Acceptability of the menstrual cup among students in further education institutions in KwaZulu-Natal, South Africa

OBJECTIVE

The primary objective of this research was to evaluate long-term user acceptability of menstrual cups in a student population in South Africa.

METHODS

A cohort of female students aged 18-24 years attending 10 further education institutions including 22 campus sites in KwaZulu-Natal, South Africa, were offered menstrual cups after receiving education and training in their use. The students were followed for up to 12 months to assess menstrual cup acceptability, user experiences and continuation.

RESULTS

A total of 509 students were enrolled. Disposable pads were the primary menstrual hygiene product used in the 3 months prior to the baseline interview (95.5%, n = 486), and 8.1% (n = 41) of students reported that they had used toilet paper or newspapers. Of the 463 (91%) students interviewed at 1 month follow-up, 86% reported that they had tried to use the menstrual cup. There was mixed reporting on ease of insertion and removal on first use. Of those who attempted use, half (49.5%, n = 197) reported that inserting the menstrual cup on first use was very easy or quite easy. Of those who did not find it easy, 80% reported that two to three insertions were required to achieve comfort. A maximum of five insertions was mentioned to achieve comfort. The majority who had used the cup (>90%) reported they would continue to use it at each follow-up visit.

CONCLUSION

The menstrual cup was well accepted among this student population and should be considered as a cost-effective and environmentally sustainable option in menstrual health management initiatives in South Africa.

Lessons from the evaluation of the South African National Female Condom Programme

BACKGROUND

Understanding of the facilitators and challenges to female condom (FC) uptake has been limited due to lack of evaluation of national FC programmes.

SETTING

The FC has been an integral component of South Africa's (SA) HIV prevention programme for 20 years and is the largest government-funded FC programme worldwide.

METHODS

The national FC evaluation used a mixed-methods approach and consisted of key informant interviews and a telephone survey in a national sample of public and non-public sites. A sub-sample of sites participated in client and provider interviews, and a self-administered client survey. A review of distribution statistics from South Africa's District Health Information System was also conducted.

RESULTS

All 256 public-sector and 28 non-public-sector facilities reported having ever distributed FCs. Less than 5% of these facilities reported stock-outs and less than 3% reported they had a supply of expired female condoms. Systems for male condom (MC) and FC distribution were complementary, with similar ordering, delivery and reporting processes. FC promotion by providers (n = 278) varied with regard to FC training, whether attitudes about FCs influenced providers offer of FCs, and how they counselled clients about FCs. Of the 4442 self-administered client surveys in 133 facilities, similar proportions of women (15.4%) and men (15.2%) had ever used FCs. Although FCs were available at almost all sites surveyed, only two-thirds of clients were aware of their availability.

CONCLUSION

Data highlight the role of providers as gatekeepers to FC access in public and non-public sectors and provide support for further FC programme expansion in SA and globally.

Offering choice in female condoms: The South African experience

South Africa (SA) has an integrated male and female condom (FC) programme. Since 2014, the programme has introduced two new FC brands. This study evaluated the early introduction of the availability of new FCs. Twenty-three sites participating in the National SA Female Condom Evaluation were included. Providers and clients completed interviewer-administered questionnaires assessing FC brand availability, length of distribution, how clients are informed about new FCs and reactions to the choice of more than one FC. A total of 55 providers and 51 clients were interviewed. Although all 23 sites reported they had distributed new FCs, only one had all three types available. Almost all providers (96%) thought it was important to increase choice, although some (27%) worried that having different FCs may confuse clients. Almost all clients (96%) felt it was important to increase the choice of FCs, and most women (80%) felt that using one type of FC would make it easy to use another type. Providers called for more brand-specific Information, Education and Communication (IEC) training for themselves and the community. Providers and clients seem to be very positive about the choice of FCs. Providers recommended more support in the form of IEC materials and training to assist in the provision of the expansion of FC brands.

Disease profile of children under 5 years attending primary health care clinics in a high HIV prevalence setting in South Africa

OBJECTIVE

To describe the presenting complaints and disease profile of children attending primary health care (PHC) clinics in two provinces of South Africa.

METHODS

Participants were sick children 2-59 months old presenting for care at PHC clinics in KwaZulu-Natal (KZN) and Limpopo provinces from 2006-2007. Children were assessed by an expert Integrated Management of Childhood Illnesses (IMCI) practitioner. Children for whom parental/guardian consent was obtained were tested for HIV.

RESULTS

A total of 1357 children attending one of 74 clinics were assessed. HIV seroprevalence overall was 7.1%, but was significantly higher in KZN than Limpopo (7.5 vs. 2.4%; OR = 3.3, 95%CI 1.9-5.8%). Commonest presenting complaints were cough (72%), skin conditions (22%) and diarrhoea (19%). Of 1349 children, 120 (8.9%) had a weight below the third percentile; 108/1357 (8.0%) children required urgent referral, most commonly for severe pneumonia (53.7%) and severe malnutrition (16.7%). In multivariate analyses, severe pneumonia, growth faltering and urgent referral were independently associated with younger age, residence in KZN and HIV infection (P < 0.05).

CONCLUSIONS

Many children with severe illnesses and undiagnosed HIV infection present to PHC facilities. PHC staff require skills to correctly manage these conditions and undertake HIV testing. Although IMCI provides evidence-based guidelines, implementation must be improved to achieve adequate coverage of life-saving interventions.

Paediatric HIV management at primary care level: an evaluation of the integrated management of childhood illness (IMCI) guidelines for HIV

Background

Integrated Management of Childhood Illness (IMCI) is a WHO/UNICEF strategy to improve child survival in resource poor settings. South Africa adopted IMCI in 1997, and IMCI guidelines were adapted to include identification and management of HIV infected and exposed children. This study describes the validity of the IMCI/HIV algorithm when used by IMCI experts, the use of IMCI/HIV guidelines by IMCI trained health workers in routine clinical practice, and the burden of HIV among children under 5 years attending first level health facilities.

Methods

Seventy seven randomly selected IMCI trained health workers were observed in 74 health facilities in two provinces of South Africa. Consultations were observed with 1357 sick children; each child was reassessed by an IMCI expert to confirm the correct findings. Consent was requested for HIV testing of all children who attended with a parent or legal guardian. Positive rapid HIV tests were confirmed with HIV PCR in children aged less than 18 months. HIV positive children had a CD4 count and HIV clinical staging done.

Results

Of 1064 children with HIV results available, 76 (7.1% CI: 5.7% - 8.9%) children were confirmed HIV positive. IMCI experts using the HIV algorithm classified 54/76 (71.1% CI: 59.5%-80.9%) HIV positive children as suspected symptomatic HIV, and 15/22 remaining HIV positive children were identified as HIV exposed. Therefore, 69/76 (90.8% CI: 81.9-96.2) HIV infected children were identified by IMCI experts. No classification was made for HIV by observed health workers in 899/1357(66.2%) children.

906/1243(72.9%) mothers had been tested previously for HIV, of whom 221(24.4%) reported testing positive. Of 221 children therefore identified as HIV exposed, only 78(35.3%) had been tested for HIV within routine services.

Conclusion

The HIV algorithm is a valid tool for identifying HIV infected and exposed children when correctly and comprehensively implemented. However, it is not being used by IMCI trained health workers in routine practise, leading to a failure to implement life saving interventions.