Therapeutic advances in reproductive health最新文献

Background: Digital knowledge translation (KT) interventions play a crucial role in advancing adolescent sexual and reproductive health (ASRH). Despite the extensive literature on their effectiveness, there's a lack of synthesized evidence on the efficacy of digital KT tools for adolescent ASRH globally.

Objectives: This review aimed to systematically identify and map existing empirical evidence on digital KT tools targeting ASRH outcomes and identify research gaps.

Design: The review employed an evidence gap-map (EGM) approach following 2020 PRISMA reporting guidelines.

Data sources and methods: A comprehensive literature search was conducted across databases including Medline, EMBASE, Global Health, CINAHL, Scopus, and Cochrane. Covidence software was used for data management. EPPI-Mapper software was used to synthesize findings and develop a graphical EGM.

Results: The EGM comprises 68 studies: 59 experimental and 9 systematic reviews, predominantly from African (19 studies) and American regions (22 studies), with limited research from the Eastern Mediterranean and South East Asian regions. It examines digital KT tools' influence on sexual and reproductive health (SRH) outcomes, identifying research gaps. Websites are extensively studied for their impact on adolescent behavior, knowledge, attitude, and self-efficacy, yet research on their effects on ASRH and health services access is limited. Similarly, mobile apps and short message service (SMS)/text messages impact various aspects of SRH outcomes, but research on their effects on health services utilization is insufficient. Interventions like digital pamphlets and gaming lack exploration in health service access. OTT media and social media need further investigation. Mass media, including radio, television, and podcasts, are largely unexplored in adolescent SRH outcomes. Topics such as menstrual hygiene, abortion, and sexual and intimate partner violence also lack research.

Conclusion: The review underscores the dominance of certain KT tool interventions like SMS and websites. Despite advancements, research gaps persist in exploring diverse digital platforms on underrepresented outcomes globally. Future research should expand exploration across digital platforms and broaden the scope of outcome measures.

Trial registration: The protocol is registered with PROSPERO (CRD42022373970).

Background: Antenatal care is essential for reducing maternal and neonatal mortality, particularly in low-income regions. However, the adequacy of the care provided is crucial for achieving maternal health goals. Maternal mortality rates in Uganda are still among the highest globally. Thus, evaluating the adequacy of antenatal care (ANC) services, especially in high-risk regions is imperative.

Objective: To determine the prevalence of adequate ANC and associated factors in Eastern Uganda.

Design: A multicenter quantitative cross-sectional study was conducted at four healthcare facilities in Eastern Uganda from July to August 2022.

Methods: We included immediate postpartum mothers who had given birth within 48 h with a record of their ANC information on a card or book. Adequate ANC was measured by a composite index of 10 core components per WHO guidelines on ANC for a positive pregnancy experience. Data were collected using a structured questionnaire designed with Kobo Toolbox and analyzed using Stata 15.0. Bivariable and multivariable logistic regression analyses assessed factors associated with receiving adequate ANC. Statistical significance was determined by a p value <0.05.

Results: We recruited 1104 postnatal mothers, most aged 20-34 years (n = 805, 72.9%). Only 5.9% received adequate ANC, with most mothers receiving an average of 6.9 (±2.0) of the 10 assessed ANC components. Receiving adequate ANC was associated with urban residency (AOR: 2.3; 95% CI: 1.16-4.38, p = 0.017), age between 20 and 34 years (AOR: 3.5; 95% CI: 1.07-11.30, p = 0.038), current or previous complications (AOR: 1.8; 95% CI: 1.02-3.29, p = 0.043), and delivery at a general hospital (AOR: 4.8; 95% CI: 2.60-8.83, p < 0.001).

Conclusion: There is a critical gap in providing adequate ANC in Eastern Uganda, especially for rural and younger mothers. Policy efforts should focus on expanding access, enhancing maternal education, and strengthening healthcare infrastructure to meet the recommended ANC standards.

Background: Menstruation is a universal and normal phenomenon during the reproductive age of females; adolescence is an essential period where females are preparing and adjusting themselves to manage their menstrual bleeding safely and cleanly. Menstrual hygiene management (MHM) is an issue that is insufficiently acknowledged and has not received adequate attention among visually impaired adolescent girls (VIAGs).

Objectives: The purpose of this study was to determine the knowledge and practice of MHM and associated factors among VIAGs of selected institutions in Rwanda.

Design: This study consisted of a cross-sectional study design using a quantitative approach.

Methods: A cross-sectional study was conducted in April and May 2021 on 92 VIAGs. They were recruited from educational institutions in two Provinces in Rwanda. Voluntary participation and confidentiality were assured. Socioeconomic and demographic data, menstruation, and menstrual hygiene questionnaires were used to obtain the required information. Statistical Packages for the Social Sciences (SPSS) for Windows version 25 was used. Descriptive statistics, Chi-square test, and logistic regressions were used for data analysis.

Results: The study reached 92 respondents. The majority of the respondents, 67.4% had a poor level of menstruation and menstrual hygiene knowledge while only 32.6% had a good level of menstruation and menstrual hygiene knowledge. Also, it is confirmed that the majority of respondents, 52.1% had a good level of practice, while 47.8% had a poor level of menstrual hygiene practice. The multivariable analysis revealed that factors associated with the menstrual hygiene practice were as follows: the mother's education (odds ratio (OR): 5.979; 95% CI: [1.700-21.032]; p value: 0.005) and level of knowledge of menstruation and menstrual hygiene (OR: 0.132; 95% CI: [0.028-0.622]; p value: 0.010).

Conclusion: The knowledge and practice of MHM among VIAGs were poor. Recommendations included the need for mothers to assist their daughters in improving learning and practice of menstrual hygiene, as well as the integration of MHM into school curricula. Further research is suggested to better understand MHM among Rwandan adolescent girls, both visually impaired and non-blind.

The ideal morphology of the sperm cell was initially described based on the characteristics of sperm able to migrate through the endocervical canal assuming these had the best fertilization potential. Sperm morphology assessment has moved over the years toward stricter criteria based on the findings from studies that underline its value in successful reproductive outcomes. While treatment options are clear for some conditions related to abnormal sperm morphology, the value of sperm morphology in assisted reproduction requires further investigation. The objective of this review is to offer care providers updated guidance for choosing appropriate treatment strategies based on sperm morphology assessment and morphological deviations. Issues to be considered for a reliable determination and interpretation of sperm morphology using the current thresholds and criteria are discussed. In addition, key knowledge on morphological abnormalities relevant to the clinical care of infertile patients, distinguishing between monomorphic and polymorphic forms as well as the isolated or non-isolated occurrence of teratozoospermia in semen is presented. Furthermore, the impact of impaired morphology on assisted reproductive technique outcomes is summarized in light of the latest research.

Background: Maternal and child mortality rates remain a serious public health challenge in Ethiopia. Short interpregnancy intervals are known to negatively impact perinatal and child health; therefore, improving this practice is a key strategy to reduce mortality and adverse outcomes.

Objective: This study aimed to evaluate the extent of short intervals between pregnancies and the factors associated with them among women who gave birth at public hospitals in the North Wollo Zone of northeastern Ethiopia in 2023.

Design: A facility-based cross-sectional study was conducted in the North Wollo Zone of northeastern Ethiopia in 2023.

Methods: This study was conducted on mothers who delivered at public hospitals in the North Wollo Zone of northeastern Ethiopia. The study participants were selected using a systematic random sampling technique between February 1, 2023, and April 1, 2023. Data were collected through an interviewer-administered questionnaire using the Kobo Collect tool and analyzed using SPSS version 27.0. Bivariable and multivariable analyses were performed to determine the relationship between the outcome and predictor variables. A p value of less than 0.05 was considered significant in the multivariable analysis.

Results: The study found that 51.5% of participants had short interpregnancy intervals. Several independent factors were associated with a short birth interval, including the status of the last pregnancy (adjusted odds ratio (AOR): 9.51; 95% CI: 3.932-23.0028), educational status of the woman (AOR: 4.545; 95% CI: 1.208-17.108), and use of modern contraceptives in previous pregnancies (AOR: 6.460, 95% CI: 3.882-23.008).

Conclusion: Despite the efforts made through public health interventions in Ethiopia, the prevalence of short interpregnancy intervals in this study was high. Therefore, increasing the utilization of modern contraceptives and promoting health education at both health facilities and community levels could contribute to addressing this issue.

Uterine fibroids, known as leiomyomas, are non-cancerous tumors in women. Uterine fibroids disproportionately affect African American women, as they are more common and severe. Uterine fibroids are the leading cause of hysterectomy in African American women. Over 80% of African American women will receive a uterine fibroids diagnosis before 50. Myomectomies (removal of uterine fibroids) and hysterectomies (removal of the uterus) are more prevalent in African American women due to more significant symptoms. Socioeconomic status, including education and income, influences access to healthcare, with some treatments directly affected by insurance coverage and the cost of the procedure. This review aimed to characterize the socioeconomic disparities and inequities regarding uterine fibroids awareness, perceptions, and treatment and to understand how socioeconomic status impacts knowledge and treatment of uterine fibroids. Recognition of the treatment barriers and decisions due to socioeconomic status is a critical step in ensuring equitable treatment options for women diagnosed with uterine fibroids. A narrative literature review was conducted using PubMed, MedLine, and Google Scholar. A total of 98 articles were returned. After adjusting for the exclusion criteria, 10 articles were included in this review. The review demonstrated the disparities in treatment options based on race and socioeconomic status. Low-income women were more likely to receive more invasive treatment, which resulted in more time off work and increased medical bills. In addition, women in lower-income brackets frequented the emergency department at an increased level. This review underscored the need for additional research to learn about the role of socioeconomic status in uterine fibroid awareness and treatment.

Background: Cesarean section poses a fourfold risk for postpartum hemorrhage (PPH), necessitating accurate blood loss estimation to enable timely interventions. However, the conventional visual estimation method often leads to underestimation, resulting in undiagnosed PPH even in our setting, Uganda. Yet, the quantitative standard techniques remain underutilized.

Objective: We compared visual and calculated blood loss among women undergoing cesarean delivery at Gulu Regional Referral Hospital in northern Uganda.

Design: We employed a cross-sectional study design.

Methods: We enrolled pregnant women scheduled for cesarean section and determined both calculated and visually estimated blood loss. Data analysis involved using Pearson's moment correlation coefficient to compare the two methods and logistic regression to determine the factors associated with PPH.

Results: We included 105 participants, most were primigravida (n = 100, 43%), aged 15-24 years (n = 100, 52%), with term gestation (n = 100, 75%). The mean visual estimated blood loss (vEBL) was 235.3 ± 123.7 ml (interquartile range (IQR) 50-600 ml), while the calculated estimated blood loss (cEBL) was 435.0 ± 1328.2 ml (IQR -11,182.1-2226.7 ml). Visual estimation underestimated blood loss in 90% of cases (n = 100), and 21% (n = 21) had undiagnosed PPH (>1000 ml blood loss). None of the respondents had PPH (>1000 ml blood loss) following vEBL. There was a small positive correlation between both methods (vEBL and cEBL; r = 0.1165; p = 0.2482). Women aged >35 years were 1.60 times more likely to experience PPH than their counterparts aged 25-34 years (adjusted odds ratio (AOR): 1.60; 95% CI: 1.11-2.30, p < 0.011). Chorioamnionitis increased the risk of PPH by 2.2 times (AOR: 2.20; 95% CI: 1.20-4.05, p < 0.012).

Conclusion: The visual estimation technique significantly underestimated blood loss in up to 90% of cases, particularly during emergency cesarean sections. Among the 21% of cases diagnosed with PPH based on calculated blood loss, advanced maternal age and chorioamnionitis were notable contributing factors. Routine hemoglobin and hematocrit testing in obstetric care can be effectively utilized to objectively assess blood loss, aiding in the accurate diagnosis and management of PPH. Implementing these measures, even in resource-constrained settings, can significantly reduce the morbidity and mortality associated with PPH.

Trial registration: Not applicable.

Background: Reproductive healthcare is essential for all people, including lesbian and bisexual women. However, lesbians and bisexual women are among society's most marginalised and excluded members.

Objective: This study aimed to explore the challenges faced by lesbian and bisexual women in accessing Sexual and Reproductive Health (SRH) Services in Bulawayo, Zimbabwe.

Design: An exploratory, descriptive qualitative study was conducted on two populations that included eight participants identified through the Voice of the Voiceless organisation in Bulawayo and 10 key informants and probed the challenges faced by lesbians and bisexual women when accessing SRH services.

Methods: Data were gathered through 10 key informant interviews and 1 focus group discussion (FGD; with 8 participants). The interviews and FGDs were recorded, transcribed verbatim, coded and thematically analysed.

Results: The themes that emerged included the uptake of SRH services among lesbians and bisexual women, the challenges faced by lesbians and bisexual women when accessing SRH services, and strategies to aid the uptake of SRH services by lesbians and bisexual women. The findings showed that the uptake of SRH services was generally low and was influenced by factors such as clinical settings. The challenges mentioned included stigma and the unavailability of specific lesbian and bisexual women's services. By contrast, the most frequent strategies included affirmative training for healthcare providers and improved clinical settings to become friendly and inclusive.

Conclusion: There is an imperative for targeted SRH services that address the distinct needs of lesbians and bisexual women, in line with the 95-95-95 strategy and Sustainable Development Goals target 3.7. The observed low uptake of these services can be attributed to several systemic barriers, including inadequate training of health providers, negative attitudes and lack of inclusive policies. Enhancing the sensitivity of health facilities, strengthening links to sexual health education and implementing supportive legal frameworks are essential steps to improve SRH outcomes in this population. These findings elucidate critical gaps within the current healthcare system and present significant opportunities for policymakers to formulate evidence-based strategies to ensure equitable access to SRH services, thereby advancing public health objectives.