Reproductive Health最新文献

Background: Female Sex Workers (FSW) in Sub Saharan Africa face multiple challenges increasing their vulnerability to poor health, particularly poor sexual and reproductive (SRH) health outcomes and violence. The aim of this study was to assess the use of gynecology health care services and factors associated with its use as well as experiences of violence among FSW in Togo.

Method: A cross-sectional study was carried out in 2021 among FSW in two cities of Togo. A snowball sampling method was used and initial seeds were identified in each site in collaboration with FSW non-governmental organizations. A logistic regression was performed to identify factors associated with the use of a SRH service and violence.

Results: A total of 447 FSW with a median age of 30 [IQR: (24-38)] participated in this study and 43.4% of them had reached at least secondary school. Among them, 29.1% reported having been to a gynecological consultation over the previous year. Factors associated with a gynecological consultation included: living in the Lomé capital city (aOR = 0.35, 95%CI 0.22-0.54), and an experience of condom breakage or slippage (aOR = 2.00; 95%CI 1.19-2.64). The majority reported at least one lifetime pregnancy (87.9%), 39.8% reported ever having an unintended pregnancy and 67.6% of them ever had an abortion. Finally, 61.1% indicated being victims of physical, sexual, or emotional violence in the previous six months. Sex workers living in Lomé (aOR = 1.78; 95%CI 1.16-2.73); a history of abortion (aOR = 1.53; 95%CI 1.03-2.31) and having more than 15 clients per week (aOR = 4.87; 95% CI 1.99-11.94), were more likely to experience violence.

Conclusion: There is an under-utilization of health care services among FSW in Togo in addition to overall poor sexual and reproductive health outcomes with a high prevalence of gender-based violence. Those results highlight the importance of continued advocacy for the integration of SRH care with HIV prevention services geared toward FSW as well as a holistic approach to SRH care with innovative ways to prevent violence.

Background: Fertility rates have been decreasing both worldwide and in China. Although current policies have been aimed at raising the birth rate in China, their overall effects have been unclear. Therefore, exploration of fertility intention and related influencing factors is crucial.

Methods: This study used a convergent parallel mixed methods combining descriptive and cross-sectional designs with a framework analysis. Convenience sampling was used to select mothers of childbearing age with two children (n = 603), living in Guangdong Province, China. Participants completed an online questionnaire investigating sociodemographic characteristics, as well as determinants and attitudes regarding the third-child fertility intention. Correlation coefficients and multivariate regression analyses were used to present quantitative findings. Eleven interviews were conducted, and a framework analysis method was used for data analysis. The results for the qualitative and quantitative study components were analyzed separately and were subsequently integrated through side-by-side comparison and joint display.

Result: Attitudes toward fertility intention were negative, and the rate of fertility intention was 10.4% in Guangdong Province. In the quantitative component, women's age, perceived value of having a third child, and attitudes were found to be factors promoting the intention to have a third child, whereas monthly family income, grandparents' health status, and policy support were found to be factors hindering the intention to have a third child. Four major themes emerged regarding the perceptions and experiences regarding fertility intention in the qualitative component. After integrated analysis, younger age, knowledge regarding policy support, and access to childcare support were found to be factors significantly affecting the intentions of mothers with two children regarding having a third child.

Conclusion: Fertility issues require continued attention. Our findings provide a reference for optimizing existing policies to increase fertility intentions. Providing policy support, such as public childcare support, flexible working hours for mothers, affordable childcare, and greater psychological support, would enable mothers to improve their parenting. In addition, increasing the dissemination of knowledge regarding policies is necessary to improve the level of public understanding and promote fertility intention.

Fertility punishment is a powerful interpretation of the low birth rate in contemporary China, but it is not consistent with the fact that the proportion of second children has been increasing year by year for some time. From the perspective of Bandura's "Self-efficacy", based on the post-80 s and post-90 s youth samples in the Psychology and Behavior Investigation of Chinese Residents 2021, this paper explores the quantitative relationship between the number of children and individual self-efficacy. The data indicates that: (1) Fertility is closely linked to self-efficacy, with young people who have two children exhibiting higher self-efficacy; (2) The quantitative relationship between the number of children and self-efficacy varies based on parental roles-men/fathers show almost no change in self-efficacy when moving from having no children to one child, but demonstrate a significant increase in self-efficacy when they have two children. In contrast, women/mothers experience the lowest self-efficacy when having one child, which only shows a significant improvement when they have two children. These findings provide a new perspective for theoretically explaining the current fertility situation and expand the application of self-efficacy. In terms of policy efforts, it is necessary to provide support for women's one-child fertility, and to increase the publicity of the view of more children and more efficacy to resist the potential energy of low fertility that arises from the view of more children and more burdens.

Background: Endometriosis is a common cause of female reproductive problems, and vitamin intake may affect its incidence. Therefore, we further explored the association between multivitamin intake and endometriosis in a large population-based study.

Methods: This study included 3351 participants from the National Health and Nutrition Examination Survey (NHANES) 1999-2006. The dietary intake of eight vitamins was calculated as the average of two 24-h recall interviews, and information on endometriosis was obtained through questionnaires that included gynecological history. Multiple logistic regression analysis was used to explore the relationship between multivitamin intake and endometriosis. Smoothed curve fitting analysis was employed to assess the dose-response relationship between vitamins and endometriosis. Finally, subgroup analysis and interaction tests were conducted to determine the association of covariates between vitamins and endometriosis.

Results: In this large-scale cross-sectional study, multiple logistic regression analysis showed that the intake of vitamins A, B1, B2, B6, C and folate was negatively associated with the occurrence of endometriosis. The odds ratios associated with a per-SD increase were 0.836 (95%CI: 0.702, 0.997), 0.817 (95%CI: 0.702, 0.951), 0.860 (95%CI: 0.746, 0.991), 0.784 (95%CI: 0.669, 0.919), 0.845 (95%CI: 0.718, 0.994), and 0.772 (95%CI: 0.660, 0.903), respectively. Smoothed curve fitting analysis revealed that the intake of vitamins A, B1, B2, B6, C, and folate was negatively associated with the risk of endometriosis (P < 0.05). Vitamin E showed a saturating effect, with an optimal cutoff point at 13.18. Below this cutoff, the intake of vitamin E was negatively correlated with the risk of endometriosis (OR = 0.947, 95% CI: 0.906, 0.989), whereas above the cutoff, there was no significant correlation between vitamin E intake and the risk of endometriosis (OR = 1.001, 95% CI: 0.997, 1.005).

Conclusions: The results of this study indicate a significant linear negative correlation between the intake of vitamins A, B1, B2, B6, C, and folate, and the risk of endometriosis, and reveal a threshold effect for vitamin E intake on the risk of endometriosis. These findings could inform clinical dietary interventions and may support the development of preventive strategies for endometriosis, potentially aiding in its reduction.

Background: Menstrual irregularities significantly distress women living with HIV (WLHIV), impacting their reproductive health and quality of life. Although the underlying mechanism remains inconclusive, studies have outlined possible contributory factors. This narrative review explores the burden of menstrual irregularities and associated hormonal dysregulation among women living with HIV in Nigeria. It synthesises data from studies to present an overview of the prevalence, patterns, potential etiology, and impacts of menstrual irregularities among WLHIV.

Main body: A literature search across electronic databases such as PubMed, Google Scholar, and Web of Science was conducted, and information was extracted and synthesized to delineate the burden of menstrual irregularities in WLHIV. Eligibility criteria included original studies assessing the prevalence, aetiology, and impact of menstrual abnormalities among WLHIV in Nigeria. A narrative data synthesis approach utilized common themes and key concept extraction, including identifying patterns in the literature to present specific trends such as prevalence, patterns, etiology, and determinants. Menstrual irregularities were found to be prevalent among Nigerian WLHIV, varying from 29 to 76% across different regions, exceeding reports of similar studies in developed nations. Similarly, menstrual disorders including amenorrhea, oligomenorrhea, and polymenorrhea, were attributed to factors like HIV acquisition, antiretroviral therapy, low body mass index, and hormonal imbalances. Low CD4 count and high viral load with associated complications have been identified as major contributing factors. Distortion of the hypogonadal-pituitary-ovarian axis by viral-induced pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), and interferon-gamma (IFN-γ) may disrupt the hormonal balance necessary for regular menstrual cycles. Fluctuating levels of follicle-stimulating hormone (FSH), luteinising hormone (LH), estradiol, and prolactin have been reported among WLHIV. Although adherence to antiretroviral therapy has offered immense relief, its direct therapeutic effects on menstrual irregularities are inconclusive..

Conclusions: This study highlights the burden of menstrual disorders among WLHIV. It underscores the interplay between clinical, therapeutic, and client-associated factors as determinants of these abnormalities. Exploring associated complications like secondary infertility, reduced bone mineral density, and resultant osteoporosis, mirrors the significant impact of menstrual and hormonal irregularities on the reproductive health and quality of life of WLHIV.

Background: Evidence suggests that family-centered care for sick newborns, where parents are co-caregivers in newborn care units, can result in increased breastfeeding frequency, higher weight gain, earlier discharge, and reduced parental anxiety. This study explored healthcare providers' perceptions and experiences of parental participation in care for sick newborns in the newborn care units in two high-volume maternity units in Uganda, with the aim of informing interventions that promote family-centered care for newborns.

Methods: An exploratory qualitative study was conducted between August and December 2023. Sixteen in-depth interviews were held at a regional and general hospital in the rural eastern region of Uganda. The interviews were audio-recorded and then transcribed, followed by a reflexive thematic analysis approach to generate themes.

Findings: We identified four key themes: (1) creating order to ensure the safety of newborns in the newborn care unit; (2) parental participation as a tool for overcoming workload in the Newborn care unit; (3) redirecting parental involvement to focus on medically endorsed newborn care practices; and (4) stress management targeting mothers to ensure newborn survival.

Conclusion: Healthcare providers encourage parents to participate in caring for their newborns in the newborn care units, mainly to reduce their workload. However, our study highlights the imbalanced nature of parental involvement, where HCPs control the tasks parents can or cannot perform, essentially deploying them as "assistants" rather than equal partners, contrary to the ideals of family-centered care. Transforming the current "healthcare provider-centered" model of caring for sick newborns to one that is family-centered will require training providers on the benefits of family-centered care and developing guidelines for its structured implementation within a resource-limited setting.

Background: Early marriage, the formal or informal union before age 18, remains a critical challenge in several low-and middle-income countries. It has adverse health and education-related implications on child brides. This study examined the regional distribution of early marriage and its associated factors in Ghana.

Methods: We performed a cross-sectional analysis of data extracted from the 2022 Ghana Demographic and Health Survey. Our study comprised 10,098 ever married/cohabiting aged 15 to 49. Regional variations in the prevalence of child marriage were visualised using a spatial map. A mixed-effect multilevel binary logistic regression analysis was performed to assess the factors associated with early marriage. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI).

Results: The prevalence of early marriage was 29.2% [27.9, 30.6] in Ghana. Women in the North East 38.2% [33.4, 43.2], Western North 36.7% [32.1, 41.5] and Ahafo regions 35.8% [32.0, 39.8] had the highest prevalence of early marriage, whilst women in the Western 22.2% [18.4, 26.5] and Greater Accra 19.7% [15.8, 24.3 regions] had the lowest prevalence of early marriage in Ghana. The odds of early marriage was lower among women aged 20-49 compared to those aged 15-19. Women with secondary [aOR = 0.40; 95% CI 0.33, 0.48] and higher education [aOR = 0.07; 95% CI 0.04, 0.12], those who belonged to the Gurma ethnic group [aOR = 0.59; 95% CI 0.41, 0.84], and women from richer [aOR = 0.64; 95% CI: 0.47, 0.87] and richest [aOR = 0.42; 95% CI 0.28, 0.64] households were less likely to be married early compared to those with no education, those belonging to the Akan ethnic group, and those from the poorest wealth quintile households, respectively. The odds of early marriage was higher among women whose family size was five or more [aOR = 1.50; 95% CI 1.31, 1.72] and women living in the Central [aOR = 1.72; 95% CI 1.16, 2.54], Volta [aOR = 1.97; 95% CI 1.17, 3.30], Eastern [aOR = 1.53; 95% CI 1.01, 2.29], Ashanti [aOR = 1.98; 95% CI 1.33, 2.97], Western North [aOR = 1.77; 95% CI 1.18, 2.65], and Ahafo regions [aOR = 1.74; 95% CI 1.18, 2.56].

Conclusion: About one in three marriages were early in Ghana, with variations across the regions. Age, wealth index, ethnicity, level of education, family size, and region were identified as factors associated with early marriages. The government and policymakers in Ghana should increase access to and completion of secondary education for girls, as it is crucial in reducing early marriage. Providing programmes that economically empower women and girls can decrease their vulnerability to early marriage. More vigorous enforcement of laws against early marriage is necessary. Engaging with communities, including tribal leaders, is essential to shift cultural attitudes toward early marriage.

Background: Unintended pregnancy, a pregnancy that have been either unwanted or mistimed, is a serious public health issue. The present study aims to design and implement interventions to improve unplanned pregnancy experiences.

Methods/design: This exploratory sequential mixed method study will be conducted in three phases: qualitative, intermediate, and quantitative. The qualitative phase will use qualitative conventional content analysis with in-depth and semi structured individual interviews to explain and define the components and elements of pregnancy experiences of unplanned pregnancies, which include mothers with unplanned pregnancies, their spouses, and prenatal care providers, who will be selected purposefully. Additionally, in the initial phase, the study will employ literature reviews alongside qualitative findings to elucidate the components and elements of pregnancy experiences and their improving interventions. In the second phase, appropriate interventions (prioritized and feasible) will be determined through an expert panel using the Delphi technique. In the third phase, the intervention program agreed upon in the previous phase will be implemented in the form of a randomized controlled clinical trial.

Discussion: The implementation of the interventions could be beneficial in changing attitudes and achieving positive experiences in unplanned pregnancies. It is anticipated that the design and implementation of the intervention program aimed at improving the experiences of unplanned pregnancies will be effective in minimizing adverse maternal and neonatal outcomes. Trial registration Iranian Registry of Clinical Trials (IRCT): (IRCT20170506033834N12/Date of registration: 2024‑02‑12).

Background: Across the United Kingdom's National Health Service (NHS), women with a Body Mass Index (BMI) of > 30 face restrictions accessing In Vitro Fertilisation (IVF) treatment. This study asks: what are the (un)expected and (un)intended harms and consequences experienced by women restricted from accessing NHS-funded IVF due to BMI threshold criteria?

Methods: Posts from a popular infertility online forum were collected and reflexively thematically analysed.

Results: On the forum, users discussed how they struggled to lose weight, how they faced time pressures to meet BMI thresholds, and they shared knowledge on how to comply or appear compliant with BMI cut-offs. Our study found widespread moral discourses around body weight were reproduced in the forum, particularly commonplace narratives that body weight is under personal control, that people with a high BMI should 'work' to change their bodies, and that this work helps demonstrate deservingness for IVF treatment. Moralising discourses around weight were linked to the responsibilities of a hoped-for future of motherhood, as users performed deservingness through emphasising their commitment to meeting the BMI threshold.

Conclusion: We conclude that NHS-IVF policies in the United Kingdom do not consider the burdensome emotional and moral work placed on people seeking treatment due to inflexible upper-limit BMI criteria.

Background: The need to advance the sexual and reproductive health (SRH) and rights of women with a disability is becoming more widely recognized. Regrettably, in low- and middle-income settings like Ethiopia, several barriers impede women with a disability (WWDs) from receiving SRH services and care.

Objectives: This study aims to explore barriers and enablers for women with a disability to access sexual and reproductive health services in Addis Ababa, Ethiopia.

Methods: A qualitative phenomenological study was conducted among the purposively selected reproductive age (18-49) group of WWDs living in Addis Ababa who were members of the Ethiopian National Association of Persons with physical disabilities and the Ethiopian National Association for Blind. Ten in-depth interviews, and 2 focus group discussions, were conducted using an interview guide. The analysis involved the use of both a priori codes (from the theory) and emergent inductive codes (from the question guide).

Results: In this study, several barriers were identified as keeping participants from accessing SRH services, such as unfavorable community views, organizational barriers in health facilities [HFs], financial limitations, transportation problems, and a lack of knowledge about the SRH programs that are available. The enabling factors that made WWDs access SRH services include social support and networking, access to education, positive providers' attitudes, and women's self-confidence/Assertiveness.

Conclusion: The study reveals that financial problems brought on by inadequate health insurance coverage, economic hardship, the expense of transportation to the health facility, and the lack of preferential treatment at the health facility are some of the hurdles that WWDs face while accessing SRH services and care. To address these problems and promote SRH access, measures should be taken to decrease financial barriers, improve physical access, and build strong relationships with the community, the church, and healthcare providers.