Current Issue : April - June Volume : 2012 Issue Number : 2 Articles : 8 Articles
Background: IUD uptake remains low in Pakistan, in spite of three major efforts to introduce the IUD since the\r\n1960s, the most recent of these being through the private sector. This study examines barriers to IUD\r\nrecommendation and provision among private providers in Pakistan.\r\nMethods: A facility-based survey was conducted among randomly selected private providers who were members\r\nof the Greenstar network and among similar providers located within 2 Kilometers. In total, 566 providers were\r\ninterviewed in 54 districts of Pakistan.\r\nLogistic regression analysis was conducted to determine whether correct knowledge regarding the IUD, selfconfidence\r\nin being able to insert the IUD, attitudes towards suitability of candidates for the IUD and medical\r\nsafety concerns were influenced by provider type (physician vs. Lady Health Visitor), whether the provider had\r\nreceived clinical training in IUD insertion in the last three years, membership of the Greenstar network and\r\nexperience in IUD insertion. OLS regression was used to identify predictors of provider productivity (measured by\r\nIUD insertions conducted in the month before the survey).\r\nResults: Private providers consider women with children and in their peak reproductive years to be ideal\r\ncandidates for the IUD. Women below age 19, above age 40 and nulliparous women are not considered suitable\r\nIUD candidates. Provider concerns about medical safety, side-effects and client satisfaction associated with the IUD\r\nare substantial. Providersââ?¬â?¢ experience in terms of the number of IUDs inserted in their careers, appears to improve\r\nknowledge, self-confidence in the ability provide the IUD and to lower age-related attitudinal barriers towards IUD\r\nrecommendation. Physicians have greater medical safety concerns about the IUD than Lady Health Visitors. Clinical\r\ntraining does not have a consistent positive effect on lowering barriers to IUD recommendation. Membership of\r\nthe Greenstar network also has little effect on lowering these barriers. Providersââ?¬â?¢ barriers to IUD recommendation\r\nsignificantly lower their monthly IUD insertions.\r\nConclusions: Technical training interventions do not reduce providersââ?¬â?¢ attitudinal barriers towards IUD provision.\r\nFormative research is needed to better understand reasons for the high levels of provider barriers to IUD provision.\r\nââ?¬Å?Non-trainingââ?¬Â interventions should be designed to lower these barriers....
Background: The rapid population growth does not match with available resource in Ethiopia. Though household\r\nlevel family planning delivery has been put in place, the impact of such programs in densely populated rural areas\r\nwas not studied. The study aims at measuring contraception and unmet need and identifying its determinants\r\namong married women.\r\nMethods: A total of 5746 married women are interviewed from October to December 2009 in the Butajira\r\nDemographic Surveillance Area. Contraceptive prevalence rate and unmet need with their 95% confidence interval\r\nis measured among married women in the Butajira district. The association of background characteristics and\r\nfamily planning use is ascertained using crude and adjusted Odds ratio in logistic regression model.\r\nResults: Current contraceptive prevalence rate among married women is 25.4% (95% CI: 24.2, 26.5). Unmet need of\r\ncontraception is 52.4% of which 74.8% was attributed to spacing and the rest for limiting. Reasons for the high\r\nunmet need include commodities� insecurity, religion, and complaints related to providers, methods, diet and work\r\nload. Contraception is 2.3 (95% CI: 1.7, 3.2) times higher in urbanites compared to rural highlanders. Married\r\nwomen who attained primary and secondary plus level of education have about 1.3 (95% CI: 1.1, 1.6) and 2 (95%\r\nCI: 1.4, 2.9) times more risk to contraception; those with no child death are 1.3 (95% CI: 1.1, 1.5) times more likely\r\nto use contraceptives compared to counterparts. Besides, the odds of contraception is 1.3 (95% CI: 1.1, 1.6) and 1.5\r\n(1.1, 2.0) times more likely among women whose partners completed primary and secondary plus level of\r\neducation. Women discussing about contraception with partners were 2.2 (95% CI: 1.8, 2.7) times more likely to use\r\nfamily planning. Nevertheless, contraception was about 2.6 (95% CI: 2.1, 3.2) more likely among married women\r\nwhose partners supported the use of family planning.\r\nConclusions: The local government should focus on increasing educational level. It must also ensure family\r\nplanning methods security, increase competence of providers, and create awareness on various methods and their\r\nside effects to empower women to make an appropriate choice. Emphasis should be given to rural communities....
Introduction. To investigate the association of high Body Mass Index (BMI) with semen parameters and reproductive hormones\r\nin men of reproductive age. Setting. The Saudi Center for Assisted Reproduction. Method. This study was conducted during\r\nthe period from February 2009 to February 2011. Subjects were exposed through medical history evaluation as well as physical\r\nexamination. BMI was calculated. Two semen samples about 1 week apart were taken from each participant by masturbation\r\nafter 2ââ?¬â??5 days of abstinence. The samples were assessed according to the WHO Criteria. Blood samples (5 ml) were withdrawn;\r\ncentrifuged and the resulting sera were preserved at -4 degrees Centigrade. Serum FSH, LH, PRL, and Testosterone levels were\r\nestimated by the ELISA method. Results. There was no significant correlation between BMI and any of semen and hormonal\r\nparameters. There was significant negative correlation between age and total motility. Only the advanced paternal age has shown\r\nsignificant association with low motility (P = 0.007). Conclusion. Our study showed a significant effect of aging on sperm motility\r\nand concentration....
Background: India launched a national conditional cash transfer program, Janani Suraksha Yojana (JSY), aimed at\r\nreducing maternal mortality by promoting institutional delivery in 2005. It provides a cash incentive to women\r\nwho give birth in public health facilities. This paper studies the extent of program uptake, reasons for participation/\r\nnon participation, factors associated with non uptake of the program, and the role played by a program volunteer,\r\naccredited social health activist (ASHA), among mothers in Ujjain district in Madhya Pradesh, India.\r\nMethods: A cross-sectional study was conducted from January to May 2011 among women giving birth in 30\r\nvillages in Ujjain district. A semi-structured questionnaire was administered to 418 women who delivered in 2009.\r\nSocio-demographic and pregnancy related characteristics, role of the ASHA during delivery, receipt of the incentive,\r\nand reasons for place of delivery were collected. Multinomial regression analysis was used to identify predictors for\r\nthe outcome variables; program delivery, private facility delivery, or a home delivery.\r\nResults: The majority of deliveries (318/418; 76%) took place within the JSY program; 81% of all mothers below\r\npoverty line delivered in the program. Ninety percent of the women had prior knowledge of the program. Most\r\nprogram mothers reported receiving the cash incentive within two weeks of delivery. The ASHA�s influence on the\r\nmother�s decision on where to deliver appeared limited. Women who were uneducated, multiparious or lacked\r\nprior knowledge of the JSY program were significantly more likely to deliver at home.\r\nConclusion: In this study, a large proportion of women delivered under the program. Most mothers reporting\r\ntimely receipt of the cash transfer. Nevertheless, there is still a subset of mothers delivering at home, who do not\r\nor cannot access emergency obstetric care under the program and remain at risk of maternal death....
Background: Tubal ligation is the most popular family planning method worldwide. While its benefits, such as\r\neffectiveness in protecting against pregnancies, minimal need for long-term follow-up and low side-effects profile\r\nare well documented, it has many reported complications. However, to date, these complications have not been\r\ndescribed by residents in Congo. Therefore, the study aimed at exploring the experience of women who had\r\nundergone tubal ligation, focusing on perceptions of physical, psychological and contextual experiences of\r\nparticipants.\r\nMethods: This qualitative study used a semi-structured questionnaire in a phenomenological paradigm to collect\r\ndata. Fifteen participants were purposefully selected among sterilized women who had a ligation procedure\r\nperformed, were aged between 30 and 40 years, and were living within the catchment area of the district hospital.\r\nData were collected by two registered nurses, tape-recorded, and transcribed verbatim. Reading and re-reading cut\r\nand paste techniques, and integration were used to establish codes, categories, themes, and description.\r\nResults: Diverse and sometimes opposite changes in somatic symptoms, psychological symptoms, productivity,\r\necological relationships, doctor-client relationships, ethical issues, and change of life style were the major problem\r\ndomains.\r\nConclusions: Clients reported conflicting experiences in several areas of their lives after tubal sterilization.\r\nManagement, including awareness of the particular features of the client, is needed to decrease the likelihood of\r\npsychosocial morbidity and/or to select clients in need of sterilization....
Unsafe abortion is a significant contributor to worldwide maternal mortality; however, abortion law and policy\r\nliberalization could lead to drops in unsafe abortion and related deaths. This review provides an analysis of\r\nchanges in abortion mortality in three countries where significant policy reform and related service delivery\r\noccurred. Drawing on peer-reviewed literature, population data and grey literature on programs and policies, this\r\npaper demonstrates the policy and program changes that led to declines in abortion-related mortality in Romania,\r\nSouth Africa and Bangladesh. In all three countries, abortion policy liberalization was followed by implementation\r\nof safe abortion services and other reproductive health interventions. South Africa and Bangladesh trained midlevel\r\nproviders to offer safe abortion and menstrual regulation services, respectively, Romania improved\r\ncontraceptive policies and services, and Bangladesh made advances in emergency obstetric care and family\r\nplanning. The findings point to the importance of multi-faceted and complementary reproductive health reforms\r\nin successful implementation of abortion policy reform....
Background: Understanding the strategies that health care providers employ in order to invite men to participate\r\nin maternal health care is very vital especially in today�s dynamic cultural environment. Effective utilization of such\r\nstrategies is dependent on uncovering the salient issues that facilitate male participation in maternal health care.\r\nThis paper examines and describes the strategies that were used by different health care facilities to invite\r\nhusbands to participate in maternal health care in rural and urban settings of southern Malawi.\r\nMethods: The data was collected through in-depth interviews from sixteen of the twenty health care providers\r\nfrom five different health facilities in rural and urban settings of Malawi. The health facilities comprised two health\r\ncentres, one district hospital, one mission hospital, one private hospital and one central hospital. A semi-structured\r\ninterview guide was used to collect data from health care providers with the aim of understanding strategies they\r\nused to invite men to participate in maternal health care.\r\nResults: Four main strategies were used to invite men to participate in maternal health care. The strategies were;\r\nhealth care provider initiative, partner notification, couple initiative and community mobilization. The health care\r\nprovider initiative and partner notification were at health facility level, while the couple initiative was at family level\r\nand community mobilization was at village (community) level. The community mobilization had three sub-themes\r\nnamely; male peer initiative, use of incentives and community sensitization. The sustainability of each strategy to\r\nsignificantly influence behaviour change for male participation in maternal health care is discussed.\r\nConclusion: Strategies to invite men to participate in maternal health care were at health facility, family and\r\ncommunity levels. The couple strategy was most appropriate but was mostly used by educated and city residents.\r\nThe male peer strategy was effective and sustainable at community level. There is need for creation of awareness\r\nin men so that they sustain their participation in maternal health care activities of their female partners even in the\r\nabsence of incentives, coercion or invitation....
In absence of complicating medical diseases of pregnancy in antenatal women with intrauterine growth restriction, plasma homocysteine levels were estimated. Objective was to find out hyperhomocysteinemia in clinical IUGR and to compare with non-IUGR. One hundred IUGR women between 36 to 40 weeks of pregnancy and another 100 non-IUGR women in same antenatal period were selected from out patient department of C.R. Gardi Hospital, Ujjain, India. Plasma homocysteine level was estimated. Clinical criteria for IUGR was fundal height less than tenth percentile at 36 weeks, fundal height less than 30 centimeters and Abdominal circumference/Femur length ratio less than four. Neonatal weight and morbidity was recorded. Mean value of homocysteine in non-IUGR group was 7.64µmol/L while it was 13.81µmol/L in IUGR subjects. Poor dietary habits and homocysteine values show no statistically significant difference (p>0.05). Homocysteine levels in Low birth weight was 14.67µmol/L while in normal birth weight subjects it was 7.59µmol/L, with significant difference of p<0.05. IUGR in third trimester has higher homocysteine levels. Clinical intrauterine growth restriction subjects have significant hyperhomocysteinaemia, which is correlated to low birth weight in neonate (p=0.00)....
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