Reproductive Health最新文献

Introduction: Despite progress in improving access to and use of maternal and newborn health (MNH) services in Ethiopia, challenges persist in ensuring equitable, high-quality care.

Methods: This study assessed the effective coverage cascade across antepartum and peripartum care (PPC) using formative implementation science research data obtained during July-August 2024. A stratified multistage sampling method recruited 1,922 women with infants (0-11 months), including 1,118 from agrarian and 804 from pastoral regions. The study included facility assessments at 67 primary care facilities and 329 client exit interviews. Service contact was defined as attending at least one antenatal care (ANC) contact and delivering in a health facility. Intervention-adjusted coverage accounted for receipt of key interventions, while readiness- and quality-adjusted coverage incorporated facility input and quality index scores from facility survey readiness assessment and exit interviews. Sampling weights were applied, and household and facility data were linked using ecological methods -that is, by aligning data from the same woreda rather than linking records at the individual level.

Results: Mean facility readiness scores for ANC and PPC were 74% and 80%, respectively. The mean care experience score from exit interviews was 83%, while antepartum and peripartum service provision scores were 60% and 61%. Household survey data showed that fewer than three-quarters of women received recommended ANC interventions, while 82% of women received peripartum and newborn interventions. Most facilities had uterotonics, newborn resuscitation bags, and essential maternal health services. However, gaps in trained staff, diagnostics, emergency transport, and dignified care persisted. Missing services-including ultrasound, deworming, maternal depression screening, and postpartum family planning counseling-highlighted critical service delivery challenges. The effective coverage cascade shows significant drop-offs across the continuum of care. For ANC, 81% of women made initial contact, only 63% received care in facilities with essential inputs, 49% received essential interventions, and only 26% ultimately received quality services. A similar pattern was observed for peripartum services: about 74% of women delivered at a health facility, only 59% received PPC in a facility with essential inputs, 49% received essential interventions, and just 26% received quality services. Regional disparities were evident across the cascade.

Conclusion: While MNH service access has expanded, substantial cascade losses and inequities persist, particularly between agrarian and pastoral regions. Addressing these challenges requires equity-focused strategies to enhance readiness, improve service quality, integrate care, and strengthen accountability.

Introduction: Despite the effectiveness of female condoms (FCs) in preventing sexually transmitted infections, their use remains low. University students, at high risk for unsafe sex, need targeted interventions. This study assessed knowledge and utilization among female undergraduates to inform policies and strategies for improving accessibility and uptake in higher education institutions.

Methods: A cross-sectional study was conducted among 246 undergraduate female students at Makerere University in March-April 2023. Participants were selected using simple random sampling. Data were collected through a structured, self-administered questionnaire covering demographic characteristics, FC knowledge, utilization, and barriers to use. Descriptive statistics were used to summarize the data, while logistic regression identified factors associated with FC knowledge and utilization.

Results: Of the 246 participants, the mean age was approximately 25.8 years ± 4.6. While 76.8% had heard of female condoms, mainly through fellow female students (39.4%), only 10.6% reported having ever used one. Barriers included a perceived lack of flexibility (73.6%), insertion difficulties (56.5%), and inaccessibility (17.5%). Third-year students had significantly higher odds of FC knowledge than first years (aOR = 7.10, 95% CI: 2.12-23.73, p = 0.001). Compared to Protestants, Catholic participants were less likely to be knowledgeable about female condoms (aOR = 0.27, 95% CI: 0.10-0.74, p = 0.011). Similarly, participants from category, other religions also showed significantly lower knowledge (aOR = 0.05, 95% CI: 0.01-0.56, p = 0.014). Married students had significantly higher odds of FC use than single students (aOR = 6.25, 95% CI: 2.26-17.27, p = 0.000). Fourth-year students showed higher odds of FC use in bivariate analysis (OR = 6.29, 95% CI: 1.05-37.57, p = 0.044), but this was not significant in multivariable analysis (aOR = 1.95, 95% CI: 0.25-15.22, p = 0.525).

Conclusion: The study showed significant gaps in knowledge and utilization of female condoms among undergraduate female students. Barriers included inaccessibility, difficulty of use, and religious beliefs. A comprehensive sexual health education through integrating family planning clinics and seminars, collaborations between universities and health organizations, and tailored interventions are needed to improve awareness, acceptance, and utilization of female condoms.

Background: Refugee populations in Ghana faced significant challenges in accessing maternal healthcare services, including antenatal care, skilled birth attendance, and postnatal care, due to socio-economic, cultural, and health system factors. Limited research has explored the specific barriers encountered by refugee mothers in Ghana. This study explored the experiences of refugee mothers in accessing maternal healthcare services in Krisan and Ampain Refugee Camps in the Western Region, Ghana.

Methods: Anchored by Bronfenbrenner's Ecological Systems Theory, Giorgi's descriptive phenomenological design was employed to collect data from refugee mothers aged 15-49. Data was gathered through in-depth interviews using a structured interview guide. Purpose, snowball, and maximum variability sampling techniques were applied to recruit participants who could provide relevant insights. In total, 29 interviews were conducted, and the data, including field notes and interview transcripts, were thematically analyzed to identify key patterns and themes.

Results: Major themes that emerged were language barriers, financial constraints, discrimination, inadequate social support, transportation difficulties, long waiting times at health facilities, and negative attitudes from healthcare providers. Social support networks and good interpersonal relationships with healthcare staff were however reported as enablers to maternal healthcare access.

Conclusion: Maternal healthcare for refugee mothers was found to found to requires targeting their unique circumstances and healthcare needs. Integrating policies such as the United Nations High Commissioner for Refugees (UNHCR) Health Strategy and Sphere Standards into national health systems could improve access to equitable maternal care for refugees. Policymakers, including Ghana's Ministry of Health and UNHCR, should collaborate with healthcare providers and non-governmental organizations (NGOs) to implement policies that ensure equitable access and person-centred care for refugee.

Afghanistan faces persistently high maternal mortality, high fertility, and low use of modern contraceptives-trends at risk of worsening under current restrictions on women's mobility, education, and access to health services. Although family planning is a cost-effective strategy in high-fertility, low-resource settings, generating demand has long remained a challenge in Afghanistan. While socio-cultural barriers to family planning are well documented, limited evidence captures how women themselves interpret and negotiate fertility and childbearing within these constraints. This study explored married women's attitudes toward fertility and childbearing in Kabul to inform locally appropriate approaches to strengthening reproductive well-being. Methods In 2024, in-depth semi-structured interviews were conducted with 23 married women aged 20-43 years (mean = 32.1) in Kabul, Afghanistan, purposively selected for demographic diversity. Interviews were audio-recorded when possible or otherwise documented in detailed notes, and analyzed concurrently in MAXQDA 2024, with data collection continued until no new codes or insights emerged across three successive interviews. Results Five major categories were identified: (1) socio-cultural norms and expectations, (2) religious and ethical perspectives, (3) economic and functional dimensions of childbearing, (4) health and well-being considerations, and (5) emotional and psychological motivations. Across interviews, pronatalist norms and expectations for early and repeated childbearing remained dominant and were reinforced by misconceptions about contraception. Nevertheless, some women emphasized maternal health, child well-being, and more balanced decision-making within families-reflecting a diversity of reproductive perspectives within the prevailing social context. Conclusions Women's fertility attitudes reflected the coexistence of enduring pronatalist expectations with value-oriented considerations emphasizing maternal and child well-being. These perspectives illustrate nuanced forms of reproductive reasoning that may inform culturally responsive approaches to reproductive health promotion. Future research should examine how such orientations vary across Afghan settings. Within the current social constraints, discreet and context-appropriate counseling integrated into existing maternal and child health services could help support informed fertility decisions and contribute to safer maternal outcomes.