Contraception and reproductive medicine最新文献

Introduction: Accessing quality and equitable contraceptive services is significant for reaching the recently announced Sustainable Development Goals. In Ethiopia, women with disabilities continue to confront several barriers to accessing adequate contraceptive services. Nevertheless, little is known about contraceptive uptake and associated factors among pregnant women with disabilities in Ethiopia. This study aimed to assess the contraceptive uptake and associated factors among pregnant women with disabilities in the Central Ethiopia Regional State, Ethiopia.

Methods: A community-based cross-sectional study was conducted, with 562 study participants recruited using a multistage random sampling procedure. Data were collected through face-to-face interviews using the Kobo Toolbox. A bivariate and multivariable logistic regression model was used to identify variables associated with contraceptive uptake. At p < 0.05, the association of variables was found to be statistically significant.

Result: In this study, only 38.1% (95% CI: 33.5, 42.3) of study participants used contraceptives. The significantly associated factors were: women's age (≥ 35 years, AOR = 0.17, 95% CI: 0.07, 0.46, p < 0.0001), marital status (AOR = 0.21, 95% CI: 0.12, 0.64, p < 0.0001), women education (tertiary and above, AOR = 8.44, 95% CI: 4.2, 13.2, p < 0.0001), number of pregnancies (AOR = 0.28, 95% CI: 0.17, 0.45, p < 0.0001), lack of contraceptives awareness (AOR = 0.12. 95% CI: 0.06, 0.24 p < 0.0001), contraceptive service accessibility (AOR = 6.02, 95% CI: 3.8, 9.54, p < 0.0001), and spousal support to use contraceptives (AOR = 4.52, 95% CI: 2.85, 7.2, p < 0.0001).

Conclusion: This finding concludes that there is a significant unmet need for contraceptive services among pregnant women with disabilities in the Central Ethiopia Regional State, Ethiopia. To enhance contraceptive uptake, it is suggested to engage husbands in health promotion initiatives, implement community-based awareness campaigns, train healthcare providers on the unique needs of women with disabilities and design disability-friendly health facilities.

Background: Knowledge of the ovulatory cycle plays a crucial role in reducing the incidence of unintended pregnancies and promoting women's reproductive health. However, there exists a paucity of research on the determinants associated with ovulatory cycle knowledge specifically within the context of Ghana. Therefore, the objective of this study was to investigate the individual and community-level factors that influence knowledge of the ovulatory cycle among women of reproductive age in Ghana.

Methods: The study utilized data from the 2022 Ghana Demographic and Health Survey, which included a representative sample of 6,839 women of reproductive age. Using a multilevel logistic regression model, the study aimed to identify factors influencing knowledge of the ovulatory cycle. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were employed to assess the associations between explanatory variables and knowledge of the ovulatory cycle. Statistical significance was determined at a p-value threshold of less than 0.05. All data analyses were performed using STATA version 17 software.

Results: The prevalence of knowledge regarding the ovulatory cycle among Ghanaian women was 42.3% (95% CI: 41.1-43.5%). In the multivariable mixed-effects logistic regression model, factors associated with knowledge of the ovulatory cycle included women aged 30-39 (AOR: 1.62, 95% CI: 1.54-2.73) and 40-49 (AOR: 1.51, 95% CI: 1.39-1.66), women's educational attainment (AOR: 1.62, 95% CI: 1.55-2.59), household wealth index (AOR: 1.51, 95% CI: 1.10-2.25), and partner's education level (AOR: 1.59, 95% CI: 1.20-2.11). Additionally, community-level factors such as community level literacy (AOR: 4.5, 95% CI: 2.22-9.25), and residing in the Eastern (AOR: 0.36, 95% CI: 0.19-0.68) and Oti (AOR: 0.26, 95% CI: 0.13-0.53) regions were significantly associated with knowledge of the ovulatory cycle.

Conclusion: The prevalence of ovulatory cycle knowledge among Ghanaian women was low, with significant determinants including age, women's education, wealth, partner's education, community literacy rates, and regional disparities. These findings highlight the importance of targeted educational interventions to improve reproductive health literacy, especially in underserved communities and regions with lower educational attainment in Ghana.

Background: One of the Sustainable Development Goals (2030) focuses on reducing the total fertility rate. Reducing grand multiparity in Ethiopia remains a challenge. Understanding the underlying factors that contribute to this issue is crucial for explaining why grand multiparity remains prevalent despite various health interventions and socio-economic progress.

Methods: A community-based cross-sectional study was conducted using data from the Ethiopian Demographic and Health Survey 2019. Multilevel multivariable logistic regression analysis was employed to model the hierarchical data. The final findings were presented as adjusted odds ratios (AOR) with 95% confidence intervals (CI). A p-value < 0.05 was considered statistically significant.

Result: The trend analysis of grand multiparity in Ethiopia over 19 years shows no significant change (linear trend = 1.23, p = 0.27). The prevalence slightly decreased from 72% in the 2000 EDHS to 66.3% (95% CI: 65.7 - 66.96%) in the 2019 mini EDHS. Additionally, the highest prevalence of grand multiparity was observed among illiterate women (79.7%), those from poor households (54.8%), non-family planning users (77.5%), and residents of the Oromia (15.8%) and SNNPR (15.4%) regional states. Significant individual-level factors associated with grand multiparity include wealth index, marital status, maternal education, non-use of family planning, use of short-acting family planning, age at first birth < 18 years, and short birth intervals. At the community level, rural residency was significantly associated with grand multiparity.

Conclusion: This study emphasizes the need for targeted interventions to address the socio-economic and reproductive factors driving grand multiparity, especially in rural areas and among disadvantaged populations. To improve maternal and child health outcomes, we recommend that the government focus on lowering fertility rates through need-based family planning services and promoting the well-being of women of reproductive age.

Background: Infertility defined as the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Globally, infertility affects 15% of couples in the reproductive age.

Purpose: To identify determinants of infertility among married women who attend care at public health facilities of Gamo Zone and South Omo Zone, Southern Ethiopia.

Patients and methods: An Institution-based un-matched case-control study was conducted from May 1, 2022-May 30, 2023G.C. Participants were selected by systematic random sampling method after allocating the sample size proportionally to the health facilities. The data was collected by using the Open Data Kit (ODK) app through face-to-face interviews and exported to SPSS version 25 for analysis. The chi-square test and multivariable logistic regression model were used to identify determinants (P value < 0.05).

Result: A total of 760 married women (152 cases and 608 controls) in the reproductive age group were included in this study. The mean age of the respondents was 26.5(SD ± 5.27) years. In multivariable analysis: age, educational status of the woman, residence, family size, ever use of contraceptives, history of STI, history of abortion, menstrual pattern and current alcohol use were identified as determinants of infertility.

Conclusion: Factors such as older age, lower education, rural living, smaller families, lack of contraceptive use, history of STIs, past abortions, irregular periods, and current alcohol consumption were found to increase the risk of infertility. To reduce infertility rates, it is crucial to improve STI prevention, expand access to family planning services, and promote women's education.

Introduction: Emergency contraception is an essential method for preventing unintended pregnancies, especially after unprotected sexual intercourse. However, knowledge, attitudes, and practices related to emergency contraception among university students remain underexplored, particularly in low-resource settings such as Goma, Democratic Republic of the Congo. The objective of this study is to assess the knowledge, attitudes, practices, and determinants influencing the use of emergency contraception among female students in Goma.

Methods: A cross-sectional survey was conducted with 677 female students from two universities in Goma who were selected via a cluster sampling method. Data were collected via a preestablished questionnaire, and participants were interviewed after providing consent. The data were analysed via STATA 16, with chi-square tests to compare variables, considering a significance threshold of 5%.

Results: A total of 625 (92.32%) students reported being aware of emergency contraception, and 80.32% demonstrated good knowledge of it. In terms of attitudes, 533 (85.28%) students had positive attitudes towards emergency contraception. Among the 625 students who were familiar with emergency contraception, 416 had engaged in sexual intercourse, with 294 (70.67%) having utilized emergency contraception. Factors significantly linked to emergency contraception use included being single (adjusted OR = 1.9 [95% CI: 1.1-3.2]), possessing good knowledge (adjusted OR = 3.0 [95% CI: 1.6-5.8]), and having a positive attitude (adjusted OR = 2.4 [95% CI: 1.1-4.9]).

Conclusion: Although the students demonstrated good awareness of emergency contraception and its utilization, the high frequency of emergency contraception use underscores the importance of promoting knowledge about conventional contraceptive methods. It is crucial to enhance educational campaigns within universities to mitigate the elevated risk of unsafe abortions.

Background: Male knowledge and acceptance of modern contraceptive use play a significant role in uptake. This study assessed the factors associated with male acceptance of modern contraceptive methods in Ho Municipality.

Methods: A cross-sectional study with a quantitative approach was employed. Systematic random sampling was used to select 503 participants from households with married men and women. A structured pre-tested questionnaire, including open-ended and closed-ended questions, was researcher assistant administered. Data analysis was conducted using STATA version 17.

Results: The majority of the respondents identified that contraceptives are used to prevent pregnancy (91.19%), and also identified the following as birth control commodities: birth control pills (64.94%), female condoms (15.71%), intrauterine devices - IUDs (4.79%), and implants (4.21%). Factors such as affordability, employment status, income, and access significantly influenced male acceptance of contraceptives. The study revealed that men (84.67%) agreed with their partner to use contraceptives after sexual intercourse while only 37% agreed to use contraceptives before sexual intercourse. Among those who did not accept the use of modern contraceptives, the reason provided was the fear of side effects (65.13%). Men who find modern contraceptives affordable were more likely to use them (AOR = 8.15; 95%CI:3.49-19.02; p-value < 0.001). Also, unemployed men were less likely to use modern contraceptives (AOR = 0.14; 95%CI:0.044-0.44; p-value = 0.001). Men with lower income (50-900 cedis average monthly income level) were less likely to use modern contraceptives (AOR = 0.28; 95%CI:0.07-1.02; p-value = 0.05).

Conclusion: Increasing interventions aimed at continuously reducing the cost of modern contraceptives is essential for improving male acceptance and the overall success of modern contraceptive use in other communities with low male involvement. The government, Healthcare agencies, community leaders, and family planning organizations should work together to actively intervene in lowering the cost of modern contraceptives to improve access by men.

Objective: Surgical sterilization, including vasectomy in males and tubal ligation in females, is a highly effective but underutilized contraception method. Adoption rates vary globally mostly due to misconceptions by both the general public and practicing physicians. Our survey aims to explore physicians' knowledge, attitudes and beliefs about surgical sterilization techniques in Lebanon.

Study design: A web-based survey was sent to residents and attending physicians of different specialties in Lebanon between April 2022 and April 2023. The survey included 21 multiple-choice questions divided in four parts (demographics, knowledge, attitudes and beliefs) and required around 8 min to complete. Data was analyzed using IBM SPSS Statistics. A descriptive analysis was performed using the chi-square test for categorical variables and ANOVA for continuous variables.

Results: One hundred eighty-three physicians specialized in Urology, OB/GYN, Family medicine and Internal medicine filled the survey. The majority were resident physicians (79%), male (57%), single (72%) and did not receive training in family planning (73%). Knowledge assessment showed an average score of 5/7. After setting this as a passing score, 60.7% of participants passed the assessment with higher likelihood of passing among attending physicians (84.6%), OB/GYN physicians (94.4%), married participants (80.8%), and physicians who received training in family planning (91.8%). Lower likelihood of passing was among Family Medicine (60%), and Internal Medicine (72.5%) physicians. Recommendations varied among specialties. Most physicians perceived the general public preferring tubal ligation as a sterilization method (98%).

Conclusion: Lebanese primary care physicians have a lower level of knowledge of surgical sterilization procedures compared to specialists. This, coupled with low levels of family planning training and negative perception of patient beliefs may impact attitudes and recommendations. Ongoing education and family planning training is needed to increase awareness among physicians, especially primary care physicians, to allow them to provide more adequate counseling to patients.

Introduction: Cardiovascular diseases can adversely affect the quality of sexual life and marital satisfaction for both patients and their spouses. The aim of the current study is to determine the effect of couple counseling based on the CHARMS model on sexual quality of life and marital satisfaction of wives of men suffering from myocardial infarction (MI).

Method: This two-group randomized clinical trial study with a parallel design was conducted in 2024 in Urmia, Iran. Participants included men with myocardial infarction and their spouses. Sampling was done on a convenience basis. Participants were randomly allocated into two groups: control (50 couples) and intervention (50 couples). The intervention consisted of six counseling sessions. Couples in intervention group were divided into six groups. Each group attended counseling sessions following the CHARMS model on a weekly basis. Data collection tools were include: Demographic information questionnaire, Women's Sexual Quality of Life Questionnaire and Enrich Marital Satisfaction Questionnaire, which were completed by women in both groups before and after the intervention. The Independent t-test, Chi-square, Fisher's exact test and a general linear model were used for comparing groups with SPSS software. The data analyst was blinded to the group allocation.

Findings: The average age of women in the intervention and control groups was 45.16 ± 5.90 and 44.75 ± 4.94 years, respectively, with most being housewives and having two children. The average age of men in the intervention and control groups was 48.6 ± 4.51 and 47.5 ± 5.5 years, respectively. The demographic and clinical characteristics of the two groups were similar (P > 0.05). Before the intervention, the average scores for sexual quality of life and marital satisfaction among women were not statistically significantly different between the control and intervention groups (P > 0.05). After the intervention, based on the ANCOVA and after adjusting for the baseline values, the average score for the sexual quality of life among women in the intervention and control groups was 61.96 ± 7.51 and 49.01 ± 6.32, respectively. This difference being statistically significant (Adjusted Mean Difference = 12.95; 95% CI = 1.18 to 21.13; P < 0.001). Additionally, the average score for women's marital satisfaction in the intervention and control groups was 127.96 ± 13.03 and 118.61 ± 12.01, respectively, with this difference also being statistically significant (Adjusted Mean Difference = 9.35; 95% CI = 4.23 to 15.73; P = 0.002).

Conclusions: The results of the current study indicate that sexual counseling for couples, utilizing the CHARMS model, effectively enhances the quality of sexual life and marital satisfaction for wives of men with myocardial infarction. Therefore, it is crucial to evaluate the sexual quality of life for cardiac patients and their partners i

Background: Female Condoms are 90-95% effective against HIV transmission when correctly and consistently used and are also cost-effective. In general, condoms prevent sexually transmitted infections (STIs) and unwanted pregnancies. Although the COVID-19 pandemic had the potential to undermine routine healthcare services delivery and utilisation, there is limited evidence about the pandemic's effect on Female Condom uptake in Gauteng, one of the hardest-hit provinces in South Africa. This study aimed to compare female condom distribution in Gauteng Province, South Africa, before and during COVID-19, to inform decision-making for the attainment of universal access to sexual and reproductive health (SRH) by 2023 as per the sustainable development goal 3.7 and also, to empower women over their SRH during future pandemics.

Methods: This secondary data anslysis examined the percentage change in routine female condom distribution in Gauteng province and its five districts as an indirect effect (lockdown) of the COVID-19 pandemic, by comparing the aggregated District Health Information System (DHIS) data collated from primary health care facilities within the ditrict, before COVID-19 (2018-2019) and during COVID-19 (2020). Analysis in MS Excel 2016 illustrates the changes in the patterns and the trend in female condom distribution over the study period.

Results: In 2020, during the COVID-19 pandemic, Gauteng province experienced a 43.7% increase in female condom distribution compared to the pre-COVID-19 period of 2019. The highest female condom distribution during the pandemic was observed in the Ekurhuleni Metropolitan (150.0%), followed by the Sedibeng (92.8%) and the Johannesburg Metropolitan (67.9%) districts respectively. However, the Tshwane Metropolitan (-8.5%) and the West Rand (-16.6%) districts experienced a decline in female condom distribution during COVID-19.

Conclusion: Gauteng province witnessed a substantial surge in female condom distribution during COVID-19 in 2020, with a disproportionate district variation in demand. Female condom distribution is crucial, necessitating its enhancement and the continuum of distribution and stakeholders stockpiling at all times with particular attention to a potential increase in demand during outbreaks with lockdowns. Undisrupted access to female condoms will enable a consistent and correct use and empower women against HIV, STIs and unintended pregnancies, as a strive towards universal access to SRH.

Background: The unmet need for contraception among adolescent women in India is a significant public health concern, contributing to unintended pregnancies and abortions. This paper seeks to examine the regional variations and factors driving rural-urban disparities in unmet family planning needs in Uttar Pradesh (UP), India's most populous state, where the total unmet need among adolescents is as high as 19%.

Methods: The study is based on 11,018 adolescent women from the recent round of India's DHS, NFHS-5 (2019-21). To fulfil the study's objective, Multilevel logit model and Oaxaca Blinder Decomposition was applied.

Results: The Multilevel logit model results show statistically significant variations at community and district level, implying a strong presence of unobserved factors affecting the unmet demand. Oaxaca decomposition results show that difference in rural and urban adolescent unmet need is explained by factors like wealth, religion and intra-state regions.

Conclusion: The results call for the need to implement culturally appropriate reproductive and sexual health literacy programs to increase uniform access to modern contraception and to raise women's autonomy in the state of Uttar Pradesh.