. Results suggest agency may play a role in shaping antecedents, like communication, to sexual behaviors.
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Affiliation(s)
- Leah R. Koenig
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,Address correspondence to: Leah R. Koenig, M.S.P.H, Department of Population, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
| | - Mengmeng Li
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Linnea A. Zimmerman
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Patrick Kayembe
- Department of Epidemiology and Biostatistics, School of Public Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Chaohua Lou
- National Health Commission Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - Eric Mafuta
- Department of Epidemiology and Biostatistics, School of Public Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - José Ortiz
- Faculty of Medical Sciences, University of Cuenca, Cuenca, Ecuador
| | - Caroline Moreau
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Moodley K, Rennie S, Behets F, Obasa AE, Yemesi R, Ravez L, Kayembe P, Makindu D, Mwinga A, Jaoko W. Allocation of scarce resources in Africa during COVID-19: Utility and justice for the bottom of the pyramid? Dev World Bioeth 2020; 21:36-43. [PMID: 32845575 PMCID: PMC7461286 DOI: 10.1111/dewb.12280] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 11/28/2022]
Abstract
The COVID‐19 pandemic has raised important universal public health challenges. Conceiving ethical responses to these challenges is a public health imperative but must take context into account. This is particularly important in sub‐Saharan Africa (SSA). In this paper, we examine how some of the ethical recommendations offered so far in high‐income countries might appear from a SSA perspective. We also reflect on some of the key ethical challenges raised by the COVID‐19 pandemic in low‐income countries suffering from chronic shortages in health care resources, and chronic high morbidity and mortality from non‐COVID‐19 causes. A parallel is drawn between the distribution of severity of COVID‐19 disease and the classic “Fortune at the bottom of the pyramid” model that is relevant in SSA. Focusing allocation of resources during COVID‐19 on the ‘thick’ part of the pyramid in Low‐to‐Middle Income Countries (LMICs) could be ethically justified on utilitarian and social justice grounds, since it prioritizes a large number of persons who have been economically and socially marginalized. During the pandemic, importing allocation frameworks focused on the apex of the pyramid from the global north may therefore not always be appropriate. In a post‐COVID‐19 world, we need to think strategically about how health care systems can be financed and structured to ensure broad access to adequate health care for all who need it. The root problems underlying health inequity, exposed by COVID‐19, must be addressed, not just to prepare for the next pandemic, but to care for people in resource poor settings in non‐pandemic times.
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Tsui A, Anglewicz P, Akinlose T, Srivatsan V, Akilimali P, Alzouma S, Bazie F, Gichangi P, Guiella G, Kayembe P, Mehrotra A, OlaOlorun F, Omoluabi E, Oumarou S, Sodani PR, Thiongo M, Byrne M, Dreger K, Decker M, Cardona C, Muhoza P, Combs C, Koffi AK, Radloff S. Performance monitoring and accountability: The Agile Project's protocol, record and experience. Gates Open Res 2020; 4:30. [PMID: 32908964 PMCID: PMC7463111 DOI: 10.12688/gatesopenres.13119.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2020] [Indexed: 11/20/2022] Open
Abstract
The Performance Monitoring and Accountability 2020 (PMA2020) project implemented a multi-country sub-project called PMA Agile, a system of continuous data collection for a probability sample of urban public and private health facilities and their clients that began November 2017 and concluded December 2019. The objective was to monitor the supply, quality and consumption of family planning services. In total, across 14 urban settings, nearly 2300 health facilities were surveyed three to six times in two years and a total sample of 48,610 female and male clients of childbearing age were interviewed in Burkina Faso, Democratic Republic of Congo, India, Kenya, Niger and Nigeria. Consenting female clients with access to a cellphone were re-interviewed by telephone after four months; two rounds of the client exit, and follow-up interviews were conducted in nearly all settings. This paper reports on the PMA Agile data system protocols, coverage and early experiences. An online dashboard is publicly accessible, analyses of measured trends are underway, and the data are publicly available.
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Affiliation(s)
- Amy Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Titilope Akinlose
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Varsha Srivatsan
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Pierre Akilimali
- University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Fiacre Bazie
- Higher Institute of Population Sciences, Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
| | - Peter Gichangi
- International Centre for Reproductive Health Kenya, Nairobi, Kenya
| | - Georges Guiella
- Higher Institute of Population Sciences, Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso
| | - Patrick Kayembe
- University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Sani Oumarou
- Institut National de la Statistique, Niamey, Niger
| | | | - Mary Thiongo
- International Centre for Reproductive Health Kenya, Nairobi, Kenya
| | - Meagan Byrne
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Kurt Dreger
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Michele Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Carolina Cardona
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Pierre Muhoza
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Carolyn Combs
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Alain K Koffi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Scott Radloff
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Alonge O, Neel AH, Kalbarczyk A, Peters MA, Mahendradhata Y, Sarker M, Owoaje E, Deressa W, Kayembe P, Salehi AS, Gupta SD. Synthesis and translation of research and innovations from polio eradication (STRIPE): initial findings from a global mixed methods study. BMC Public Health 2020; 20:1176. [PMID: 32787949 PMCID: PMC7421832 DOI: 10.1186/s12889-020-09156-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lessons from polio eradication efforts and the Global Polio Eradication Initiative (GPEI) are useful for improving health service delivery and outcomes globally. The Synthesis and Translation of Research and Innovations from Polio Eradication (STRIPE) is a multi-phase project which aims to map, package and disseminate knowledge from polio eradication initiatives as academic and training programs. This paper discusses initial findings from the knowledge mapping around polio eradication activities across a multi-country context. METHODS The knowledge mapping phase (January 2018 - December 2019) encompassed four research activities (scoping review, survey, key informant interviews (KIIs), health system analyses). This paper utilized a sequential mixed method design combining data from the survey and KIIs. The survey included individuals involved in polio eradication between 1988 and 2019, and described the contexts, implementation strategies, intended and unintended outcomes of polio eradication activities across levels. KIIs were conducted among a nested sample in seven countries (Afghanistan, Bangladesh, the Democratic Republic of Congo, Ethiopia, India, Indonesia, Nigeria) and at the global level to further explore these domains. RESULTS The survey generated 3955 unique responses, mainly sub-national actors representing experience in over 74 countries; 194 KIIs were conducted. External factors including social, political, and economic factors were the most frequently cited barriers to eradication, followed by the process of implementing activities, including program execution, planning, monitoring, and stakeholder engagement. Key informants described common strategies for addressing these barriers, e.g. generating political will, engaging communities, capacity-building in planning and measurement, and adapting delivery strategies. The polio program positively affected health systems by investing in system structures and governance, however, long-term effects have been mixed as some countries have struggled to institutionalize program assets. CONCLUSION Understanding the implementing context is critical for identifying threats and opportunities to global health programs. Common implementation strategies emerged across countries; however, these strategies were only effective where organizational and individual capacity were sufficient, and where strategies were appropriately tailored to the sociopolitical context. To maximize gains, readiness assessments at different levels should predate future global health programs and initiatives should consider system integration earlier to ensure program institutionalization and minimize system distortions.
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Affiliation(s)
- Olakunle Alonge
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
| | - Abigail H Neel
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Anna Kalbarczyk
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Michael A Peters
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Yodi Mahendradhata
- Universitas Gadjah Mada, Faculty of Medicine, Public Health and Nursing, Yogyakarta, Indonesia
| | - Malabika Sarker
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Heidelberg Global Institute of Health (HIGH), Heidelberg University, Heidelberg, Germany
| | - Eme Owoaje
- University of Ibadan College of Medicine, Ibadan, Nigeria
| | - Wakgari Deressa
- Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | - Patrick Kayembe
- University of Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | | | - S D Gupta
- Indian Institute of Health Management Research, Jaipur, India
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Kalbarczyk A, Rao A, Mahendradhata Y, Majumdar P, Decker E, Anwar HB, Akinyemi OO, Rahimi AO, Kayembe P, Alonge OO. Evaluating the process of partnership and research in global health: reflections from the STRIPE project. BMC Public Health 2020; 20:1058. [PMID: 32787895 PMCID: PMC7421813 DOI: 10.1186/s12889-020-08591-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 11/20/2022] Open
Abstract
Background Thoughtful and equitable engagement with international partners is key to successful research. STRIPE, a consortium of 8 academic and research institutions across the globe whose objective is to map, synthesize, and disseminate lessons learned from polio eradication, conducted a process evaluation of this partnership during the project’s first year which focused on knowledge mapping activities. Methods The STRIPE consortium is led by Johns Hopkins University (JHU) in partnership with 6 universities and 1 research consultancy organization in polio free, at-risk, and endemic countries. In December 2018 JHU team members submitted written reflections on their experiences (n = 9). We held calls with each consortium member to solicit additional feedback (n = 7). To establish the partnership evaluation criteria we conducted preliminary analyses based on Blackstock’s framework evaluating participatory research. In April 2019, an in-person consortium meeting was held; one member from each institution was asked to join a process evaluation working group. This group reviewed the preliminary criteria, adding, subtracting, and combining as needed; the final evaluation criteria were applied to STRIPE’s research process and partnership and illustrative examples were provided. Results Twelve evaluation criteria were defined and applied by each member of the consortium to their experience in the project. These included access to resources, expectation setting, organizational context, external context, quality of information, relationship building, transparency, motivation, scheduling, adaptation, communication and engagement, and capacity building. For each criteria members of the working group reflected on general and context-specific challenges and potential strategies to overcome them. Teams suggested providing more time for recruitment, training, reflection, pre-testing. and financing to alleviate resource constraints. Given the large scope of the project, competing priorities, and shifting demands the working group also suggested a minimum of one full-time project coordinator in each setting to manage resources. Conclusion Successful management of multi-country, multicentered implementation research requires comprehensive communication tools (which to our knowledge do not exist yet or are not readily available), expectation setting, and institutional support. Capacity building activities that address human resource needs for both individuals and their institutions should be incorporated into early project planning.
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Affiliation(s)
- Anna Kalbarczyk
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, USA.
| | - Aditi Rao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, USA
| | - Yodi Mahendradhata
- Universitas Gadjah Mada Faculty of Medicine, Public Health, and Nursing, Yogyakarta, Indonesia
| | | | - Ellie Decker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, USA
| | - Humayra Binte Anwar
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Oluwaseun O Akinyemi
- Department of Health Policy and Management, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Patrick Kayembe
- University of Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Olakunle O Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, USA
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14
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Tsui A, Anglewicz P, Akinlose T, Srivatsan V, Akilimali P, Alzouma S, Bazie F, Gichangi P, Guiella G, Kayembe P, Mehrotra A, OlaOlorun F, Omoluabi E, Oumarou S, Sodani PR, Thiongo M, Byrne M, Dreger K, Decker M, Cardona C, Muhoza P, Combs C, Koffi AK, Radloff S. Performance monitoring and accountability: The Agile Project’s protocol, record and experience. Gates Open Res 2020; 4:30. [DOI: 10.12688/gatesopenres.13119.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 11/20/2022] Open
Abstract
The Performance Monitoring and Accountability 2020 (PMA2020) project implemented a multi-country sub-project called PMA Agile, a system of continuous data collection for a probability sample of urban public and private health facilities and their clients that began November 2017 and concluded December 2019. The objective was to monitor the supply, quality and consumption of family planning services. In total, across 14 urban settings, nearly 2300 health facilities were surveyed three to six times in two years and a total sample of 48,610 female and male clients of childbearing age were interviewed in Burkina Faso, Democratic Republic of Congo, India, Kenya, Niger and Nigeria. Consenting female clients with access to a cellphone were re-interviewed by telephone after four months; two rounds of the client exit, and follow-up interviews were conducted in nearly all settings. This paper reports on the PMA Agile data system protocols, coverage and early experiences. An online dashboard is publicly accessible, analyses of measured trends are underway, and the data are publicly available.
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15
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Anglewicz P, Akilimali P, Guiella G, Kayembe P, Kibira SPS, Makumbi F, Tsui A, Radloff S. Trends in subcutaneous depot medroxyprogesterone acetate (DMPA-SC) use in Burkina Faso, the Democratic Republic of Congo and Uganda. Contracept X 2019; 1:100013. [PMID: 32550528 PMCID: PMC7286145 DOI: 10.1016/j.conx.2019.100013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/25/2019] [Accepted: 10/30/2019] [Indexed: 11/10/2022] Open
Abstract
Objectives Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is seen as a valuable innovation in family planning, but little is known about trends in DMPA-SC use or characteristics of users. Using data from Burkina Faso, the Democratic Republic of Congo (DRC) and Uganda, we measured trends in DMPA-SC and identified characteristics associated with DMPA-SC use. Study design We used repeated cross-sectional representative data collected between 2016 and 2019. First, we plotted trends in DMPA-SC use for all women and married women. Next, we presented the sociodemographic and family-planning-related characteristics of DMPA-SC users. Finally, we conducted weighted multivariate logistic regression analysis to examine how DMPA-SC users were different from women (1) using all other modern methods combined and (2) not using any modern method. Results DMPA-SC use increased monotonically in all three countries. Many DMPA-SC users were first-time users of modern contraception (54.5% in Burkina Faso, 34.6% in DRC, 50.7% in Uganda). Never-married women had lower odds than married women of using DMPA-SC (compared to other modern methods) in all three countries [Burkina Faso adjusted odds ratio (AOR) 0.40, 95% confidence interval (95% CI) 0.20–0.80; DRC AOR 0.31 95% CI 0.10–0.93; Uganda AOR 0.24; 95% CI 0.08–0.71]. Level of education was positively associated with DMPA-SC use (compared to no use) (Burkina Faso AOR 1.79; 95% CI 1.03–3.14; Uganda AOR 3.23; 95% CI 1.33–7.84). Conclusions DMPA-SC is a rapidly growing method in these settings. Despite the comparable levels of and increases in use for all three countries, the characteristics associated with DMPA-SC use generally differed across countries. Implications This is the first analysis of patterns of DMPA-SC use with representative data for African countries. Our results confirm that DMPA-SC is increasingly popular, although the profile of users varies across settings.
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Affiliation(s)
- Philip Anglewicz
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, 615 N. Wolfe Street E4533, Baltimore, MD 21205, USA
| | - Pierre Akilimali
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Patrick Kayembe
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Simon P S Kibira
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Amy Tsui
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, 615 N. Wolfe Street E4533, Baltimore, MD 21205, USA
| | - Scott Radloff
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, 615 N. Wolfe Street E4533, Baltimore, MD 21205, USA
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Blum RW, Sheehy G, Li M, Basu S, El Gibaly O, Kayembe P, Zuo X, Ortiz J, Chan KS, Moreau C. Measuring young adolescent perceptions of relationships: A vignette-based approach to exploring gender equality. PLoS One 2019; 14:e0218863. [PMID: 31247045 PMCID: PMC6597075 DOI: 10.1371/journal.pone.0218863] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 06/11/2019] [Indexed: 11/18/2022] Open
Abstract
This paper reports the development and baseline data of a vignettes-based measure of gender equality. METHODS Vignettes were developed through 3-day long focus groups. After piloting in 13 sites and repiloting a revised version in 6 countries, responses were categorized by the construct tapped and a scoring system developed. Finalized vignettes were then tested in DR Congo, Ecuador and China. RESULTS Young adolescents can successfully respond to vignettes; and can differentiate self from hypothetical protagonists of same and opposite sex. Response differences by sex of respondent and protagonist were statistically significant across a range of scenarios and settings. CONCLUSION This is the first vignettes-based measure for young adolescents assessing young adolescent perceptions of relationships differentiated by sex of the protagonist.
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Affiliation(s)
- Robert W. Blum
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Grace Sheehy
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Mengmeng Li
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Sharmistha Basu
- Deutsche Gesellschaft fur Internationale Zusammenarbeit (GIZ), New Delhi, India
| | | | - Patrick Kayembe
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Xiayun Zuo
- Shanghai Institute of Planned Parenthood Research, Shanghai, China
| | - Jose Ortiz
- Faculty of Medical Sciences of the University of Cuenca-Ecuador, Cuenca, Ecuador
| | - Kitty S. Chan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Caroline Moreau
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Ahmed S, Choi Y, Rimon JG, Alzouma S, Gichangi P, Guiella G, Kayembe P, Kibira SP, Makumbi F, OlaOlorun F, Omoluabi E, Otupiri E, Oumarou S, Seme A, Shiferaw S, Anglewicz P, Radloff S, Tsui A. Trends in contraceptive prevalence rates in sub-Saharan Africa since the 2012 London Summit on Family Planning: results from repeated cross-sectional surveys. Lancet Glob Health 2019; 7:e904-e911. [PMID: 31109881 PMCID: PMC6560024 DOI: 10.1016/s2214-109x(19)30200-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/15/2019] [Accepted: 04/10/2019] [Indexed: 11/21/2022]
Abstract
Background The Family Planning 2020 (FP2020) initiative, launched at the 2012 London Summit on Family Planning, aims to enable 120 million additional women to use modern contraceptive methods by 2020 in the world's 69 poorest countries. It will require almost doubling the pre-2012 annual growth rate of modern contraceptive prevalence rates from an estimated 0·7 to 1·4 percentage points to achieve the goal. We examined the post-Summit trends in modern contraceptive prevalence rates in nine settings in eight sub-Saharan African countries (Burkina Faso; Kinshasa, DR Congo; Ethiopia; Ghana; Kenya; Niamey, Niger; Kaduna, Nigeria; Lagos, Nigeria; and Uganda). These settings represent almost 73% of the population of the 18 initial FP2020 commitment countries in the region. Methods We used data from 45 rounds of the Performance Monitoring and Accountability 2020 (PMA2020) surveys, which were all undertaken after 2012, to ascertain the trends in modern contraceptive prevalence rates among all women aged 15–49 years and all similarly aged women who were married or cohabitating. The analyses were done at the national level in five countries (Burkina Faso, Ethiopia, Ghana, Kenya, and Uganda) and in selected high populous regions for three countries (DR Congo, Niger, and Nigeria). We included the following as modern contraceptive methods: oral pills, intrauterine devices, injectables, male and female sterilisations, implants, condom, lactational amenorrhea method, vaginal barrier methods, emergency contraception, and standard days method. We fitted design-based linear and quadratic logistic regression models and estimated the annual rate of changes in modern contraceptive prevalence rates for each country setting from the average marginal effects of the fitted models (expressed in absolute percentage points). Additionally, we did a random-effects meta-analysis to summarise the overall results for the PMA2020 countries. Findings The annual rates of changes in modern contraceptive prevalence rates among all women of reproductive age (15–49 years) varied from as low as 0·77 percentage points (95% CI −0·73 to 2·28) in Lagos, Nigeria, to 3·64 percentage points (2·81 to 4·47) in Ghana, according to the quadratic model. The rate of change was also high (>1·4 percentage points) in Burkina Faso, Kinshasa (DR Congo), Kaduna (Nigeria), and Uganda. Although contraceptive use was rising rapidly in Ethiopia during the pre-Summit period, our results suggested that the yearly growth rate stalled recently (0·92 percentage points, 95% CI −0·23 to 2·07) according to the linear model. From the meta-analysis, the overall weighted average annual rate of change in modern contraceptive prevalence rates in all women across all nine settings was 1·92 percentage points (95% CI 1·14 to 2·70). Among married or cohabitating women, the annual rates of change were higher in most settings, and the overall weighted average was 2·25 percentage points (95% CI 1·37–3·13). Interpretations Overall, the annual growth rates exceeded the 1·4 percentage points needed to achieve the FP2020 goal of 120 million additional users of modern contraceptives by 2020 in the select study settings. Local programme experiences can be studied for lessons to be shared with other countries aiming to respond to unmet demands for family planning. The findings of this study have implications for the way progress is tracked toward achieving the FP2020 goal. Funding The Bill & Melinda Gates Foundation.
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Affiliation(s)
- Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Yoonjoung Choi
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jose G Rimon
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Bill & Melinda Gates Institute for Population and Reproductive Health, Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins Universiy, Baltimore, MD, USA
| | | | - Peter Gichangi
- International Center for Reproductive Health-Kenya, and Technical University of Mombasa, Mombasa, Kenya
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Patrick Kayembe
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Simon P Kibira
- Department of Community Health, Makerere University School of Public Health, Kampala, Uganda
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | | | - Elizabeth Omoluabi
- Center for Research, Evaluation Resources and Development, Ile-Ife, Osun State, Nigeria
| | - Easmon Otupiri
- Department of Population, Family and Reproductive Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sani Oumarou
- Institut National de la Statistique, Niamey, Niger
| | - Assefa Seme
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Shiferaw
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Philip Anglewicz
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Scott Radloff
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Amy Tsui
- Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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18
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Anglewicz P, Akilimali P, Eitmann LP, Hernandez J, Kayembe P. The relationship between interviewer-respondent familiarity and family planning outcomes in the Democratic Republic of Congo: a repeat cross-sectional analysis. BMJ Open 2019; 9:e023069. [PMID: 30670510 PMCID: PMC6348299 DOI: 10.1136/bmjopen-2018-023069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The typical approach of survey data collection is to use interviewers who are not from the study site and do not know the participants, yet the implications of this approach on data quality have seldom been investigated. We examine the relationship between interviewer-respondent familiarity and selected family planning outcomes, and whether this relationship changes over time between 2015 and 2016. SETTING We use data from the Performance Monitoring and Accountability 2020 Project in Kongo Central Province, Democratic Republic of Congo. PARTICIPANTS Participants include representative samples of women of reproductive ages (15 to 49), 1565 interviewed in 2015 and 1668 in 2016. The study used a two-stage cluster design: first randomly selecting enumeration areas (EAs), then randomly selecting households within each EA. DESIGN We first identify individual characteristics associated with familiarity between RE and respondent. Next, we examine the relationship between RE-respondent acquaintance and family planning outcomes. Finally, we use two waves of data to examine whether this relationship changes over time between 2015 and 2016. RESULTS In multivariate analysis, interviewer-respondent acquaintance is significantly associated with last birth unintended (OR 1.91, 95% CI 1.17 to 3.13) and reported infertility in 2015 (OR 2.26, 95% CI 1.03 to 4.95); and any contraceptive use (OR 1.51, 95% CI 1.01 to 2.28), traditional contraceptive use (OR 1.79, 95% CI 1.10 to 2.89), reported infidelity (OR 1.89, 95% CI 1.02 to 3.49) and age at first sex (coefficient -0.48, 95% CI -0.96 to -0.01) in 2016. The impact of acquaintance on survey responses changed over time for any contraceptive use (OR 2.09, 95% CI 1.33 to 3.30). CONCLUSIONS The standard in many large-scale surveys is to use interviewers from outside the community. Our results show that interviewer-respondent acquaintance is associated with a range of family planning outcomes; therefore, we recommend that the approach to hiring interviewers be examined and reconsidered in survey data collection efforts.
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Affiliation(s)
- Philip Anglewicz
- Department of Global Community Health and Behavioral Science, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Pierre Akilimali
- Faculty of Medicine, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
| | - Linnea Perry Eitmann
- Department of Global Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Julie Hernandez
- Department of Global Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Patrick Kayembe
- Division of Epidemiology and Biostatistics School of Public Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
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Akilimali P, Anglewicz P, Engale HN, Kurhenga GK, Hernandez J, Kayembe P, Bertrand J. Differences in family planning outcomes between military and general populations in Kinshasa, Democratic Republic of the Congo: a cross-sectional analysis. BMJ Open 2018; 8:e022295. [PMID: 30580261 PMCID: PMC6318504 DOI: 10.1136/bmjopen-2018-022295] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To examine family planning outcomes among women living in military camps in Kinshasa, Democratic Republic of the Congo, and compare these outcomes with a representative sample of non-military women in Kinshasa. PARTICIPANTS Women of reproductive ages, 15-49 years. We compare two populations: women living in military camps and the general (non-military) population in Kinshasa. STUDY DESIGN For sampling, we used a two-stage cluster sampling design, where we first randomly selected enumeration areas (EA), and then randomly selected women within each EA (separately for each of the two populations). We administered a survey on contraceptive use and family planning to all participating women. We use bivariate and multivariate analysis to compare these populations for a range of family planning outcomes. RESULTS We find many statistically significant differences between women in military camps and general female population of Kinshasa. Although they do not have more children, women in military camps are less likely to be using contraception (all methods OR 0.24, 95% CI 0.11 to 0.53; modern methods OR 0.25, 95% CI 0.08 to 0.79; traditional methods OR 0.41, 95% CI 0.24 to 0.71) and less knowledgeable about many family planning methods (less likely to have heard of implants (OR 0.23, 95% CI 0.11 to 0.48), injectables (OR 0.19, 95% CI 0.08 to 0.44), condoms (OR 0.23, 95% CI 0.12 to 0.47), withdrawal (OR 0.05, 95% CI 0.02 to 0.17) and rhythm (OR 0.12, 95% CI 0.03 to 0.44) methods), while at the same time they are more likely to want to limit their births (OR 5.17, 95% CI 2.52 to 10.62), and less likely to have obtained their preferred family planning method (OR 0.14, 95% CI 0.03 to 0.64). CONCLUSIONS Women in military camps in Kinshasa appear to be an important and underserved population with regard to family planning. Our results suggest that women in military camps have limited access to modern family planning methods.
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Affiliation(s)
- Pierre Akilimali
- Kinshasa School of Public Health, Universite de Kinshasa, Kinshasa, The Democratic Republic of the Congo
| | - Philip Anglewicz
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Henri Nzuka Engale
- Medical Division, Congolese Armed Forces, Kinshasa, The Democratic Republic of the Congo
| | | | - Julie Hernandez
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Patrick Kayembe
- Kinshasa School of Public Health, Universite de Kinshasa, Kinshasa, The Democratic Republic of the Congo
| | - Jane Bertrand
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
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Babazadeh S, Lea S, Kayembe P, Akilimali P, Eitmann L, Anglewicz P, Bertrand J. Assessing the contraceptive supply environment in Kinshasa, DRC: trend data from PMA2020. Health Policy Plan 2018; 33:155-162. [PMID: 29136172 PMCID: PMC5886263 DOI: 10.1093/heapol/czx134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2017] [Indexed: 11/23/2022] Open
Abstract
Performance Monitoring and Accountability 2020 (PMA2020) is a population-based and facility-based survey program conducted in 11 countries to track contraceptive use dynamics and the supply environment. Annual data collection provides trend data unavailable from any other source. Two-stage cluster sampling was used to select 58 enumeration areas in Kinshasa; data were collected in 2014, 2015 and 2016 from three to six service delivery points (SDPs) per EA. Of the 228–248 SDPs surveyed each year, only two-thirds reported to offer family planning (FP) services. Of those reporting to offer FP, one-fifth or more did not do so on the day of the survey. As of 2016, only one-half of SDPs offering FP had at least three methods available, a proxy for contraceptive choice; only one in five had at least five methods. Long-acting reversible contraceptives, including implants and IUDs, were less widely offered and more often stocked out than resupply methods, including condoms, pills and injectables. Contraceptive stockouts were rampant: in 2016, over a quarter of the SDPs experienced stockouts of all methods (except condoms) in the previous 3 months, and two of the three most widely used methods—implants and injectables—were also the most likely to be stocked out. The findings documented the inconsistency in pricing of methods across facilities; moreover, less than one quarter of SDPs posted prices. Patterns in the contraceptive supply environment remained relatively unchanged between 2014 and 2016. The PMA2020 SDP module provides timely, actionable information to the DRC government, FP implementing organizations and donors involved in FP service delivery in Kinshasa, DRC. Yet the value of this information will be determined by the ability of the local FP stakeholders to use it in bringing the needed improvements identified by this survey to the contraceptive supply environment.
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Affiliation(s)
- S Babazadeh
- Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112, USA and
| | - S Lea
- Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112, USA and
| | - P Kayembe
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - P Akilimali
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - L Eitmann
- Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112, USA and
| | - P Anglewicz
- Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112, USA and
| | - J Bertrand
- Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112, USA and
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Bankole A, Kayembe P, Chae S, Owolabi O, Philbin J, Mabika C. The Severity and Management of Complications Among Postabortion Patients Treated in Kinshasa Health Facilities. Int Perspect Sex Reprod Health 2018; 44:1-9. [PMID: 30138102 DOI: 10.1363/44e5618] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CONTEXT Unsafe abortion is common in Kinshasa, which contributes to high rates of maternal morbidity and mortality. Little is known about the complications and treatment experienced by women seeking postabortion care at health facilities in the city. METHODS Data from 867 women admitted to a sample of health facilities providing postabortion care in Kinshasa in 2016 were drawn from a Prospective Morbidity Survey. A measure of severity of postabortion complications was developed on the basis of information from these women and their primary care provider. Generalized ordered logistic regression analyses were used to examine associations between the characteristics of postabortion care patients and complication severity. RESULTS Nearly three-fourths (72%) of postabortion care patients were classified as certainly having had an induced abortion, and another 16% as probably having had one. Sixteen percent of postabortion care patients experienced severe complications, 46% moderate complications and 33% mild complications; 5% had no evidence of complications. Severity of complications was associated with certain patient characteristics: For example, poor patients and those who had never been married had elevated odds of having experienced severe or moderate complications rather than mild or no complications (odds ratios, 1.8-1.9). Patients' complications were most commonly treated with such outdated methods as dilation and curettage and digital curettage (49% and 23%, respectively); only 11% of patients received medication for pain. CONCLUSIONS Policies and programs promoting contraceptive use and safe legal abortion are needed in Kinshasa to reduce women's recourse to unsafe abortion. Improved quality postabortion care provision is also needed, including World Health Organization-recommended methods.
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Affiliation(s)
| | - Patrick Kayembe
- professor, Kinshasa School of Public Health, University of Kinshasa, DRC
| | - Sophia Chae
- senior research scientist, Guttmacher Institute, New York
| | | | | | - Crispin Mabika
- professor, Department of Population Sciences and Development, University of Kinshasa, DRC
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Bukabau J, Sumaili E, Cavalier E, Kayembe P, Makulo J, Mokoli V, Kifakiou B, Nkodila A, Engole Y, Lepira F, Nseka N, Delanaye P. Performance des équations d’estimation du débit de filtration glomérulaire chez l’adulte sain en Afrique centrale (Congo Kinshasa). Nephrol Ther 2017. [DOI: 10.1016/j.nephro.2017.08.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
The rapid population growth of many African cities has important implications for population health, yet little is known about factors contributing to increasing population, such as the fertility of internal migrants. We examine whether in-migrants to Kinshasa have different fertility patterns than lifetime Kinshasa residents, and identify characteristics of migrants that may explain differences in fertility. We also use detailed migration histories to examine whether fertility differs by features of migration. We use representative data from the PMA2020 Project for 2197 women in Kinshasa, including 340 women who moved to Kinshasa. We examine differences between migrants and non-migrants in fertility and other fertility-related characteristics. We also examine whether fertility differs by duration of residence in Kinshasa, number of lifetime moves, age at first migration, urban/rural classification of birthplace, and the distinction between intra-Kinshasa migration and migration to Kinshasa.. Migrants have significantly higher fertility than permanent Kinshasa residents, but the difference is relatively small in magnitude. This higher fertility appears due in part to patterns of contraceptive use among migrants. There is noteworthy heterogeneity among migrants: higher fertility among migrants is associated with longer duration in Kinshasa, more lifetime moves, urban-Kinshasa migration, older age at first migration, and moving to Kinshasa from outside (as opposed to intra-Kinshasa migration).
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Affiliation(s)
- Philip Anglewicz
- Department of Global Community Health and Behavioral Science, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St Suite 2210, New Orleans, LA USA
| | - Jamaica Corker
- Bill and Melinda Gates Foundation, 440 5th Ave N., Seattle, WA 98109 USA
| | - Patrick Kayembe
- Division of Epidemiology and Biostatistics School of Public Health, Kinshasa School of Public Health, University of Kinshasa, BP 11850 Kinshasa 1, Kinshasa, Democratic Republic of Congo
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Hernandez JH, Akilimali P, Kayembe P, Dikamba N, Bertrand J. The value of spatial analysis for tracking supply for family planning: the case of Kinshasa, DRC. Health Policy Plan 2016; 31:1058-68. [PMID: 27084735 DOI: 10.1093/heapol/czw036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2016] [Indexed: 11/12/2022] Open
Abstract
While geographic information systems (GIS) are frequently used to research accessibility issues for healthcare services around the world, sophisticated spatial analysis protocols and outputs often prove inappropriate and unsustainable to support evidence-based programme strategies in resource-constrained environments. This article examines how simple, open-source and interactive GIS tools have been used to locate family planning (FP) services delivery points in Kinshasa (Democratic Republic of Congo) and to identify underserved areas, determining the potential location of new service points, and to support advocacy for FP programmes. Using smartphone-based data collection applications (OpenDataKit), we conducted two surveys of FP facilities supported by partner organizations in 2012 and 2013 and used the results to assess gaps in FP services coverage, using both ratio of facilities per population and distance-based accessibility criteria. The cartographic outputs included both static analysis maps and interactive Google Earth displays, and sought to support advocacy and evidence-based planning for the placement of new service points. These maps, at the scale of Kinshasa or for each of the 35 health zones that cover the city, garnered a wide interest from the operational level of the health zones' Chief Medical Officers, who were consulted to contribute field knowledge on potential new service delivery points, to the FP programmes officers at the Ministry of Health, who could use the map to inform resources allocation decisions throughout the city.
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Affiliation(s)
- Julie H Hernandez
- Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112, USA
| | - Pierre Akilimali
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Patrick Kayembe
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Nelly Dikamba
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Jane Bertrand
- Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112, USA
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Kayembe P, Babazadeh S, Dikamba N, Akilimali P, Hernandez J, Binanga A, Bertrand JT. Family Planning Supply Environment in Kinshasa, DRC: Survey Findings and Their Value in Advancing Family Planning Programming. Glob Health Sci Pract 2015; 3:630-45. [PMID: 26681709 PMCID: PMC4682587 DOI: 10.9745/ghsp-d-15-00298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 11/18/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Modern contraceptive prevalence was 14.1% in 2007 in Kinshasa, the capital city of the Democratic Republic of the Congo (DRC). Yet virtually nothing was known about the family planning supply environment. METHODS Three surveys of health facilities were conducted in 2012, 2013, and 2014 to determine the number, spatial distribution, and attributes of sites providing family planning services. The 2012 and 2013 surveys aimed to identify the universe of family planning facilities while obtaining a limited set of data on "readiness" to provide family planning services (defined as having at least 3 modern methods, at least 1 person training in family planning in the last 3 years, and an information system to track distribution of products to clients) and output (measured by couple-years of protection, or CYP). In contrast, the 2014 survey, conducted under the umbrella of the Performance Monitoring and Accountability 2020 (PMA2020) project, was based on 2-stage cluster sampling. This article provides detailed analysis of the 2012 and 2013 surveys, including bivariate and multivariate analysis of correlates of readiness to provide services and of output. RESULTS We identified 184 health facilities that reported providing at least 1 contraceptive method in 2012 and 395 facilities in 2013. The percentage of sites defined as "ready" to provide services increased from 44.1% in 2012 to 63.3% in 2013. For the 3-month period between January and March 2013, facilities distributed between 0 and 879.2 CYP (mean, 39.7). Nearly half (49%) of the CYP was attributable to implants, followed by IUDs (24%), CycleBeads (11%), and injectables (8%). In 2013, facilities supported by PEPFAR (n = 121) were more likely than other facilities to be rated as ready to provide services (P<.0001); however, PEPFAR-supported sites generated less CYP on average than sites supported by family planning implementing agencies (P<.0001). Multivariate analysis showed 3 variables were associated with CYP: type of health facility, length of time in operation, and number of contraceptive methods available. Clinics generated higher (3-month) CYP than hospitals and health centers by 65.3 and 61.5 units, respectively (P<.01). The mean CYP for facilities in operation for 4-6 years was 26.9 units higher (P<.05), and 50.2 units higher for those operating 7+ years (P<.01), than the reference group of facilities in operation for 1 year or less. For each additional method available at a facility, CYP increased by almost 8 units (P<.01). CONCLUSIONS Findings from these surveys suggest that lack of physical access is not the defining reason for low contraceptive use in Kinshasa, although it is highly likely that other service-related factors contribute to low service utilization. The results contributed to increasing the momentum for family planning in the DRC in many ways, including mobilizing partners to increase contraceptive access and increasing donor investment in family planning in the DRC.
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Affiliation(s)
- Patrick Kayembe
- University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Saleh Babazadeh
- Tulane School of Public Health and Tropical Medicine, Department of Global Health Management and Policy, New Orleans, LA, USA
| | - Nelly Dikamba
- University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Pierre Akilimali
- University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Julie Hernandez
- Tulane School of Public Health and Tropical Medicine, Department of Global Health Management and Policy, New Orleans, LA, USA
| | - Arsene Binanga
- Tulane International LLC, Kinshasa, Democratic Republic of Congo
| | - Jane T Bertrand
- Tulane School of Public Health and Tropical Medicine, Department of Global Health Management and Policy, New Orleans, LA, USA
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Bertrand JT, Kayembe P, Dikamba N, Mafuta E, Hernandez J, Hellen J, Binanga A. Using mapping of service delivery sites to increase contraceptive availability in Kinshasa, Democratic Republic of the Congo. Int Perspect Sex Reprod Health 2014; 40:95-9. [PMID: 25051581 DOI: 10.1363/4009514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jane T Bertrand
- Professor, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA,
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Nachega JB, Uthman OA, Ho YS, Lo M, Anude C, Kayembe P, Wabwire-Mangen F, Gomo E, Sow PS, Obike U, Kusiaku T, Mills EJ, Mayosi BM, IJsselmuiden C. Current status and future prospects of epidemiology and public health training and research in the WHO African region. Int J Epidemiol 2012; 41:1829-46. [PMID: 23283719 PMCID: PMC3535755 DOI: 10.1093/ije/dys189] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2012] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND To date little has been published about epidemiology and public health capacity (training, research, funding, human resources) in WHO/AFRO to help guide future planning by various stakeholders. METHODS A bibliometric analysis was performed to identify published epidemiological research. Information about epidemiology and public health training, current research and challenges was collected from key informants using a standardized questionnaire. RESULTS From 1991 to 2010, epidemiology and public health research output in the WHO/AFRO region increased from 172 to 1086 peer-reviewed articles per annum [annual percentage change (APC) = 10.1%, P for trend < 0.001]. The most common topics were HIV/AIDS (11.3%), malaria (8.6%) and tuberculosis (7.1%). Similarly, numbers of first authors (APC = 7.3%, P for trend < 0.001), corresponding authors (APC = 8.4%, P for trend < 0.001) and last authors (APC = 8.5%, P for trend < 0.001) from Africa increased during the same period. However, an overwhelming majority of respondents (>90%) reported that this increase is only rarely linked to regional post-graduate training programmes in epidemiology. South Africa leads in publications (1978/8835, 22.4%), followed by Kenya (851/8835, 9.6%), Nigeria (758/8835, 8.6%), Tanzania (549/8835, 6.2%) and Uganda (428/8835, 4.8%) (P < 0.001, each vs South Africa). Independent predictors of relevant research productivity were 'in-country numbers of epidemiology or public health programmes' [incidence rate ratio (IRR) = 3.41; 95% confidence interval (CI) 1.90-6.11; P = 0.03] and 'number of HIV/AIDS patients' (IRR = 1.30; 95% CI 1.02-1.66; P < 0.001). CONCLUSIONS Since 1991, there has been increasing epidemiological research productivity in WHO/AFRO that is associated with the number of epidemiology programmes and burden of HIV/AIDS cases. More capacity building and training initiatives in epidemiology are required to promote research and address the public health challenges facing the continent.
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Affiliation(s)
- Jean B Nachega
- Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburgh, PA, USA, Centre for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa, Primary Care Sciences, Keele University, Keele, UK, Trend Research Centre, Asia University, Taichung, Taiwan, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, School of Public Health, Makerere University, Kampala, Uganda, University of Zimbabwe, Harare, Zimbabwe, University of Dakar, Dakar, Senegal, Department of Pediatrics, Universite of Lome, Lome, Togo, Centre for Global Health, University of Ottawa, Ottawa, Canada, Council on Health Research for Development (COHRED), Geneva, Switzerland and School of Psychology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Olalekan A Uthman
- Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburgh, PA, USA, Centre for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa, Primary Care Sciences, Keele University, Keele, UK, Trend Research Centre, Asia University, Taichung, Taiwan, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, School of Public Health, Makerere University, Kampala, Uganda, University of Zimbabwe, Harare, Zimbabwe, University of Dakar, Dakar, Senegal, Department of Pediatrics, Universite of Lome, Lome, Togo, Centre for Global Health, University of Ottawa, Ottawa, Canada, Council on Health Research for Development (COHRED), Geneva, Switzerland and School of Psychology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Yuh-Shan Ho
- Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburgh, PA, USA, Centre for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa, Primary Care Sciences, Keele University, Keele, UK, Trend Research Centre, Asia University, Taichung, Taiwan, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, School of Public Health, Makerere University, Kampala, Uganda, University of Zimbabwe, Harare, Zimbabwe, University of Dakar, Dakar, Senegal, Department of Pediatrics, Universite of Lome, Lome, Togo, Centre for Global Health, University of Ottawa, Ottawa, Canada, Council on Health Research for Development (COHRED), Geneva, Switzerland and School of Psychology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Melanie Lo
- Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburgh, PA, USA, Centre for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa, Primary Care Sciences, Keele University, Keele, UK, Trend Research Centre, Asia University, Taichung, Taiwan, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, School of Public Health, Makerere University, Kampala, Uganda, University of Zimbabwe, Harare, Zimbabwe, University of Dakar, Dakar, Senegal, Department of Pediatrics, Universite of Lome, Lome, Togo, Centre for Global Health, University of Ottawa, Ottawa, Canada, Council on Health Research for Development (COHRED), Geneva, Switzerland and School of Psychology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Chuka Anude
- Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburgh, PA, USA, Centre for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa, Primary Care Sciences, Keele University, Keele, UK, Trend Research Centre, Asia University, Taichung, Taiwan, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, School of Public Health, Makerere University, Kampala, Uganda, University of Zimbabwe, Harare, Zimbabwe, University of Dakar, Dakar, Senegal, Department of Pediatrics, Universite of Lome, Lome, Togo, Centre for Global Health, University of Ottawa, Ottawa, Canada, Council on Health Research for Development (COHRED), Geneva, Switzerland and School of Psychology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Patrick Kayembe
- Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburgh, PA, USA, Centre for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa, Primary Care Sciences, Keele University, Keele, UK, Trend Research Centre, Asia University, Taichung, Taiwan, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, School of Public Health, Makerere University, Kampala, Uganda, University of Zimbabwe, Harare, Zimbabwe, University of Dakar, Dakar, Senegal, Department of Pediatrics, Universite of Lome, Lome, Togo, Centre for Global Health, University of Ottawa, Ottawa, Canada, Council on Health Research for Development (COHRED), Geneva, Switzerland and School of Psychology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Fred Wabwire-Mangen
- Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburgh, PA, USA, Centre for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa, Primary Care Sciences, Keele University, Keele, UK, Trend Research Centre, Asia University, Taichung, Taiwan, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, School of Public Health, Makerere University, Kampala, Uganda, University of Zimbabwe, Harare, Zimbabwe, University of Dakar, Dakar, Senegal, Department of Pediatrics, Universite of Lome, Lome, Togo, Centre for Global Health, University of Ottawa, Ottawa, Canada, Council on Health Research for Development (COHRED), Geneva, Switzerland and School of Psychology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Exnevia Gomo
- Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburgh, PA, USA, Centre for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa, Primary Care Sciences, Keele University, Keele, UK, Trend Research Centre, Asia University, Taichung, Taiwan, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, School of Public Health, Makerere University, Kampala, Uganda, University of Zimbabwe, Harare, Zimbabwe, University of Dakar, Dakar, Senegal, Department of Pediatrics, Universite of Lome, Lome, Togo, Centre for Global Health, University of Ottawa, Ottawa, Canada, Council on Health Research for Development (COHRED), Geneva, Switzerland and School of Psychology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Papa Salif Sow
- Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburgh, PA, USA, Centre for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa, Primary Care Sciences, Keele University, Keele, UK, Trend Research Centre, Asia University, Taichung, Taiwan, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, School of Public Health, Makerere University, Kampala, Uganda, University of Zimbabwe, Harare, Zimbabwe, University of Dakar, Dakar, Senegal, Department of Pediatrics, Universite of Lome, Lome, Togo, Centre for Global Health, University of Ottawa, Ottawa, Canada, Council on Health Research for Development (COHRED), Geneva, Switzerland and School of Psychology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Ude Obike
- Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburgh, PA, USA, Centre for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa, Primary Care Sciences, Keele University, Keele, UK, Trend Research Centre, Asia University, Taichung, Taiwan, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, School of Public Health, Makerere University, Kampala, Uganda, University of Zimbabwe, Harare, Zimbabwe, University of Dakar, Dakar, Senegal, Department of Pediatrics, Universite of Lome, Lome, Togo, Centre for Global Health, University of Ottawa, Ottawa, Canada, Council on Health Research for Development (COHRED), Geneva, Switzerland and School of Psychology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Theophile Kusiaku
- Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburgh, PA, USA, Centre for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa, Primary Care Sciences, Keele University, Keele, UK, Trend Research Centre, Asia University, Taichung, Taiwan, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, School of Public Health, Makerere University, Kampala, Uganda, University of Zimbabwe, Harare, Zimbabwe, University of Dakar, Dakar, Senegal, Department of Pediatrics, Universite of Lome, Lome, Togo, Centre for Global Health, University of Ottawa, Ottawa, Canada, Council on Health Research for Development (COHRED), Geneva, Switzerland and School of Psychology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Edward J Mills
- Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburgh, PA, USA, Centre for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa, Primary Care Sciences, Keele University, Keele, UK, Trend Research Centre, Asia University, Taichung, Taiwan, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, School of Public Health, Makerere University, Kampala, Uganda, University of Zimbabwe, Harare, Zimbabwe, University of Dakar, Dakar, Senegal, Department of Pediatrics, Universite of Lome, Lome, Togo, Centre for Global Health, University of Ottawa, Ottawa, Canada, Council on Health Research for Development (COHRED), Geneva, Switzerland and School of Psychology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Bongani M Mayosi
- Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburgh, PA, USA, Centre for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa, Primary Care Sciences, Keele University, Keele, UK, Trend Research Centre, Asia University, Taichung, Taiwan, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, School of Public Health, Makerere University, Kampala, Uganda, University of Zimbabwe, Harare, Zimbabwe, University of Dakar, Dakar, Senegal, Department of Pediatrics, Universite of Lome, Lome, Togo, Centre for Global Health, University of Ottawa, Ottawa, Canada, Council on Health Research for Development (COHRED), Geneva, Switzerland and School of Psychology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Carel IJsselmuiden
- Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa, Department of Epidemiology, Infectious Diseases Program, Pittsburgh University, Graduate School of Public Health, Pittsburgh, PA, USA, Centre for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa, Primary Care Sciences, Keele University, Keele, UK, Trend Research Centre, Asia University, Taichung, Taiwan, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, School of Public Health, Makerere University, Kampala, Uganda, University of Zimbabwe, Harare, Zimbabwe, University of Dakar, Dakar, Senegal, Department of Pediatrics, Universite of Lome, Lome, Togo, Centre for Global Health, University of Ottawa, Ottawa, Canada, Council on Health Research for Development (COHRED), Geneva, Switzerland and School of Psychology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
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Adamopoulos D, Ngatchou W, Lemogoum D, Janssen C, Beloka S, Lheureux O, Kayembe P, Argacha JF, Degaute JP, van de Borne P. Intensified large artery and microvascular response to cold adrenergic stimulation in African blacks. Am J Hypertens 2009; 22:958-63. [PMID: 19521343 DOI: 10.1038/ajh.2009.106] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Arterial stiffening is more accelerated in blacks than in whites. Whether this is attributed to an enhanced vascular reactivity to environmental stress stimulation remains unknown. We therefore decided to test the hypothesis that cold pressor test (CPT) elicits a greater increase in arterial stiffness and an enhanced sympathetic skin vasoconstriction in African blacks than in whites normotensives. METHODS A total of 17 young normotensive African blacks and 17 normotensive whites were recruited. All underwent continuous assessment of blood pressure (BP), heart rate, and carotid-femoral pulse wave velocity (PWVc-f) at rest, during and after hand immersion in iced water (CPT). Concomitantly, skin microvascular blood flow was monitored by laser Doppler flowmetry on the opposite hand. RESULTS At baseline, African blacks exhibited higher values of PWVc-f than whites (7.2 +/- 0.3 vs. 6.5 +/- 0.2 m/s, respectively, P = 0.04). During CPT the increases in systolic BP and PWVc-f were greater in African blacks than in whites (systolic BP 17 +/- 2 mm Hg vs. 9 +/- 3 mm Hg, P < 0.001 and PWVc-f 0.62 +/- 0.1 m/s vs. 0.26 +/- 0.1 m/s, P = 0.03, respectively). However, there was no significant difference in the PWVc-f responses among the groups during CPT after adjustment for the increments in mean BP. Finally, CPT induced a more pronounced skin microvascular vasoconstriction in African blacks than in whites (-54.4 +/- 5 % vs. -31.3 +/- 6 %, P < 0.001). CONCLUSIONS CPT provokes a more pronounced increase in PWVc-f in normotensive African blacks than in whites, that appears to be due to a greater increase in mean BP. Additionally, African blacks present an intensified skin microvascular response to the CPT as compared to their whites counterparts.
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Adamopoulos D, Ngatsou W, Lemogoum D, Biholong B, Beloka S, Lheureux O, Kayembe P, Degaute J, van de Borne P. P1.13 ENHANCED VASCULAR REACTIVITY TO COLD PRESSOR TEST IN AFRICAN NORMOTENSIVE SUBJECTS. Artery Res 2008. [DOI: 10.1016/j.artres.2008.08.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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