Therapeutic advances in reproductive health最新文献

Background: Modern contraceptive use is vital for women's reproductive autonomy and maternal-child health, yet recent nationally representative studies on its determinants among married women in Lesotho are limited.

Objective: This study addresses these gaps using the latest Lesotho Demographic and Health Survey to provide updated evidence on prevalence and determinants.

Design: A cross-sectional study using nationally representative survey data.

Methods: The 2023-2024 Lesotho Demographic and Health Survey data were used for analysis. A weighted sample of 3102 married women of reproductive age from 400 enumeration areas across 10 districts was included in the analysis. A multilevel mixed-effects binary logistic regression model was employed to identify individual- and community-level factors associated with modern contraceptive use. Significant factors were determined using odds ratios with 95% confidence intervals and a p value of <0.05.

Results: Modern contraceptive use was reported by 65.6% of married women. Women aged 35-49 were less likely to use modern contraceptives than younger women (adjusted odds ratio (AOR) = 0.65, 95% CI: 0.43-0.98). Women with primary (AOR = 4.5, 95% CI: 1.9-10.4), secondary (AOR = 5.6, 95% CI: 2.4-13.1), or higher education (AOR = 6.1, 95% CI: 2.3-16.5), as well as those whose husbands had higher education (AOR = 1.8, 95% CI: 1.02-3.2), were more likely to use modern contraceptives. Employed women (AOR = 1.4, 95% CI: 1.07-1.5), joint decision-making with husbands (AOR = 1.45, 95% CI: 1.13-1.7), and knowledge of modern contraceptives (AOR = 1.8, 95% CI: 1.09-3.7) were also associated with higher use. Women with one to two living children (AOR = 9.7, 95% CI: 6.3-14.9) and those with three or more children (AOR = 16.4, 95% CI: 9.0-29.9) were more likely to use modern contraceptives. At the community level, women in all other districts had lower odds of use than those in Butha-Buthe.

Conclusion: Current modern contraceptive use among married women was moderately high. Key predictors included women's and husbands' education, employment, parity, joint decision-making, and contraceptive knowledge, while older women and certain districts had lower odds. These findings highlight the need for targeted interventions to enhance education, economic empowerment, spousal communication, and equitable access.

Background: Adolescent pregnancy remains a critical global health challenge, disproportionately affecting low-resource settings and jeopardizing the health, well-being and socioeconomic prospects of young mothers and their children. Globally, 75% of adolescent births occur without adequate medical care, exacerbating risks of maternal and neonatal complications. In Zimbabwe, where cultural, economic and structural barriers further limit healthcare access, adolescent girls face heightened vulnerabilities.

Objectives: This qualitative study explores the lived experiences and perceptions of adolescent mothers regarding maternal health services in Chiredzi district, Zimbabwe.

Design: This study employed a phenomenological approach to capture diverse perspectives on maternal healthcare.

Methods: In-depth interviews with 20 purposively sampled adolescent mothers (aged 15-19) attending Chiredzi General Hospital were conducted in March 2025, immediately after ethical approval was obtained (ethics number: NUST/IRB/2025/38). Data collection continued until thematic saturation was achieved. Interviews were transcribed verbatim and analysed using inductive thematic analysis.

Results: Analysis revealed 4 primary themes and 24 subthemes, highlighting key barriers to maternal healthcare access. Financial constraints, inadequate transportation and fragmented health services were prominent structural challenges. Sociocultural factors, including stigma, discriminatory attitudes and restrictive gender norms, further deterred care-seeking behaviours. Participants emphasized the need for adolescent-friendly health services, community-based education programs and economic support to mitigate these barriers. Stakeholder engagement, involving policymakers, traditional leaders and healthcare providers, was identified as critical for developing sustainable intervention strategies.

Conclusion: Addressing the maternal health disparities faced by adolescent girls requires a multifaceted, intersectional approach. Structural interventions, such as improving healthcare accessibility and affordability, must be coupled with community-level initiatives to combat stigma and promote gender equity. Empowering adolescents through education, economic opportunities and culturally sensitive support networks is essential to fostering long-term resilience. Policymakers and program implementers must prioritize adolescent-inclusive health strategies to ensure equitable maternal health outcomes in Zimbabwe and similar settings.

Background: High fertility rates and low infant mortality hurt maternal and child health and increase child dependency ratios, leading to poor economic development, low standards of living and low educational attainment. Despite efforts over the years, Ghana's fertility rates have declined at a rate lower than the global average. Using the multi-indicator cluster survey (MICS) data, we analysed the factors associated with three fertility dimensions: parity, high fertility and the desire for more children in Ghana.

Objective: The study aimed to investigate the factors associated with parity, high fertility and the desire for another child in Ghana.

Design: The MICS are cross-sectional, nationally representative surveys that employ a multi-stage, stratified cluster sampling approach to select sample units.

Methods: The data for this study were obtained from the 2017 to 2018 Multiple Indicator Cluster Survey (MICS) conducted in Ghana. Three outcome variables - parity, high fertility and the desire for another child - were defined. The explanatory variables consisted of respondents' sociodemographic and economic variables. The sample consisted of 11,228 women. We employed descriptive statistics, logistic regression and the generalised Poisson regression for the data analysis.

Results: Factors that are negatively associated with parity and high fertility include higher educational level, frequency of watching television, being insured and computer use. Residing in an urban location, being older, being in a higher wealth quintile (compared to the poorest) and the frequency of listening to the radio are all positively related to parity and being in a high-fertility zone. Women who have attained a higher level than middle/JHS, the older ones and those who are insured tend to desire another child.

Conclusion: The study found that educational level, media (television) exposure, insurance uptake and computer use are associated with a lower likelihood of having fewer children, while being in a union, residing in an urban location, being older, having higher wealth and exposure to radio are associated with parity and being in a high-fertility zone. Our study contributes to a deeper understanding of the drivers of fertility and the desire for more children in the context of low- and middle-income countries.

Background: Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine system disorders affecting reproductive-aged women of all races and ethnicities. A high prevalence of obesity exists in women with PCOS, who are also vulnerable to attrition from weight management programs. Despite recommendations the implementation of multidisciplinary approaches in weight management programs, there is a lack of literature evaluating their usage in their treatment programs.

Objectives: The objectives of this scoping review are to critically examine existing empirical literature to describe multidisciplinary approaches to weight management in populations diagnosed with PCOS and to identify potential factors associated with attrition.

Eligibility criteria: This review includes prospective studies of individuals aged 15 and older diagnosed with PCOS enrolled in a multidisciplinary weight management program. Multidisciplinary interventions were defined as participants receiving two or more multidisciplinary lifestyle interventions.

Sources of evidence: A systematic search of five electronic databases (MEDLINE, Cochrane, Embase, Cumulative Index to Nursing and Allied Health Literature, and Web of Science) identified articles with a multidisciplinary approach and reported data on attrition in PCOS weight management programs.

Charting methods: A descriptive analytical approach and narrative synthesis was conducted to identify themes related to intervention delivery, attrition, and facilitators/barriers of PCOS lifestyle interventions.

Results: From a total of 10,944 unique results, 11 articles met inclusion criteria for this review. Attrition rates ranged from 0% to 79.2%. Longer interventions were associated with higher rates of attrition. Control groups generally had lower attrition rates than their corresponding intervention groups. Studies incorporating technology-based interventions reported greater weight loss among participants.

Conclusion: Attrition is inconsistently reported among PCOS weight management studies. Variation in attrition rates is likely influenced by several factors such as intervention length and intensity, identified facilitators and barriers to PCOS weight management, and the extent to which care plans are individualized.

Background: Short birth intervals (SBI), defined as intervals of less than 33 months between consecutive live births, are a significant public health concern because of their association with adverse maternal and child health outcomes. Somalia has some of the highest maternal and neonatal mortality rates globally, compounded by limited access to family planning services.

Objectives: This study aimed to provide a descriptive analysis of the prevalence and patterns of SBI among Somali women across regions, offering insight into maternal health policies.

Design: A descriptive cross-sectional study design was employed.

Methods: Data from 9288 women aged 15-49 years drawn from the Somali Demographic and Health Survey were analyzed. Descriptive statistics were used to examine the prevalence and distribution of SBI across regions and sociodemographic groups.

Results: The overall prevalence of SBI was 77%, with regional disparities ranging from 82% in Togdheer and Hiraan to 74% in the Middle Shabelle. Women with no formal education and those in lower wealth quintiles exhibited a higher SBI prevalence than their counterparts. Rural and nomadic populations reported a higher SBI prevalence than urban residents, reflecting potential barriers to accessing family planning services.

Conclusion: This study highlights the widespread prevalence of SBI in Somalia, with notable variations according to region, education, and economic status. These findings underscore the need for targeted interventions to address the geographic, educational, and economic barriers to family planning access.

Background: Birth preparedness and complication readiness (BPCR) is a strategy that promotes the timely use of skilled maternal and neonatal care among pregnant women. Positive pregnancy outcomes can be achieved by appropriate birth preparedness and emergency complication readiness planning.

Objective: To explore the perceptions, benefits, awareness, and barriers of BPCR among pregnant women and health professionals at the antenatal care (ANC) clinic in the Oromia Region, Ethiopia.

Design: An exploratory, phenomenological descriptive qualitative study conducted from March 20 to April 24, 2022.

Methods: Three focus group discussion (FGD) sessions were conducted with 36 purposefully selected pregnant women attending ANC clinics. Key informant in-depth interviews (KIIs) were held with nine health professionals in Arsi Zone, Oromia, Ethiopia, using an interview guide. The data were analyzed using an inductive thematic analysis approach.

Results: Among the FGD participants, 19 reside in urban areas and 17 in rural areas. The KII participants comprised six midwives, two health officers, and a nurse. The participants mentioned their perception of BPCR during pregnancy, childbirth, the postpartum period, obstetric danger signs, and barriers to BPCR. Different sources of information on BPCR were mentioned, including friends, neighbors, health professionals, and family. The study showed that the participants were unfamiliar with the major BPCR components. The health professionals planned to educate pregnant women during ANC visits to enhance the adequacy of their BPCR plans. Facilitating husband support, increasing health facility accessibility, economic empowerment, and transport access will enable pregnant women to develop adequate BPCR plans.

Conclusion: This study's findings indicated that most participants did not focus strongly on BPCR plans because of low awareness, lack of support from husbands, family, and the community, poor infrastructure, and improper handling by health professionals. To increase service utilization, husbands, families, and the community should be informed about the benefits of the BPCR plan for pregnant women.

Background: Preterm premature rupture of membranes (PPROM) is a significant risk factor for perinatal morbidity and mortality. It is the main cause of preterm birth and affects approximately 10% of all pregnancies. The occurrence of PPROM has recently increased significantly. However, there is limited data on the determinants of PROM in the study area.

Objective: To assess the determinants of PPROM, among pregnant women admitted to maternity wards of public hospitals in the Sidama Region.

Design: An institution-based, unmatched case-control study.

Methods: The study was conducted in public hospitals in the Sidama Region from March 1st to May 15th, 2023. The consecutive cases were recruited until the required sample size was reached, and controls were randomly selected. Face-to-face interviews were used to collect data from 69 cases and 207 controls. Binary logistic regression analysis was used to identify determinants of PPROM. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was reported to show the strength of the association. The significance of the association was declared at a p value <0.05. The goodness-of-fit model was checked by the Hosmer-Lemeshow test.

Results: A total of 69 cases and 207 controls were included in the study. Pregnancy-induced hypertension (AOR: 2.65; 95% CI: 1.12-6.27), a history of abortion (AOR: 3.1; 95% CI: 1.41-7.08), a history of abortion (AOR: 3.78; 95% CI: 1.75-8.15), a history of cesarean section (AOR: 2.57, 95% CI: 1.10-5.99), a mid-upper arm circumference <23 cm (AOR: 2.1; 95% CI: 1.02-4.54), a history of urinary tract infection (AOR: 2.42; 95% CI: 1.10-5.32), and a hemoglobin level <11 mg/dl (AOR: 2.68; 95% CI: 1.15-6.23) were determinants of PPROM.

Conclusion: Past obstetric history, nutritional status, and risks in the index pregnancy have an association with PPROM. Therefore, strategies to reduce the occurrence of PPROM should target women in rural areas and emphasize the early identification and treatment of urinary tract infections, anemia, and pregnancy-induced hypertension.

Background: Preventing unintended pregnancies among reproductive-aged women with HIV (WWH) is crucial in combating mother-to-child transmission (MTCT) of HIV. We assessed the utilization of modern contraceptives and related factors among WWH attending the antiretroviral therapy (ART) clinic at a faith-based tertiary hospital in northern Uganda.

Objectives: To determine the proportion of and factors associated with the utilization of modern contraceptives among WWH of reproductive age attending the ART clinic in St. Mary's Hospital Lacor.

Design: This cross-sectional study was conducted at the HIV clinic within St. Mary's Hospital Lacor, from February to May 2023.

Methods: Between February and May 2023, we conducted a cross-sectional study among randomly selected WWH of reproductive age attending the ART clinic at a faith-based health facility, St. Mary's Hospital Lacor in Gulu city, northern Uganda. Quantitative data were collected using semi-structured questionnaires and analyzed using STATA version 16. Factors associated with the utilization of modern contraceptives were assessed using multivariable logistic regression. p < 0.05 was considered statistically significant.

Results: Of the 385 enrolled participants, 94 (24.4%) reported current modern contraceptive use, and 58 (15.1%) were using natural methods. Being referred to another facility to access modern contraceptives (adjusted odds ratio (aOR): 2.60, 95% confidence interval (CI): 1.31-5.17, p < 0.01), prior use of modern contraceptive (aOR: 32.47, 95% CI: 3.56-300.94, p < 0.01), and age (aOR: 0.92, 95% CI: 0.87-0.98, p < 0.01) were all statistically associated with uptake of modern contraceptives.

Conclusion: Only about one in every four WWH was currently using modern methods of contraceptives. There is a need to provide regular counseling to WWH on modern contraceptive methods to create awareness of the vital connection between modern contraceptive use and MTCT, as well as strengthen referral of clients opting to use modern contraceptives to facilities providing these services.