Reproductive Health最新文献

Background: Knowledge of fertile period among adolescent girls and young women (AGYW; 15-24 years) is crucial for understanding and managing reproductive health, yet it remains under explored. Many AGYW possess limited knowledge about their reproductive systems and the menstrual cycle, which can lead to misconceptions regarding fertile period and contraceptive use. In regions like Tanzania, where early and unintended pregnancies are prevalent, enhancing fertile period awareness through tailored educational initiatives becomes increasingly vital. This study aimed to assess the knowledge of the fertile period and associated factors among AGYW in Tanzania for evidence-based interventions.

Methods: An analytical cross-sectional study was conducted using secondary data from the 2022 Tanzania demographic and health survey. Given the survey's complex design, weighted binary logistic regression model was used to determine factors associated with knowledge of the fertile period. Adjusted odds ratio (AOR) with corresponding 95% confidence intervals (CI) were used to estimate the strength of the association. A p-value of < 0.05 was declared statistically significant.

Results: The overall prevalence of knowledge about the fertile period was 19.4% (95% CI: 17.9-20.9). Several factors were associated with a higher likelihood of having knowledge about the fertile period; being aged 20-24 years (AOR = 1.43, 95% CI: 1.16-1.76), having secondary education (AOR = 3.15, 95% CI: 2.23-4.45), exposure to media (AOR = 1.28, 95% CI: 1.02-1.59), visiting a health facility in the past 12 months (AOR = 1.40, 95% CI: 1.29-1.66), and residing in the central (AOR = 2.55, 95% CI: 1.67-3.89) or southern zones of mainland Tanzania (AOR = 1.67, 95% CI: 1.11-2.48).

Conclusion: This study revealed the factors impacting knowledge of fertile period among AGYW, highlighting the roles of educational attainment, media exposure, healthcare access, and geographical location. Increased education and health service access correlate with better knowledge. To address these challenges, tailored interventions that account for above would be essential. ​Ultimately, enhancing fertile period awareness necessitates engaging educational programs across various platforms, empowering AGYW to make informed reproductive health choices. Further research needs to be conducted to monitor the knowledge on fertile periods.

Background: Caesarean section on maternal request (CSMR) raises ethical and clinical challenges despite Sweden's low overall caesarean section (CS) rate. National written recommendations are restrictive, yet regional differences suggest unequal care. While previous research has focused on women and healthcare professionals, little is known about the views on CSMR of policymakers and other key stakeholders. The aim of this study was to investigate how stakeholders in the Swedish healthcare system view CSMR in relation to medical considerations, individual autonomy and societal values.

Methods: A qualitative study with an inductive approach was conducted using reflexive thematic analysis of semi-structured interviews. Sixteen stakeholders were recruited, including regional politicians, policymakers, national authority representatives, and members from organisations and associations with relevant interest and expertise in the field.

Results: Five themes were generated: (1) Caesarean section is a valid way of giving birth for some; (2) The right to choose and the decision process are complex issues; (3) Individual options for childbirth are desirable; (4) There is a lack of trust in maternity care; (5) Economic and ethical challenges in maternity care exist. The participants viewed CSMR as a legitimate option for some women, despite the increased medical risks, which were considered concerning but not disqualifying. Support and guidance in decision-making were considered essential by the participants. They valued continuity in care and emotional support highly. The participants expressed the views that distrust in Swedish maternity care was linked to media portrayals and inconsistent handling of CSMR. Economic and ethical concerns included questions of resource allocation and the scope of public healthcare responsibilities. The option to pay privately for a planned CS was broadly rejected by the participants.

Conclusions: This study highlights the complexity of CSMR and its varied perspectives. While individual risks may be low, population-level risks could rise with increased prevalence, and the perception of risk varies depending on perspective. Both medical and psychological risks should inform decisions, with counselling seen as crucial by the participants. Continuity of midwife care models may offer an alternative to CSMR for some. Stakeholders are key to ensuring clear guidelines, equal care, and trust in the system.

Background: Youths in sub-Saharan Africa, particularly Nigeria, face significant barriers to accessing sexual and reproductive health (SRH) information and services because of limited awareness, confidentiality concerns, restrictive policies, and provider attitudes. These barriers contribute to poor SRH knowledge and high rates of HIV infection, unintended pregnancies, and unsafe sexual practices. Digital interventions offer a promising approach to improve SRH outcomes, but evidence of their effectiveness in Nigerian university settings remains limited. This study assessed the impact of a mobile health (mHealth), internet-based, comprehensive sexuality education (CSE) intervention on SRH knowledge, sexual behavior, and service utilization among university students in Lagos, Nigeria.

Methods: A quasi-experimental study was conducted among 600 undergraduate students (300 in intervention group and 300 in control group) who were selected from two public universities in Lagos, Nigeria, via multistage sampling. The intervention consisted of weekly live CSE webinars via Google Meets, peer-led WhatsApp discussions, and digital linkages to youth-friendly SRH services. Quantitative data were collected through self-administered digital questionnaires before and after the intervention. Data analysis included baseline and end-line comparisons via Pearson chi-square tests and difference-in-differences (DID) analysis to estimate intervention effects.

Results: At baseline, 57.7% of the participants in the intervention group and 49.7% of the participants in the control group had good knowledge of SRH (p = 0.05). A total of 41.0% of the respondents in the intervention group and 37.0% in the control group had ever had sex, and consistent condom use was low (23.6% in the intervention group and 28.8% in the control group). Only 26.0% of the intervention group and 23.3% of the control group respondents had access to SRH services. Post-intervention, SRH knowledge improved by 10.2% in the intervention group compared with 2.6% in the control group. Condom use during the last sexual encounter increased significantly by 11.7% (from 32.5% to 44.2%, p < 0.05), in the intervention group but decreased by 7.5% in the control group. Uptake of SRH services in the intervention group rose by 9% (from 26.0% to 35.0%, p < 0.05), alongside increased use of teaching hospitals and primary health care centres (PHCs). Sexual behaviour outcomes were mixed, with some indicators (e.g., multiple sexual partners) worsening post-intervention.

Conclusion: The mHealth CSE intervention improved SRH knowledge, increased condom use, and enhanced the utilisation of SRH services among university students. However, its effect on risky sexual behaviours was mixed. For greater effectiveness, digital CSE should be integrated with broader SRH services.

Background: Premenstrual syndrome (PMS) is a common menstruation-related condition among adolescent girls. Vulnerability to environmental and social factors such as living under war, exposure to political violence (EPV), and human insecurity significantly influence the health and well-being of adolescents more generally. However, research on the association between PMS and social determinants in conflict settings remains limited. This study aimed to identify the severity of PMS and its association with EPV, human insecurity, and well-being among adolescent girls in Palestine refugee camps in the West Bank.

Methods: This cross-sectional study included 1,399 girls aged 15-18 years residing in 19 Palestinian refugee camps in the West Bank, occupied Palestinian territory. PMS severity was measured using a scale developed based on the literature, expert input, and the girls' experiences, comprising two categories: "none to mild" and "moderate to severe." EPV was assessed based on past experiences at individual, familial, collective, and cumulative levels. Multivariate analyses were conducted using five regression models with a primary focus on the relationship between PMS severity and EPV.

Results: The prevalence of PMS with at least one symptom was 92.1%. PMS severity was positively associated with collective EPV (adjusted odds ratio [AOR], 1.5; 95% confidence interval [CI], 1.1-2.1), whereas individual and familial EPV were only significant when included separately in the model. Girls who experienced two or three types of cumulative EPV (AOR, 2.5; 95% CI, 1.6-3.7) were more likely to experience severe PMS. High levels of human insecurity (AOR, 1.3; 95% CI, 1.0-1.6) and depression-like symptoms (AOR, 1.9; 95% CI, 1.3-2.7) were significantly associated with PMS severity.

Conclusions: The results demonstrate a significant association between PMS severity and EPV, human insecurity, and low levels of well-being. These findings suggest that prolonged occupation and unresolved conflict may adversely impact adolescent health and exacerbate PMS symptoms, highlighting the need to recognize PMS as a public health concern. In protracted conflict settings, integrating psychosocial support and menstrual health education into schools and community-based programs such as primary healthcare facilities may help adolescent girls manage PMS, menstruation-related symptoms, and associated stressors more effectively.

Background: Unsafe abortion remains a critical global health issue, particularly affecting women in low and middle-income countries including Rwanda. In Africa, 99% of abortions are unsafe. Between 2019 and 2023, there has been a reported increased of abortion-related hospitalizations at Remera Rukoma Hospital (RRH), highlighting an urgent need for investigation. Therefore, this study was conducted to determine the prevalence and factors associated with unsafe abortion among women of reproductive age attending RRH.

Methods: This cross-sectional study was conducted among 384 women of reproductive age (15-49 years) attending at RRH in Rwanda. The sample size was obtained using the Cochrane formula and systematic random sampling. Data analysis utilized SPSS Version25, employing descriptive statistics, bivariate and multivariate analyses to determine the factors associated with unsafe abortion at 95% CI, and p-value < 0.05 was considered statistically significant.

Results: The majority of participants were married (51.8%), Catholic (32.8%), attained primary education (35.4%), and were housewives (42.2%). The prevalence of unsafe abortion was 35.2%. Multivariate analysis showed unsafe abortion was higher than twice among women married before 18 years (aOR = 2.277, 95% CI: 1.247-4.157, p = 0.007), those with 3 sexual partners in the last 12 months (aOR = 2.285, 95% CI: 1.031-5.066, p = 0.042). Women who experienced gender-based violence had higher odds of engaging in unsafe abortion (aOR = 1.965, 95% CI: 1.128-3.424, p = 0.017).

Conclusion: This study revealed unsafe abortion as a significant health concern among women of reproductive age, with over one-third of participants reporting unsafe abortions. Early marriage before 18 years, multiple sexual partners, and gender-based violence emerged as key factors associated with unsafe abortion practices. Addressing this issue requires a multifaceted approach, community education, and targeted initiatives to combat gender-based violence and early marriage in Rwanda.