International Journal of MCH and AIDS最新文献

Background and objective: Obstetric pain is one of the most severe forms of pain a woman may experience during childbirth. Due to the debilitating effects of excruciating labor discomfort, pain management continues to be an important issue that requires attention. This study assessed the knowledge and utilization of obstetric analgesia in labor-management among midwives in public healthcare facilities in the north-central region of Nigeria.

Methods: This study used a descriptive cross-sectional design. One hundred twenty-three respondents who met the inclusion criteria were selected using the purposive sampling technique. Data were collected using a pretested structured questionnaire. The data were analyzed using descriptive and inferential statistics at a 0.05 level of significance.

Results: The results revealed that the respondents' overall knowledge of obstetric analgesia was adequate. The findings also revealed that more than half of the midwives have previously utilized obstetric analgesia to manage labor pain. However, the frequency of utilization of obstetric analgesia was low. A significant association was found between utilization of obstetric analgesia in labor and knowledge (χ² = 16.582, p < 0.001) as well as years of experience (χ² = 17.280, p < 0.015) and nursing rank (χ² = 36.579, p < 0.000); since the p-value < 0.05 significance.

Conclusion and global health implications: Therefore, it was recommended that midwives should be encouraged to frequently utilize obstetric analgesia to manage labor pain in order to improve the birth experience and outcome and to prevent the adverse effects that come with severe labor pain. Furthermore, the government should create policies that favor the utilization of obstetric analgesia in parturition, and midwives should incorporate the benefits of obstetric analgesia into the health education of pregnant women during antenatal counseling to promote its usage.

Long-acting antiretroviral (LAARV) agents have the potential to enhance treatment and prevention by eliminating the need for daily oral medications and increasing available options. This paper reviewed recent evidence on LAARVs and explores the opportunities and challenges of implementing these innovative prevention and treatment strategies in Sub-Saharan Africa (SSA). Several clinical trials and studies on the effectiveness, drug-drug interactions, and resistance of LAARVs in key populations in SSA are ongoing or recently completed. While the effectiveness, efficacy, and cost-effectiveness of LAARVs compared to existing oral therapies have been established, these products are not yet widely used in SSA. Significant logistical challenges in integrating LAARVs into clinic workflows under the poor health systems that are common in SSA necessitate a multi-sectoral, patient-centered approach, including the use of non-traditional healthcare delivery models.

Background and objective: Human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) remains a significant public health challenge globally, with key populations (KPs) such as female sex workers (FSWs), men who have sex with men (MSM), and people who inject drugs (PWIDs) being disproportionately affected. Despite the availability of various HIV prevention services, including pre-exposure prophylaxis (PrEP) and community-based antiretroviral therapy (ART), the willingness of KPs to access these services remains a critical concern. This study aims to assess the prevalence of HIV and the willingness to access HIV preventive services among KPs in three selected local government areas (LGAs) in Nigeria.

Methods: A cross-sectional study was conducted in 2023 across three LGAs, Gwale, Fagge, and Tarauni, in Kano State, Nigeria, using a snowball sampling technique. A total of 1,320 participants, recruited from brothels and nightclubs, were tested for HIV using self-test kits. Willingness to access HIV services was assessed using a structured questionnaire. Data were analyzed using descriptive statistics and binary logistic regression.

Results: The overall HIV prevalence among KPs was 10.8%. MSM and PWIDs exhibited higher HIV prevalence rates compared to FSWs. Willingness to access HIV preventive services was recorded at 57.7%, with significant influences from geographical location and sexual practices. Participants from Tarauni were more willing to access services, and those engaging in vaginal sex were more likely to seek preventive services. HIV self-testing had a high uptake of 95.9%, while PrEP uptake was 68.0%. Major barriers included stigma, lack of comprehensive services, and limited knowledge of service providers.

Conclusion and global health implications: This study highlights the critical need for targeted interventions addressing the specific barriers faced by KPs in these regions. Enhancing service accessibility and addressing stigma is essential for reducing HIV transmission and achieving epidemic control in Nigeria by 2030.

Background and objective: Women's autonomy plays a critical role in decision-making of health service use. This study aims to evaluate the relationship between Human Immunodeficiency Virus (HIV) testing and decision-making autonomy among Cambodian women aged 15-49.

Methods: We used data from the 2021-2022 Cambodia Demographic and Health Survey (DHS) and our sample consisted of currently married/cohabiting women aged 15-49 (N = 13,755). The outcome variable was "ever been tested for HIV." Covariates were household decision-making and reproductive health decision-making scores, socio-demographic characteristics (age, place of residency, education, wealth quintiles, and employment status), and HIV knowledge (HIV self-test kits, drugs to prevent HIV in babies during pregnancy, antiretroviral [ARV] drugs, and pre-exposure prophylaxis).

Results: Sixty-one percent of studied women reported ever being tested for HIV. The logistic regression results revealed that women with a higher household decision-making score (aOR = 2.09, p < 0.001), reproductive health decision-making score (aOR = 1.72, p < 0.001), from 25 to 29 age groups (aOR = 2.21, p < 0.001), with a higher education (aOR = 1.96, p = 0.001), from the richest groups (aOR = 1.73, p < 0.001), had knowledge of HIV test kits but never get tested (aOR = 1.38, p = 0.035), heard of drugs to avoid HIV transmission to babies during pregnancy (aOR = 1.21, p < 0.001), and heard of ARV drugs (aOR = 1.28, p < 0.001) were more likely to get tested for HIV than their counterparts. Women living in rural areas (aOR = 0.56, p < 0.001) and those who had discriminatory attitudes (aOR = 0.76, p = < 0.001) were less likely to get HIV tests than those in urban areas and those without discrimination.

Conclusion and global health implications: Findings revealed that greater autonomy is important for health care use, particularly HIV testing for women in Cambodia.

The integration of telehealth into maternal and child health (MCH) care presents an opportunity to enhance health equity, offering solutions to bridge gaps in access and quality of care. This paper explores the impact and reach of telehealth services on MCH, emphasizing its potential to address disparities in healthcare access, particularly for underserved and marginalized populations. Telehealth facilitates improved access to care by reducing geographical barriers, offering convenient and flexible consultation options, and providing cost-effective solutions for low-income families. This paper also crystallizes the importance of telehealth services on the continuity of care through consistent remote monitoring, which is crucial for managing chronic conditions and ensuring timely interventions during pregnancy and early childhood. However, the effective implementation of telehealth in MCH also faces significant challenges, including the digital divide, which limits technology access and digital literacy among vulnerable populations. Enhancing digital literacy is essential for empowering individuals to navigate telehealth services effectively and to make informed health decisions. To advance health equity, it is crucial to address these challenges by expanding technology access, improving digital literacy, and developing supportive policies that ensure comprehensive telehealth coverage while considering the Social Determinants of Health (SDoH). This paper explores the importance of leveraging telehealth and other timely interventions to improve MCH equity and justice, including the provision of technological resources and comprehensive policy frameworks. By addressing these factors, telehealth can significantly contribute to reducing health disparities and promoting equitable care for all maternal and child populations.

Background and objective: Sexual health research among women living with human immunodeficiency virus (HIV) has focused mainly on sexual practices and risk behaviors, with little consideration for treating sexual dysfunction and improving sexual satisfaction. The aim of this pilot study was to assess the effectiveness of an adaptive counseling care model in the management of female sexual dysfunction (FSD) among women living with HIV and without HIV in northern Nigeria.

Methods: This was a prospective cohort study of 200 women with HIV and a matched comparison arm of 200 women without HIV. Sexual function was assessed using the Female Sexual Function Index (FSFI), with a score ≤ 26.55 indicating FSD. We counseled women with FSD using the Permission, Limited Information, Specific Suggestions, Intensive Therapy (PLISSIT) model and evaluated the effectiveness of the model by comparing mean differences in baseline and six weeks post-intervention FSFI scores.

Results: The overall prevalence of FSD was 96.8%, with no difference between HIV-positive and HIV-negative participants (p = 0.398). Based on the six domains of the FSFI, the most common reported dysfunctions were sexual pain (21.7%), sexual desire disorder (17.6%), orgasm disorder (17.6%), lubrication disorder (17.2%), sexual arousal (16.9%), and poor sexual satisfaction (9.0%). The overall mean FSFI score (±standard deviation, SD) for those with FSD, in both groups (n = 387) prior to the counseling intervention was 16.05±10.65 (HIV-positive: 18.58±8.46; HIV-negative: 13.98±10.85). At the end of the intervention, the overall mean FSFI score in both groups increased to 23.58±16.53 (HIV-positive: 21.37±11.24; HIV-negative: 16.72±13.81) (p < 0.05 in all cases).

Conclusion and global health implications: FSD is very common among women in Northern Nigeria, irrespective of HIV status. An adapted counseling care model improved sexual function in both HIV-positive and HIV-negative women. The PLISSIT model can guide healthcare providers to initiate and navigate sexual health discussions with women in this setting.

Background and objective: The continuum of care (CoC) is an important approach that should be prioritized for improving maternal health. The World Health Organization recommends working with individuals, families, and communities to ensure continuous care throughout pregnancy, childbirth, and the postpartum period. The purpose of this study was to assess the impact of an intervention on the awareness of the CoC among main caregivers and the completion of CoC among pregnant women.

Methods: During the COVID-19 pandemic, a community-based quasi-experimental study was conducted in two townships of the Yangon Region, including 200 pairs of pregnant women and their caregivers. The intervention focused on providing health education sessions and distributing pamphlets to caregivers in the intervention group. The study aimed to assess the awareness of main caregivers about CoC and completion of CoC among pregnant women. A key predictor variable for evaluating the outcome was receiving an intervention package by the main caregivers in the intervention. The analysis used logistic regression, including the propensity score model, and was conducted using STATA vs 15.1.

Results: The final analysis included 193 pairs. Most main caregivers were husbands: 47 were husbands in the intervention and 59 in the control group, while 24 mothers were included in both groups. The awareness of CoC for maternal health among main caregivers from the intervention group was 9.97 times higher than those from the control group (AOR = 9.97, 95% CI: 5.12 to 19.43, p < 0.001). The completion of CoC among women from the intervention group was 2.17 times higher than those from the controls (AOR = 2.17, 95% CI 1.08 to 4.37, p < 0.05). The awareness of main caregivers was found to be a significant predictor for completion of CoC.

Conclusion and global health implications: Health education intervention for main caregivers could improve CoC completion among pregnant women. It provided baseline information for further interventions at the family level for improving CoC among pregnant women in the future.

Background and objective: Although male partners are eager to support the implementation of prevention of mother-to-child transmission (PMTCT) of HIV programs, several obstacles prevent them from participating. The purpose of this study was to explore the support of male partners of HIV-positive women in sustaining the implementation of PMTCT interventions.

Methods: This study adopted a qualitative approach. The case study research design was used to generate an in-depth understanding of the factors that hinder male participation in PMTCT interventions. Non-probability purposive sampling was used to 20 sample participants. Data was collected from two focus group discussions and analyzed using open coding. Trustworthiness was achieved by credibility, transferability, and confirmability. Adherence to ethical principles was upheld.

Results: Findings revealed two themes, perceived practices that hinder the provision of support and perceived support provided to sustain PMTCT intervention during childbirth. Sustaining PMTCT interventions included how the male partner adheres to interventions that prevent the transmission of the virus, like consistent condom use, especially during breastfeeding, support in exclusive breastfeeding, adherence to ART, and limiting the use of cultural practices.

Conclusion and global health implications: The involvement of males in the interventions of PMTCT has been found to improve the sustainability of eliminating transmission of the virus to the baby. All clinics were recommended to be men user-friendly to encourage men to accompany their partners. Men are to be actively involved during decision-making and physical examination, where possible. Workshops and information-sharing sessions for men forums and community members on PMTCT interventions to be conducted.

Background and objective: Maternal mortality remains extremely high in fragile settings, with hemorrhage as the leading cause. This study describes a new model for more effective training on postpartum hemorrhage (PPH) prevention and treatment.

Methods: Using a low-dose (of information) and high-frequency (of repetitions) approach (LDHF), the strategy comprised an introductory webinar, self-paced study, 2-day in-person workshops, cascade training, continuous facility-based skills drills, and a WhatsApp community of practice and supervision (CoP). Innovations consisted of the practical, midwifery-centered, and short-duration training, and the integration of tranexamic acid (TXA) and heat-stable carbetocin (HSC) into existing modules from the "Bleeding-After-Birth-Complete" toolkit. Effects were assessed through mixed-methods evaluation. Confidentiality and "do-not-harm" principles were respected.

Results: Nine training sessions were conducted in South Sudan and Uganda combined, engaging 126 participants. Average knowledge increases of 21% in South Sudan and 18% in Uganda were recorded. Feedback also indicated changes in practices and attitudes: enhanced competency, teamwork, clinical protocols adherence, appreciation for midwife-led practical sessions, the LDHF method, and continuous support through the WhatsApp CoP. In post-workshop action plans, facility teams outlined steps to apply acquired knowledge and skills. These included training colleagues, establishing quality improvement projects, conducting skill drills, ensuring job aid visibility, and systematically reporting on PPH in the data collection templates of the facilities.

Conclusion and global health implications: This case study highlights the value of a practical, LDHF refresher training strategy. This strategy bolstered providers' skills, knowledge, and confidence in using HSC and TXA for PPH prevention and treatment. Findings can guide future training in similar fragile, low-resource, and humanitarian settings. Strengthening midwifery leadership, fostering interdisciplinary collaboration, and using the LDHF training approach can contribute to resilient health systems and taskforce, aligning with global efforts to reduce maternal mortality.