Sexual Reproductive Health and Rights Repository (Aga Khan University)
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Home based postpartum care and determinants in Ethiopia: A multilevel analysis
Get PDFIntroduction:
Neonatal mortality remains a persisting public health challenge in Ethiopia. Timely intervention to neonatal morbidity and early neonatal care visit could reduce the burden of mortality. Studies related to home based postnatal care is limited in Ethiopia. Therefore, this study aimed to assess home based postnatal care visits and determinants in Ethiopia.
Methods:
A secondary data analysis using 2016 EDHS data was conducted among 7590 women who had live births two years preceding the survey. A multilevel mixed-effect logistic regression analysis model was used and those variables with a P-value ≤ of 0.05 in multivariable analysis were considered as predictors. Results: Home based postpartum care by health care providers was 6.3% and 67.9% of women gave birth at home. Women perceived that distance is not big problem [AOR = 1.37; 95% CI: 1.06, 1.68], richer wealth index [AOR = 1.69; 95% CI: 1.15, 2.48], attending antenatal care visit [AOR = 2.17; 95% CI:1.57, 2.99], giving birth in health institution [AOR = 2.07; 95% CI:1.53, 2.80], giving birth by cesarean section [AOR = 3.41; 95% CI: 2.33, 4.99], and having awareness about neonatal danger sign [AOR = 3.68; 95% CI: 2.90,4.70] were factors associated with home based postpartum care.
Conclusion:
Home based care by health care providers was low. Therefore, measures should be taken in increasing the number of nearby health care facility, strengthen the continuum of care on antenatal care follow-up, institutional delivery and improve mother’s knowledge about neonatal danger sign
Effectiveness and safety of gonadotropins used in female infertility: a population-based study in the Lazio region, Italy
Get PDFPurpose:
Infertility is a topic of growing interest, and female infertility is often treated with gonadotropins. Evidence regarding comparative safety and efficacy of different gonadotropin formulations is available from clinical studies, while real-world data are missing. The present study aims to investigate effectiveness and safety of treatment with different gonadotropin formulations in women undergoing medically assisted procreation treatments in Latium, a region in central Italy, through a real-world data approach.
Methods:
A retrospective population-based cohort study in women between the ages of 18 and 45 years who were prescribed with at least one gonadotropin between 2007 and 2019 was conducted. Women were enrolled from the regional drug dispense registry, and data on their clinical history, exposure to therapeutic cycles (based on recombinant “REC” or extractives “EXT” gonadotropin, or combined protocol “CMD” (REC + EXT)), and maternal/infantile outcomes were linked from the regional healthcare administrative databases. Multivariate logistic regression models were applied to estimate the association between exposure and outcomes.
Results:
Overall, 90,292 therapeutic cycles prescribed to 35,899 women were linked to pregnancies. Overall, 15.8% of cycles successfully led to pregnancy. Compared to extractives, recombinant and combined treatments showed a stronger association with conception rate (RRREC adj = 1.06, 95% CI: 1.01–1.12; RRCBD adj = 1.17, 95% CI: 1.11–1.24). Maternal outcomes occurred in less than 5% of deliveries, and no significant differences between treatments were observed (REC vs EXT, pre-eclampsia: RR adj = 1.24, 95% CI: 0.86–1.79, ovarian hyperstimulation syndrome: RR adj = 1.25, 95% CI: 0.59–2.65, gestational diabetes: RR adj = 1.06, 95% CI: 0.84–1.35). Regarding infantile outcomes, similar results were obtained for different gonadotropin formulations (REC vs EXT: low birth weight: RR adj = 0.98, 95% CI: 0.83–1.26, multiple births: RR adj = 1.06, 95% CI: 0.92–1.23, preterm birth: RR adj = 1.03, 95% CI: 0.92–1.26).
Conclusions:
Efficacy and safety profiles of REC proved to be similar to those of EXT. Regarding the efficacy in terms of conception rate and birth rate, protocols using the combined approach performed slightly better. Outcomes related to maternal and infantile safety were generally very rare, and safety features were overlapping between gonadotropin formulations
Psychometric properties of the Danish version of the questionnaire professionals’ attitudes towards addressing sexual health (PA-SH-D)
Get PDFBackground:
Health professionals’ attitudes towards addressing sexual health are important to promote patients’ sexual health. Therefore, measurement of health professionals’ attitudes towards addressing sexual health is essential.
Aim:
This study aimed to adapt the questionnaire Students’ Attitudes towards Addressing Sexual Health (SA-SH-D) to health professionals working with rehabilitation in Danish municipalities and evaluated psychometric properties of the adapted questionnaire: The Danish Version of the Professionals’ Attitudes towards Addressing Sexual Health (PA-SH-D).
Methods:
The SA-SH-D was adapted to PA-SH-D and a face validity evaluation focusing on phrasing, functionality, perception and relevance was done. In a pilot study, the PA-SH-D was answered by health professionals and internal consistency reliability and floor and ceiling effects were evaluated.
Outcomes:
Face validity included phrasing, functionality, perception and relevance of the items in PA-SH-D, internal consistency with Cronbach's alpha in the total scale and floor and ceiling effects.
Results:
Face validity of the PA-SH-D was acceptable. The sample size was 52 health professionals working with rehabilitation, the internal consistency reliability (Cronbach's alpha: 0.89 [lower confidence interval {CI}: 0.85]) and floor and ceiling effects (0.0%–13.7%) of the PA-SH-D were acceptable.
Clinical translation:
As sexual health is important in human quality of life, the validation of the PA-SH-D is highly valuable as it evaluates health professionals’ attitudes towards addressing sexual health, and thereby is able to measure the need for education and training in sexual health and detect changes in attitudes following an educational intervention.
Strengths and limitations:
Strengths were that the PA-SH-D measures both attitudes and competences and covered a need in clinical practice. The recruitment was broad and we used the work of others to orient this work. Limitations were that this study covered a preliminary psychometric evaluation and a thorough evaluation covering other aspects of psychometry should be done. We used both paper-based and online-based survey which possibly could cause bias. The study had a relatively small sample size. Comparing health professionals to students can be seen as both a limitation and a strength.
Conclusion:
The results in face validity and internal consistency reliability indicate usefulness of the PA-SH-D to measure health professionals’ attitudes towards addressing sexual health. Further evaluation of psychometric properties of the PA-SH-D is recommended
‘Healthy relationships’ campaign: preventing and addressing family and gender-based violence
Get PDFThis article explores the approach utilized by Military Family Services (MFS), a division of Canadian Forces Morale and
Welfare Services, to develop and implement a campaign focused on supporting and promoting healthy intimate relationships for Canadian Armed Forces (CAF) families. MFS redesigned a family violence campaign with the intention
of modelling positive and healthy relationships and related behaviours and demonstrating how military members and
their families could adopt such behaviours. The “Healthy Relationships” campaign is a significant departure from previous initiatives that focused solely on family violence and more directly on physical violence. Th e campaign intended to
widen the understanding of family violence, reduce the stigma associated with seeking support, and increase awareness
of the range of relevant services and programs available. Th e campaign adopted a reflective approach that encouraged
the CAF community and families to reflect on the health of their relationships and to learn from other couples who
faced and overcame relationship challenges. The article discusses the campaign approach and collaborative and creative
processes, including the engagement of military and Veteran families. Lessons learned and campaign metrics are also
highlighted, while exploring the shift in narrative and messaging to the CAF on family violence. The article also provides insights for those working in the family and gender-based violence fields
The diagnostic value of core needle biopsy in cervical cancer: A retrospective analysis
Get PDFCervical carcinoma is a major cause of morbidity and mortality among women worldwide. Histological subtype, lymphovascular space invasion and tumor grade could have a prognostic and predictive value for patients’ outcome and the knowledge of these histologic characteristics may influence clinical decision making. However, studies evaluating the diagnostic value of various biopsy techniques regarding these parameters of cervical cancer are scarce. We reviewed 318 cases of cervical carcinoma with available pathology reports from preoperative core needle biopsy (CNB) assessment and from final postoperative evaluation of the hysterectomy specimen. Setting the postoperative comprehensive pathological evaluation as reference, we analysed CNB assessment of histological tumor characteristics. In addition, we performed multivariable logistic regression to identify factors influencing the accuracy in identifying LVSI and tumor grade. CNB was highly accurate in discriminating histological subtype. Sensitivity and specificity were 98.8% and 89% for squamous cell carcinoma, 92.9% and 96.6% for adenocarcinoma, 33.3% and 100% in adenosquamous carcinoma respectively. Neuroendocrine carcinoma was always recognized correctly. The accuracy of the prediction of LVSI was 61.9% and was positively influenced by tumor size in preoperative magnetic resonance imaging and negatively influenced by strong peritumoral inflammation. High tumor grade (G3) was diagnosed accurately in 73.9% of cases and was influenced by histological tumor type. In conclusion, CNB is an accurate sampling technique for histological classification of cervical cancer and represents a reasonable alternative to other biopsy techniques
Quality of care for abortion-related complications: insights from the WHO multi-country survey on abortion-related morbidity across 11 African countries
Get PDFRisk factors for lower extremity lymphedema after cervical cancer treatment: a systematic review and meta-analysis
Get PDFBackground:
The main risk factors for the development of lower extremity lymphedema after cervical cancer treatment are controversial. Our aim was to evaluate the main risk factors of lower extremity lymphedema after cervical cancer treatment.
Methods:
We searched the English database PubMed, Embase, Medline, Central and the Chinese database CNKI to obtain relevant studies. Inclusion criteria: (I) the subjects were cervical cancer patients receiving treatment; (II) cohort studies or case-control studies; (III) exposure factors were not limited; (IV) the outcome was lower extremity lymphedema after treatment; (V) the odds ratio (OR) value and 95% confidence interval of exposure factors can be obtained. The chi-square test was used to test for heterogeneity. The Egger test was used to test for publication bias. OR (95% CI) was calculated using inverse variance.
Results:
A total of 12 retrospective studies with a total of 3,401 patients were included in this literature review. The incidence of lower extremity lymphedema after cervical cancer treatment was between 12.6% and 43.1%. Meta-analysis results demonstrated that the main risk factors were: body mass index (BMI) (OR =1.37, 95% CI: 1.10–1.71, P=0.005), age (OR =1.68, 95% CI: 1.07–2.64, P=0.02), International Federation of Gynecology and Obstetrics (FIGO) stage (OR =1.50, 95% CI: 1.24–1.82, P0.05).
Conclusions:
BMI, age, FIGO stage, radiotherapy, LN dissection and the number of LNs removed are the main risk factors for lower extremity lymphedema after cervical cancer treatment. When treating patients with cervical cancer, effective interventions should be sought to reduce the risk of lower extremity edema
Low rates of HPV vaccination and cervical cancer screening: challenges and opportunities in the context of the COVID-19 pandemic
Get PDFThis invited commentary discusses the article by Richards et al. describing differences in rates of on-time HPV vaccination and cervical cancer screening in 2018 among enrollees in different insurance plans. The commentary focuses on the larger problem of low vaccination HPV rates and decreasing cervical cancer screening rates seen across all sectors. We outline challenges posed by the COVID-19 pandemic on HPV vaccination and cervical cancer screening, and discuss opportunities to improve cervical cancer prevention
Exploring health care providers’ experiences of and perceptions towards the use of misoprostol for management of second trimester incomplete abortion in Central Uganda
Get PDFIntroduction:
Women living in low- and middle-income countries still have limited access to quality second trimester post abortion care. We aim to explore health care providers’ experiences of and perceptions towards the use of misoprostol for management of second trimester incomplete abortion.
Methods:
This qualitative study used the phenomenology approach. We conducted 48 in-depth interviews for doctors and midwives at 14 public health facilities in central Uganda using a flexible interview guide. We used inductive content analysis and made code frequencies based on health care provider cadre, and health facility level and then abstracted themes from categories.
Results:
Well trained midwives were perceived as competent to manage second trimester post abortion care stable patients, however doctor’s supervision in case of complications was considered important. Sometimes, midwives were seen as offering better care than doctors given their stronger presence in the facilities. Misoprostol received unanimous support and viewed as: safe, effective, cheap, convenient, readily available, maintained patient privacy, and saved resources. Challenges faced included: side effects, prolonged hospital stay, treatment failure, inclination to surgical evacuation, heavy work load, inadequate space, lack of medical commodities, frequent staff rotations which affects the quality of patient care. To address these challenges, respondents coped by: giving patients psychological support, analgesics, close patient monitoring, staff mentorship, commitment to work, team work and patient involvement in care.
Conclusion:
Misoprostol is perceived as an ideal uterine evacuation method for second trimester post abortion care of uncomplicated patients and trained midwives are considered competent managing these patients in a health facility setting with a back-up of a doctor. Health care providers require institutional and policy environment support for improved service delivery
Determinants of cervical cancer screening service utilization among women attending healthcare services in Amhara region referral hospitals: a case–control study
Get PDFBackground:
Cervical cancer is the second leading cause of cancer-related death and one of the top 20 causes of death among women in Ethiopia. Cervical cancer screening service has a vital value to reduce morbidity and mortality. Even though cervical cancer screening service utilization in Ethiopia is unacceptably low, its determinant factors were not well studied in the study area. Hence, this study was aimed at filling this information gap. This study aimed to identify determinants of cervical cancer screening service utilization among women attending healthcare services in Amhara region referral hospitals, Ethiopia.
Methods:
Hospital-based case–control study was conducted among 441 women (147 cases and 294 controls) from May to July 2021. Cases were included consecutively and controls were selected using a systematic random sampling technique from the randomly selected hospitals. A pretested interviewer-administered questionnaire was used to collect the data from respondents. The data were entered into Epi data version 4.6 and exported to SPSS version 25 for analysis. Bivariable and multivariable logistic regression analysis was employed. Adjusted odds ratio with its 95% confidence interval and p value < 0.05 were used to estimate the strength and significance of the association.
Result:
A total of 147 cases and 294 controls were enrolled in this study. Women with 30–39 years-old [AOR = 2.3; 95% CI 1.21, 4.68] and 40–49 years-old [AOR = 4.4 95% CI 1.97, 10.12], urban residence [AOR = 2.6; 95% CI 1.36, 5.21], secondary education [AOR = 4.4; 95% CI 2.18, 8.87] and diploma and above [AOR = 2.0; 95% CI: 1.05, 4.59], ever gave birth [AOR = 9.4; 95% CI 4.92, 18.26], having multiple sexual partners [AOR = 2.8; 95% CI 1.60, 5.03], good knowledge towards cervical cancer screening [AOR = 3.6; 95% CI 2.07, 6.43] and positive attitude on cervical cancer screening [AOR = 2.0, 95% CI 1.20, 3.70] were significant determinants of cervical cancer screening service utilization.
Conclusion:
In this study, age (30–39 and 40–49), urban residence, secondary education, ever gave birth, good knowledge of cervical cancer screening, positive attitude towards cervical cancer screening, and having multiple sexual partners were significant determinants of cervical cancer screening service utilization. There is a need to strengthen the policy and health education on safe sexual practices and healthy lifestyles through information dissemination and communication to scale up screening service utilization