Frontiers in reproductive health最新文献

Introduction: Young people's access to appropriate health information in Ghana has been marginal, hence their utilisation of existing services remains poor. Most sexual and reproductive health (SRH) policies and outreach programmes target adolescents, neglecting emerging adults who are equally vulnerable to SRH risks. This study seeks to elicit emerging adults' knowledge and experiences with SRH programmes, and their recommendations to improve the services for their needs.

Methods: Using data from 30 in-depth interviews and 10 focus group discussions with youth aged 18-24 years in a suburb of Accra, we provide insights on emerging adults' experiences with SRH programmes and their recommendations for their improvement, as well as young men's perspectives on SRH programmes, in particular.

Results: The participants were in three socio-economic groups: tertiary students, informal workers and apprentices. The main SRH education that the emerging adults had received was from their earlier formal education in Junior and Senior High Schools but not in their current places of school or work. However, they indicate that the SRH education programmes and information they received earlier in life were inadequate to tackle pragmatic issues that contemporary youth face. Furthermore, SRH programmes operate in unfriendly environments with negative messages that cause them to lack vital information.

Discussion: For the success of SRH programmes, the youth should be targeted with diverse contemporary approaches specific for their SRH needs. Key recommendations comprised making available SRH education tailored for emerging adults' current demographic and socio-economic groups, and providing appropriate SRH content and youth-friendly community centres.

Adenomyosis is a commonly encountered pathology in women of reproductive age and frequently coexists with infertility. The effect of adenomyosis on fertility, particularly on in vitro fertilisation and intracytoplasmic sperm injection outcomes, is not well understood. Various pretreatment modalities have been used to improve pregnancy rates and live birth outcomes; however, because of a lack of high-quality evidence, there is no clear consensus on the best pretreatment option. This review was conducted through a PubMed search aiming to highlight the relationship between pretreatment and fertility in women with adenomyosis. Medical, ablative surgical, and non-surgical therapies were reviewed. According to the current literature, gonadotropin-releasing hormone agonist therapy and placement of a levonorgestrel intrauterine system are two suitable medical pretreatment strategies that can improve the clinical pregnancy rates of patients with adenomyosis. Surgical ablation of adenomyosis can also be beneficial, although surgical management can be challenging. Non-surgical thermal techniques, including high-intensity focused ultrasound ablation, percutaneous microwave ablation, and radiofrequency ablation, are much less invasive techniques that have shown effectiveness in improving fertility. Although evidence remains limited, all these procedures have demonstrated a favourable safety profile. Further studies are needed to better develop these techniques and demonstrate their effectiveness.

Introduction: The rate of sexual activity among adolescents is very high, with serious repercussions such as human immunodeficiency virus (HIV) and sexually transmitted diseases. Understanding the factors that influence adolescents' engagement in sexual activity is crucial for promoting healthy sexual attitudes and behaviors in schools, sex education programs, communities, and families. This study aimed to examine the factors influencing sexual decision-making among Cambodian adolescents.

Methods: In accordance with the Standards for Reporting Qualitative Research (SRQR), this study used a descriptive qualitative methodology with individual interviews. The participants in the study were 30 Cambodian adolescents (15 males and 15 females) who were all unmarried and sexually active. They were recruited using various methods, including social networking services, and interviewed to explore their sexual decision-making processes.

Results: The analysis revealed that the decision-making process was influenced by both internal and external factors. Internal factors included sexually explicit Internet material and arousal from sexy outfits, while external factors included foreign vs. Khmer culture, the surrounding environment including community, peers, and family, and educational advice received at school. Gender differences were noted in responses to stimuli like sexy outfits and perceptions of cultural norms.

Conclusions: This study underscores the complexity of adolescent sexual decision-making in Cambodia. It highlights the need for sex education that is not only comprehensive but also culturally sensitive, addressing the diverse influences on these adolescents. Future research should include a broader demographic group, including rural adolescents, to gain more comprehensive insights.

Implications for practice: This study uncovers how cultural norms, peers, and the media impact sexual behaviors, emphasizing the significant gender differences in these aspects. The findings shed light on the necessity of culturally sensitive and comprehensive sex education and the urgent need for tailored approaches to health promotion and education.

Background: High unmet need for family planning combined with other factors, such as high early marriage and teenage pregnancy, increases the risk of developing obstetric fistula and other complications. This study aimed to assess spatial distribution and urban-rural disparities of unmet need for family planning among married/in-union women in Ethiopia.

Methods: The study was conducted on secondary data from a cross-sectional survey that was conducted nationally between September and December 2019 using a two-stage cluster design on a total of 265 enumeration areas. A total weighted sample of 5,349 married/in-union women was included in the analysis. ArcGIS Pro and SaTScan software were used to handle spatial analysis. Finally, multivariable decomposition analysis via a logit model was used to decompose the observed difference in unmet need by the compositional difference and the difference in effects of explanatory variables between places of residence.

Results: Spatial distribution of unmet need for family planning was clustered in Ethiopia with a global Moran's I index value of 0.25 (p-value = 0.004). Accordingly, enumeration areas in West Hararge, Arsi, Bale, Gujji, Borena, Jimma, and East Wellega zones of Oromia region, and Gurage, Hadiya, Silte, Gedio, Sidama, Wolaita, Alaba, and Dawro zones of South Nation and Nationality People region, and the southern part of Zone 3 in Afar region were detected as hotspot areas. The decomposition results revealed that there is a significant disparity in unmet need between urban and rural resident women (0.074, p-value < 0.001). Endowment and coefficient factors accounted for the urban-rural disparity, contributing 68.32% and 31.68%, respectively. Household size, husband's opinion of family planning, community acceptance of family planning, woman's age at first sexual intercourse, and the woman's age were key determinants of the urban-rural disparity.

Conclusion: The results revealed a significant disparity in the unmet need for family planning based on place of residence, with a clustered spatial distribution across the study area and notable hotspot areas. Thus, targeted interventions should focus on mobilizing resources to high-risk areas and addressing the needs of high-risk groups to reduce the observed variation.

Objectives: Endometrial scratching (ES) and/or intravenous intralipid therapy (in cases of increased uterine natural killer cells, uNKs) are still conducted in several fertility centers as "add-on" treatments in patients undergoing ART, although convincing evidence for beneficial effects is lacking.

Study design: In this retrospective study, associations between ES treatment or additional intralipid therapy and pregnancy and live birth rates of 1,546 patients undergoing 2,821 IVF-/ICSI-treatment cycles with fresh or frozen embryo transfers in a German fertility-center between 1st January 2014 and 31th May 2017 were analyzed.

Results: Overall pregnancy and live birth rates for all 2,821 treatment cycles (468 cycles with ES) were 32.8% and 23.5%. There were no statistically significant differences in pregnancy or live birth rates between first treatment cycles with and without ES (p = 0.915 and p = 0.577) or between second cycles following an unsuccessful first cycle with and without ES (p = 0.752 and p = 0.623). These results were confirmed using multivariable generalized estimating equations (GEE) models accounting for non-independency of multiple treatment cycles per patients that included all cycles and showed no significant effect of ES on pregnancy (p = 0.449) or live birth rates (p = 0.976). Likewise, a GEE model revealed no significant effect of intralipid treatment on pregnancy (p = 0.926) and live birth rates (p = 0.727).

Conclusions: Our results reveal no evidence that ES increases the pregnancy or live birth rates in women undergoing their first or further IVF cycle with fresh or frozen embryo transfer. Intralipid treatment was also not beneficial. Even if patients explicitly ask for it, these procedures are not recommended outside of clinical studies.

Background: Risky sexual practices among taxi drivers pose a significant threat to public health, contributing to the spread of sexually transmitted infections (STIs) and HIV/AIDS. The nature of their profession often exposes taxi drivers to factors that increase their vulnerability to engaging in risky sexual practices. Although research on sexual health in general is readily available, studies specifically focused on this population are limited. Understanding the contributing factors behind risky sexual practices among taxi drivers is crucial to developing targeted interventions that address their unique needs and vulnerabilities.

Objectives: To assess the prevalence and associated factors of risky sexual practices among taxi drivers in Finoteselam town, northwest Ethiopia, 2023.

Methods: A cross-sectional study was conducted among 359 taxi drivers in the Finoteselam town. Data were collected using pre-tested questionnaires and analyzed using SPSS. Bivariate and multivariable analyses were performed to identify factors associated with risky sexual practices. In the bivariate analysis, a p-value ≤ 0.25 at 95% CI was used to consider the variables in the multivariate analysis. Finally, statistical significance was declared with a p-value of less than 0.05 with a 95% CI.

Results: The prevalence of risky sexual practices among taxi drivers was 32.9 (95% CI: 28.01, 38.7). Living alone (AOR = 3.47, 95% CI: 1.86, 6.48), taxi ownership (AOR = 2.08, 95% CI: 1.01, 4.25), neglecting the discussion of the SRH issue (AOR = 2.05, 95% CI: 1.08, 4.00), substance use (AOR = 1.56, 95% CI: 1.04, 2.09), attending night clubs (AOR = 6.04, 95% CI: 1.97, 18.55) and watching pornographic materials (AOR = 4.44, 95% CI: 2.14, 9.19) were significantly associated with risky sexual practices.

Conclusions and recommendation: This study revealed a high prevalence of risky sexual practices among taxi drivers in Finoteselam town. Therefore, a comprehensive approach involving different stakeholders is required for reducing risky sexual practices. Information dissemination, awareness creation (about risks of attending nightclubs, substance use, and watching pornography), and encouraging knowledge sharing about sexual health are some of the interventions required to reduce risky sexual practices among taxi drivers.

Introduction: Depletion of Lactobacillus species and an overgrowth of anaerobes in the vaginal tract bacterial vaginosis (BV)], is associated with non-optimal reproductive health outcomes, and increased susceptibility to sexually transmitted infections (STIs). BV is currently treated with antibiotics, although these provide suboptimal cure levels and high recurrence rates. Vaginal microbiota transplantation (VMT), the transfer of vaginal fluid from healthy donors with an optimal vaginal microbiota to a recipient with BV, has been proposed as an alternative treatment strategy.

Methods: Here, we investigated knowledge and perceptions of blood donors to the concept of an optimal vaginal microbiome and VMT via the Western Cape Blood Service (WCBS) clinics in Cape Town, South Africa, by a self-administered questionnaire.

Results & discussion: Analysis of responses from 106 eligible women showed that 86% (91/106) would consider donating samples. Responses significantly associated with willingness to donate vaginal samples included: (1) belief that helping others outweighs the inconvenience of donating vaginal sample (p = 1.093e^-05) and (2) prior knowledge of the concept of a healthy vaginal microbiome (p = 0.001). Most potential donors (59/91; 65%) were willing to receive a VMT themselves if needed. Participants who were unwilling to donate vaginal samples (15/106; 14%) indicated that vaginal sample collection would be unpleasant and/or embarrassing. The benefits of a collaboration with WCBS for this project include the naturally altruistic nature of blood donors, the constant in-flow of donors to WCBS clinics, and the infrastructure and logistical aspects in place. Data from this observational study highlight factors affecting the willingness of blood donors to become vaginal sample donors.

Purpose of review: Women in Africa bear the burden of the HIV epidemic, which has been associated with the high prevalence of bacterial vaginosis (BV) in the region. However, little progress has been made in finding an effective cure for BV. Drawing on advances in microbiome-directed therapies for gastrointestinal disorders, similar live-biotherapeutic based approaches for BV treatment are being evaluated. Here, we summarize current knowledge regarding vaginal microbiota in BV, explore geographical differences in vaginal microbiota, and argue that novel BV therapeutics should be tailored specifically to meet the needs of African women.

Recent findings: Cervicovaginal microbiota dominated by Lactobacillus crispatus are optimal, although these are uncommon in African women. Besides socio-behavioural and environmental influences on the vaginal microbiota, host and microbial genetic traits should be considered, particularly those relating to glycogen metabolism. Novel microbiome-directed approaches being developed to treat BV should employ transfers of multiple microbial strains to ensure sustained colonization and BV cure.

Summary: Improving the efficacy and durability of BV treatment with microbiome-directed therapies by appropriately accounting for host and microbial genetic factors, could potentially reduce the risk of HIV infection in African women.

Background: The challenges of safe menstrual hygiene management practices in low-income settings, including the study areas are pressing. However, Studies specifically focusing on barriers that schoolgirls face in managing monthly menstruation in schools of Bahir Dar are inadequate and scarce.

Method: To ensure the robustness of the findings, a comprehensive study was conducted among schoolgirls and boy students aged 12-20 in three schools. This study employed focus group discussions and in-depth interviews with students and leaders of the school gender club. A word cloud generator was used to visually represent frequently mentioned keywords, and the data generated from interviews were analyzed using the Open Code 4.03 tool.

Results: The findings, derived from focus group discussions and in-depth interviews, revealed several significant barriers that schoolgirls face in practicing safe menstrual hygiene management. These barriers, including sociocultural factors (133), inadequate use of menstrual hygiene management facilities (73), inadequate knowledge before menarche (59), and a general lack of support (35), underscore the multifaceted nature of the issues. Importantly, these findings emphasize the urgent need for targeted interventions to address these barriers and improve menstrual hygiene management among schoolgirls.

Conclusion: Schoolgirls in Bahir Dar encounter numerous challenges in maintaining safe menstrual hygiene practices. Addressing the identified modifiable barriers represents crucial areas for intervention, requiring collaborative efforts from school communities and other relevant stakeholders to create an environment conducive to promoting and enhancing safe menstrual hygiene practices.