Frontiers in reproductive health最新文献

The world is not on track to reach the majority of the UNAIDS 2025 targets, and people who inject drugs (PWID) continue to be left behind, hindered by counterproductive law enforcement practices, punitive laws, economic distress, and social stigma and discrimination. Poor access to HIV pre-exposure prophylaxis (PrEP) among PWID is nested within the limited access to broader harm reduction services, including needle and syringe programs, opioid overdose management, opioid agonist therapy (also known as medication-assisted treatment), and condoms. Among PWID, women who inject drugs are disproportionately affected and face additional gender-based barriers. Intersections between PWID and other key and priority population groups also exist. Although the prioritization of PWID for new PrEP products like the dapivirine vaginal ring and injectable cabotegravir has lagged in research, studies have shown that PWID find injectable and long-acting options acceptable and preferrable, including among women who inject drugs. While new PrEP products introduce new opportunities, equity in access must be assured for optimized impact toward achieving epidemic control. Programming for services must engage and empower PWID community leadership to address the structural barriers to services, implement community-led, differentiated, and integrated service modalities, and offer the choice of all harm reduction options to close the equity gaps in health outcomes. While waiting for necessary evidence and approvals, programs should work together with the PWID community to prioritize, expand, and facilitate efforts and investments toward increased access to and integration of PrEP and all recommended harm reduction services for PWID.

Background: In sub-Saharan African countries, including Ethiopia, the utilization of sexual and reproductive health information during adolescence is considered to be low. The aim of this study was to assess the level of sexual and reproductive health literacy among adolescents in Ethiopia as well as the factors associated with sexual and reproductive health literacy in this population.

Methods: An institutional-based cross-sectional study design was employed. Systematic sampling methods were used to select 909 study participants. A validated scale was used, consisting of 31 questions with a 5-point Likert scale. A total score was computed, ranging from 31 (minimum score) to 155 (maximum score), which was finally categorized into limited and adequate sexual and reproductive health literacy. A multivariate linear regression model was fitted to determine the factors influencing adolescents' sexual and reproductive health literacy.

Results: The percentage of adolescents with slightly adequate and excellent sexual and reproductive health literacy was 38.9% and 6.3%, respectively. On the other hand, 677 (74.5%) participants overall had limited sexual and reproductive literacy. Healthcare workers and reading books were the preferred sources of sexual and reproductive health information that were associated with higher sexual and reproductive health literacy by 6.42 (95% CI 1.62-11.22) and 6.57 (95% CI 1.62-11.22), respectively. Adolescents' ability to pay for their healthcare was associated with better sexual and reproductive health literacy by 13.76 times (95% CI 8.21-19.32).

Conclusion: More than three-quarters of the adolescents had limited sexual and reproductive health literacy. Sources of sexual and reproductive health information, including healthcare workers, books, and the Internet, were significantly associated with adolescents' sexual and reproductive health literacy. Hence, primary stakeholders need to incorporate sexual and reproductive health into the curriculum at high schools.

Background: Reproductive rights are an essential element of public health interventions to reduce adolescent and youth mortality and morbidity. A lack of knowledge about sexual and reproductive health is an important barrier that contributes to a variety of health and social issues. This study assessed the knowledge of reproductive rights among Oda Bultum University students, eastern Ethiopia.

Methods: An institution-based cross-sectional study was carried out among 727 students from December 1 to 30, 2020. Participants were selected using a multistage sampling technique. Data were collected using a self-administered, pre-tested, and structured questionnaire. Data were entered into EpiData version 4.1 and analyzed using SPSS version 27. The study employed both bivariable and multivariable logistic regression analysis to determine the variables associated with knowledge regarding reproductive rights. The significance and degree of strength were declared at a p-value < 0.05 using an adjusted odds ratio with a 95% confidence interval.

Results: The overall knowledge of reproductive rights among university students was 47.2% (95% CI: 43.3%, 50.9%). Male gender (AOR = 2.11, 95% CI: 1.50, 2.97), urban residence (AOR = 1.62, 95% CI: 1.16, 2.28), formal maternal education (AOR = 2.26, 95% CI: 1.62, 3.17), participation in a sexual and reproductive health club (AOR = 2.67, 95% CI: 1.74, 4.10), utilization of sexual and reproductive health services (AOR = 6.29, 95% CI: 4.22, 9.36), and discussion about sexual and reproductive health issues (AOR = 1.60, 95% CI: 1.11, 2.30) were the factors that improved the knowledge of reproductive rights.

Conclusions: Almost half of the university students know about reproductive rights. Various factors identified were associated with the knowledge of reproductive rights among university students, including gender, residence, parental education level, engagement in sexual and reproductive health clubs, utilization of sexual and reproductive health services, and discussions about sexual and reproductive issues. Healthcare professionals at all levels should concentrate on offering excellent services related to reproductive health and establishing programs for specific education and counseling on reproductive rights for all well-behaved students.

Introduction: The age at first birth refers to the age at which a woman has her first child. It can significantly influence the demographic behavior of women and the general community. Moreover, teenage childbearing is a serious public health and social problem. The main objective of this study was to identify factors associated with age at first birth among women in Ethiopia.

Methods: Secondary data on women were obtained from the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS). These population-based cross-sectional data were downloaded from the Measure Demographic and Health Survey website (http://www.measuredhs.com). The study included a random sample of 8,885 women aged 15-49 years from 305 enumeration areas. A multilevel survival analysis was employed to identify the factors associated with teenage childbearing among women in Ethiopia.

Results: The majority (67.7%) of randomly sampled women were subjected to teenage childbearing. Women being rural dwellers [hazard ratio (HR) = 1.27, 95% CI: 1.05, 1.54]; women from middle-income families (HR = 1.43, 95% CI: 1.18, 1.74); and women from higher-income families (HR = 1.40, 95% CI: 1.15, 1.70) were associated with a higher risk of teenage childbearing. Conversely, contraception method users (HR = 0.87, 95% CI: 0.77, 0.99), Muslims (HR = 0.75, 95% CI: 0.64, 0.89), Orthodoxes (HR = 0.68, 95% CI: 0.57, 0.80), women with secondary education (HR = 0.53, 95% CI: 0.43, 0.65), women with higher education (HR = 0.28 (95% CI: 0.22, 0.37), and the higher age of household head (HR = 0.99, 95% CI: 0.98, 0.99) were associated with a lower risk of teenage childbearing among women in Ethiopia.

Conclusion: Since the median age of women to have their first child was 18 years old, this study strongly suggests that stakeholders at the federal and regional levels must work closely toward enforcing the legal age of marriage and implementing national adolescents' and youths' targeted sexual and reproductive health programs.

Aim: Although sexual and reproductive health for adolescents is a recognized fundamental human right and a critical component of health policy, it is poorly addressed and seldom researched in pastoral communities. The study aimed to determine the status of sexual and reproductive health knowledge, attitudes, and practice among pastoral school adolescents in Ethiopia.

Study design: An Institution-based comparative study was conducted from Nov. 2020 to Jan. 2021.

Methods: We conducted a comparative cross-sectional study at four randomly selected high schools. Seven hundred seventy-three adolescent students participated, with 384 from Gorodola and 389 from Wadara districts, Guji zone Ethiopia. The data was collected using 34 self-administered questions and analyzed using descriptive, t-test, and linear regression models.

Results: The study found that only 44.2% of all the participants had good knowledge, 46.1% had good attitudes and 35.4% had good utilization of Sexual and Reproductive Health Services. Respondents from Wadara High School had significantly higher mean knowledge scores (49.3% vs. 44.2%, p < 0.01) than those of Gorodola High School. There was no significant difference in mean utilization scores between case and compare (45.08% vs. 37%, p > 0.01). Adolescents who were not communicated on SRH matters, previously utilized FHS, and visited Friendly Health facilities were associated with poor utilization of sexual and reproductive health services.

Conclusion and public health contributions: Wadera High School adolescents have better Sexual and reproductive health knowledge and utilization than Gorodola high schools. Community public health care providers in Wadara District explain the outcome through their contributions. Within the context of inherent disadvantage in the school environment setting, there is a need to improve sexual and reproductive health education with a greater emphasis on school girls.

Background: Abortion complications are the leading causes of maternal death in low and middle-income countries, including Ethiopia. Providing quality and comprehensive abortion care services is crucial for improving the health of women and increased their satisfaction. Evaluating a client's satisfaction with abortion care is clinically relevant since women's satisfaction with health services is one of the key indicators of high-quality healthcare services. Therefore, this study aimed to assess women's satisfaction with comprehensive abortion care services and associated factors.

Methods: An institution-based cross-sectional study was implemented among 333 women in Central Gondar Zone public primary hospitals from October 1, 2022, to April 30, 2023. Eligible participants were selected using a systematic random sampling technique. The data was collected using an interviewer-administered semi-structured, and pretested questionnaire. STATA version 17 and SPSS version 25 software were used for data entry and analysis respectively. Bivariable and multivariable logistic regression models were used to identify factors associated with clients' satisfaction with comprehensive abortion care services. A P-value of ≤0.05 with a 95% confidence interval was the cutoff point for determining statistical significance.

Results: This study revealed that the level of client satisfaction with comprehensive abortion care services was 60.4% (95% CI: 55.0%, 66.0%). The use of abortion medication (AOR = 4.41, 95% CI: 2.59, 7.48), women's age 20-24 years (AOR = 2.94, 95% CI: 1.02, 8.48), and being a student (AOR = 2.88, 95% CI: 1.10, 7.51) were significantly associated with women's satisfaction with comprehensive abortion care services.

Conclusions: Women's satisfaction with comprehensive abortion care services was relatively low, and it was strongly correlated with the method of abortion, age, and occupation. To improve women's satisfaction requires a comprehensive understanding of women's values and perspectives, providing sexual and reproductive health education, and quality abortion care services are recommended.

Polycystic ovary syndrome (PCOS) exhibits high prevalence and heritability despite causing negative impacts on fertility and fecundity. Previous hypotheses have postulated that some PCOS-associated traits, especially above-average levels of testosterone, were associated with benefits in ancestral environments. As such, PCOS would represent, in part, a maladaptive extreme of adaptations related to relatively high testosterone. To evaluate this hypothesis, we conducted a series of systematic literature reviews on the associations of testosterone levels, and prenatal testosterone metrics, with measures of strength, robustness, muscularity, and athleticism in females. We also systematically reviewed the literature on associations of testosterone with dominance in females and reviewed archaeological evidence concerning female strength and muscularity and its correlates. The main findings were fivefold: (1) elevated testosterone levels were generally associated with higher strength, muscularity and athleticism in females; (2) females with PCOS showed notable evidence of increased strength, muscularity, and athleticism compared to controls; (3) females with higher testosterone levels exhibited clear evidence of high dominance, (4) despite evidence that higher testosterone is linked with higher bone mineral density in healthy females, PCOS was not clearly associated with this phenotype; and (5) archaeological evidence from osteology, and data from some current small-scale societies, indicated that females often exhibit substantial levels of muscularity. Overall, the hypothesis that relatively high levels of testosterone are associated with benefits to females in some contexts was largely supported. These results provide evidence for the "maladaptive extremes of adaptation" model, with implications for treatment of females with PCOS and for future research.

Introduction: A Delphi consensus was performed to evaluate expert opinions on the management of key aspects of ovarian stimulation.

Methods: A Scientific Committee developed eleven statements for patient profiles corresponding to predicted ovarian responses (low, normal, and high) based on antral follicle count (AFC) and anti-Müllerian hormone (AMH). The statements were distributed (online survey) to French and Belgian fertility specialists. Consensus was reached when ≥66.7% of participants agreed or disagreed.

Results: Among 52 respondents, a consensus agreement was reached for each patient profile for personalizing the initial dose of gonadotropin, taking age, weight, body mass index, nature of the cycle, and the decision to perform a fresh transfer or a freeze-all strategy into consideration. The respondents preferred a fresh transfer for low and normal responders and a freeze-all strategy in case of high risk of hyperstimulation, newly diagnosed uterine or tubal pathology and premature progesterone elevation. A consensus was reached for 10-15 oocytes as optimal oocyte target from the first round of voting. The panel agreed to increase the gonadotropin dose in case of insufficient response and preferred a GnRH antagonist protocol for a subsequent cycle in case of excessive response. Finally, a consensual answer was obtained for using LH/hCG activity in case of hypogonadotropic hypogonadism, advanced age, inadequate response during first stimulation and suspected FSH receptor polymorphism.

Discussion: The AMPLITUDE consensus supports the importance of optimizing the ovarian stimulation protocol for patients undergoing assisted reproductive technology treatment. Additional studies could complete these findings and guide fertility specialists in their daily practice to improve ovarian stimulation outcomes.

Background: In conventional, gonadotropin stimulated, in vitro fertilization or intracytoplasmic sperm injection (c-IVF/ICSI) growth and development of multiple follicles is induced by gonadotropins, combined with gonadotropin-releasing hormone agonist or antagonist. In recent studies, singletons conceived after c-IVF/ICSI cycles had lower birth weight not only than spontaneously conceived children but also children born after unstimulated natural IVF/ICSI cycles (NC-IVF/ICSI). Lower birth weight is associated with a catch-up growth within the first years of life. Following the Barker hypothesis accelerated growth has been associated with a higher risk of cardiovascular diseases later in life. The aim of the study is to assess, if children conceived with NC-IVF/ICSI have a higher birthweight and therefore do not show a catch-up growth within the first two years. Therefore, we assume that children born after NC-IVF/ICSI have a better long-term cardiometabolic risk profile. Whether the weight- and height gain is comparable to spontaneously conceived children is unknown, since to our knowledge we are the first study to investigate the longitudinal growth of children born after unstimulated natural cycle ICSI (NC-ICSI).

Material and methods: We conducted a single-center, prospective cohort study (2010-2017) including children (n = 139) born after NC-ICSI or c-ICSI treatment. Growth parameters up to 24 months were collected. Standard deviation scores based on growth references were calculated.

Results: The study included 98 children in the NC-ICSI and 41 children in the c-ICSI group. The median birth weight in NC-ICSI children was 3.4 kg [0.1 standard deviation score (SDS)] compared to 3.3 kg (-0.3 SDS) in c-ICSI children (p = 0.61). Median length at birth was 50 cm in both groups (NC-ICSI (-0.5 SDS), c-ICSI children (-0.8 SDS), p = 0.48). At age 24 months, median weight in NC-ICSI children was 12.2 kg (0.3 SDS) versus 12.2 kg (0.2 SDS) in c-ICSI children (p = 0.82) and median length 87.5 cm (0.1 SDS) versus 88.0 cm (0.4 SDS) (p = 0.43).

Conclusion: We found no difference in growth between children conceived after stimulated and unstimulated ICSI. Growth parameters of both treatment groups did not differ from Swiss national growth references (N = 8500). One of the main limitations of our study was the small sample size (N = 139) of complete data sets over time and the high drop-out rate of 49% (68/139). Nevertheless, with the increasing number of children born after IVF/ICSI every year it is of immense importance to search for possibilities to reduce their long-term cardiometabolic risk and we want our data to contribute to this discussion.