Current Issue : January - March Volume : 2012 Issue Number : 1 Articles : 8 Articles
Parent-child sexuality communication has been identified as a protective factor for adolescent sexual and\r\nreproductive health, including HIV infection. The available literature on this topic in sub-Saharan Africa is increasing;\r\nhowever a systematic review of studies has not been conducted. This article reviews the literature in the area of\r\nparental or caregiver and child communication about sexuality and HIV/AIDS in sub-Saharan Africa. A review of\r\npeer reviewed literature published between 1980 and April 2011 was conducted. Communication process studies\r\ninvestigating the frequency, content, style, tone of discussions, preferences, as well as associations with and barriers\r\nto sexuality communication are reviewed. In addition, studies which examine behavioral associations with parentchild\r\nsexuality communication, and intervention studies to improve parent-child sexuality communication are\r\nexamined. The findings from process studies suggest wide variation in terms of frequency of discussions, with a\r\nrange of socio-demographic and other factors associated with sexuality communication. Overall, findings\r\ndemonstrate that discussions tend to be authoritarian and uni-directional, characterized by vague warnings rather\r\nthan direct, open discussion. Moreover, parents and young people report a number of barriers to open dialogue,\r\nincluding lack of knowledge and skills, as well as cultural norms and taboos. Findings are less clear when it comes\r\nto associations between parental communication and adolescent sexual activity and contraception use. However,\r\nnascent indications from intervention research suggest positive findings with increases in frequency and comfort of\r\ndiscussions, among other outcomes. Gaps in the research are identified and discussed with implications for future\r\nstudies....
Background: Many women in Russia rely on abortion as a primary birth control method. Although refusal to use\r\ncontraceptives, including condoms, may undermine public health efforts to decrease HIV sexual risk behaviors, few\r\nstudies have investigated the risk factors associated with abortion among women at high risk for HIV. This study\r\nsought to identify the correlates of abortions and of lack of condom use among high risk STD clinic patients in St\r\nPetersburg Russia.\r\nMethods: Cross-sectional analysis of data collected between 2009 and 2010 from women who had casual or\r\nmultiple sexual partners in the previous three months was analyzed. Multivariate logistic regression assessed the\r\nindependent correlates of abortion(s) and no condom use in the prior three months. Independent variables\r\nincluded socio-demographics, at risk drinking per alcohol use disorder identification test (AUDIT-C) criteria, having\r\nsex after drinking alcohol, having a sexual partner who injects illicit drugs, and parity.\r\nResults: Of 87 participants, 45% had an abortion in their lifetime and 26% did not use condoms in the prior three\r\nmonths. Abortion was independently associated with low income (OR, 3.33, 95%CI, 1.13-9.78) and at risk drinking\r\n(OR, 3.52, 95%CI, 1.24-10.05). Lack of condom use was independently associated with being more likely to have sex\r\nafter drinking (OR, 3.37, 95%CI, 1.10-10.28) and parity (OR, 3.69, 95%CI, 1.25-10.89).\r\nConclusions: Programs to increase contraceptive use including condom use among women at high risk for STD/\r\nHIV in Russia are needed. Programs to reduce sexual HIV risk and abortion rates must address alcohol misuse and\r\ntarget women with limited income....
Background: A high body mass index (BMI) has been associated with reduced semen quality and male\r\nsubfecundity, but no studies following obese men losing weight have yet been published. We examined semen\r\nquality and reproductive hormones among morbidly obese men and studied if weight loss improved the\r\nreproductive indicators.\r\nMethods: In this pilot cohort study, 43 men with BMI > 33 kg/m2 were followed through a 14 week residential\r\nweight loss program. The participants provided semen samples and had blood samples drawn, filled in\r\nquestionnaires, and had clinical examinations before and after the intervention. Conventional semen characteristics\r\nas well as sperm DNA integrity, analysed by the sperm chromatin structure assay (SCSA) were obtained. Serum\r\nlevels of testosterone, estradiol, sex hormone-binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating\r\nhormone (FSH), anti-M�¼llerian hormone (AMH) and inhibin B (Inh-B) were measured.\r\nResults: Participants were from 20 to 59 years of age (median = 32) with BMI ranging from 33 to 61 kg/m2. At\r\nbaseline, after adjustment for potential confounders, BMI was inversely associated with sperm concentration (p =\r\n0.02), total sperm count (p = 0.02), sperm morphology (p = 0.04), and motile sperm (p = 0.005) as well as\r\ntestosterone (p = 0.04) and Inh-B (p = 0.04) and positively associated to estradiol (p < 0.005). The median (range)\r\npercentage weight loss after the intervention was 15% (3.5 - 25.4). Weight loss was associated with an increase in\r\ntotal sperm count (p = 0.02), semen volume (p = 0.04), testosterone (p = 0.02), SHBG (p = 0.03) and AMH (p =\r\n0.02). The group with the largest weight loss had a statistically significant increase in total sperm count [193\r\nmillions (95% CI: 45; 341)] and normal sperm morphology [4% (95% CI: 1; 7)].\r\nConclusion: This study found obesity to be associated with poor semen quality and altered reproductive\r\nhormonal profile. Weight loss may potentially lead to improvement in semen quality. Whether the improvement is\r\na result of the reduction in body weight per se or improved lifestyles remains unknown....
Background: Sub-Saharan Africa is among the countries where 10% of girls become mothers by the age of 16\r\nyears old. The United Republic of Tanzania located in Sub-Saharan Africa is one country where teenage pregnancy\r\nis a problem facing adolescent girls. Adolescent pregnancy has been identified as one of the reasons for girls\r\ndropping out from school. This study�s purpose was to evaluate a reproductive health awareness program for the\r\nimprovement of reproductive health for adolescents in urban Tanzania.\r\nMethods: A quasi-experimental pre-test and post-test research design was conducted to evaluate adolescents�\r\nknowledge, attitude, and behavior about reproductive health before and after the program. Data were collected\r\nfrom students aged 11 to 16, at Ilala Municipal, Dar es Salaam, Tanzania. An anonymous 23-item questionnaire\r\nprovided the data. The program was conducted using a picture drama, reproductive health materials and group\r\ndiscussion.\r\nResults: In total, 313 questionnaires were distributed and 305 (97.4%) were useable for the final analysis. The mean\r\nage for girls was 12.5 years and 13.2 years for boys. A large minority of both girls (26.8%) and boys (41.4%) had\r\nexperienced sex and among the girls who had experienced sex, 51.2% reported that it was by force. The girls�\r\nmean score in the knowledge pre-test was 5.9, and 6.8 in post-test, which increased significantly (t = 7.9, p =\r\n0.000). The mean behavior pre-test score was 25.8 and post-test was 26.6, which showed a significant increase\r\n(t = 3.0, p = 0.003). The boys� mean score in the knowledge pre-test was 6.4 and 7.0 for the post-test, which\r\nincreased significantly (t = 4.5, p = 0.000). The mean behavior pre-test score was 25.6 and 26.4 in post-test, which\r\nshowed a significant increase (t = 2.4, p = 0.019). However, the pre-test and post-test attitude scores showed no\r\nstatistically significant difference for either girls or boys.\r\nConclusions: Teenagers have sexual experiences including sexual violence. Both of these phenomena are\r\nprevalent among school-going adolescents. The reproductive health program improved the students� knowledge\r\nand behavior about sexuality and decision-making after the program for both girls and boys. However, their\r\nattitudes about reproductive health were not likely to change based on the educational intervention as designed\r\nfor this study....
Background: Female Genital Mutilation/Cutting (FGM/C) is a harmful traditional practice with severe health\r\ncomplications, deeply rooted in many Sub-Saharan African countries. In The Gambia, the prevalence of FGM/C is\r\n78.3% in women aged between 15 and 49 years. The objective of this study is to perform a first evaluation of the\r\nmagnitude of the health consequences of FGM/C in The Gambia.\r\nMethods: Data were collected on types of FGM/C and health consequences of each type of FGM/C from 871\r\nfemale patients who consulted for any problem requiring a medical gynaecologic examination and who had\r\nundergone FGM/C in The Gambia.\r\nResults: The prevalence of patients with different types of FGM/C were: type I, 66.2%; type II, 26.3%; and type III,\r\n7.5%. Complications due to FGM/C were found in 299 of the 871 patients (34.3%). Even type I, the form of FGM/C\r\nof least anatomical extent, presented complications in 1 of 5 girls and women examined.\r\nConclusion: This study shows that FGM/C is still practiced in all the six regions of The Gambia, the most common\r\nform being type I, followed by type II. All forms of FGM/C, including type I, produce significantly high percentages\r\nof complications, especially infections....
Background: Little is known about the fertility desires of HIV infected individuals on highly active antiretroviral\r\ntherapy (HAART). In order to contribute more knowledge to this topic we conducted a study to determine if HIVinfected\r\npersons on HAART have different fertility desires compared to persons not on HAART, and if the\r\nknowledge about HIV transmission from mother-to-child is different in the two groups.\r\nMethods: The study was a cross-sectional survey comparing two groups of HIV-positive participants: those who\r\nwere on HAART and those who were not. Semi-structured interviews were conducted with 199 HIV patients living\r\nin a rural area of western Uganda. The desire for future children was measured by the question in the\r\nquestionnaire ââ?¬Å?Do you want more children in future.ââ?¬Â The respondentsââ?¬â?¢ HAART status was derived from the\r\ninterviews and verified using health records. Descriptive, bivariate and multivariate methods were used to analyze\r\nthe relationship between HAART treatment status and the desire for future children.\r\nResults: Results from the multivariate logistic regression model indicated an adjusted odds ratio (OR) of 1.08 (95%\r\nCI 0.40-2.90) for those on HAART wanting more children (crude OR 1.86, 95% CI 0.82-4.21). Statistically significant\r\npredictors for desiring more children were younger age, having a higher number of living children and male sex.\r\nKnowledge of the risks for mother-to-child-transmission of HIV was similar in both groups.\r\nConclusions: The conclusions from this study are that the HAART treatment status of HIV patients did not\r\ninfluence the desire for children. The non-significant association between the desire for more children and the\r\nHAART treatment status could be caused by a lack of knowledge in HIV-infected persons/couples about the\r\npositive impact of HAART in reducing HIV transmission from mother-to-child. We recommend that the health care\r\nsystem ensures proper training of staff and appropriate communication to those living with HIV as well as to the\r\ngeneral community....
Background: To evaluate the performance of the WHO criteria for defining maternal near miss and identifying\r\ndeaths among cases of severe maternal morbidity (SMM) admitted for intensive care.\r\nMethod: Between October 2002 and September 2007, 673 women with SMM were admitted, and among them 18\r\ndied. Variables used for the definition of maternal near miss according to WHO criteria and for the SOFA score\r\nwere retrospectively evaluated. The identification of at least one of the WHO criteria in women who did not die\r\ndefined the case as a near miss. Organ failure was evaluated through the maximum SOFA score above 2 for each\r\none of the six components of the score, being considered the gold standard for the diagnosis of maternal near\r\nmiss. The aggregated score (Total Maximum SOFA score) was calculated using the worst result of the maximum\r\nSOFA score. Sensitivity, specificity, positive and negative predictive values of these WHO criteria for predicting\r\nmaternal death and also for identifying cases of organ failure were estimated.\r\nResults: The WHO criteria identified 194 cases of maternal near miss and all the 18 deaths. The most prevalent\r\ncriteria among cases of maternal deaths were the use of vasoactive drug and the use of mechanical ventilation (=1\r\nh). For the prediction of maternal deaths, sensitivity was 100% and specificity 70.4%. These criteria identified 119 of\r\nthe 120 cases of organ failure by the maximum SOFA score (Sensitivity 99.2%) among 194 case of maternal near\r\nmiss (61.34%). There was disagreement in 76 cases, one organ failure without any WHO criteria and 75 cases with\r\nno failure but with WHO criteria. The Total Maximum SOFA score had a good performance (area under the curve\r\nof 0.897) for prediction of cases of maternal near miss according to the WHO criteria.\r\nConclusions: The WHO criteria for maternal near miss showed to be able to identify all cases of death and almost\r\nall cases of organ failure. Therefore they allow evaluation of the severity of the complication and consequently\r\nenable clinicians to build a plan of care or to provide an early transfer for appropriate reference centers....
Objectives: Women aged 40-44 years in 2005 ought to have been subjected to much more influence on attitudes\r\nand knowledge on contraceptive methods during their fertile period than women who were in the same age span\r\nin 1975 when the abortion laws were introduced.\r\nMaterial: From official statistics, the rates of induced abortion and birth rates in women aged 40-44 years were\r\ncollected for Sweden, Denmark, Norway and Finland for each five-year during the period 1975-2005.\r\nResults: With the exception of Sweden all other studied Scandinavian countries have lowered their abortion rates\r\nsince 1975 (p < 0.001) and reduced the proportion of induced abortions in relation to birth rate (p < 0.001). In 2005\r\nthese countries also had lower rates of induced abortion than Sweden in the age group 40-44 years (p < 0.001).\r\nConclusion: There is a significant change in rates of induced abortion in women aged 40-44 years in Finland,\r\nNorway, Denmark, and at status quo in Sweden. 40-44 years in Finland, Norway, Denmark, and at status quo in\r\nSweden. This indicates that family planning programs works well in the Nordic countries. The differences found\r\nmay be assumed to possible diverging focus on attitudes or ethical considerations....
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