Contraception and reproductive medicine最新文献

Background: Women with disabilities face higher risks of maternal morbidity and mortality, particularly in low- and middle-income countries like sub-Saharan Africa (SSA). Barriers such as socio-cultural stigma, health facility inaccessibility, and lack of supportive healthcare contribute to their limited access to maternity services, exacerbating their vulnerability. Despite significant research on maternal health in SSA, studies focusing on women with disabilities remain scarce, and current healthcare services often fail to accommodate their needs. This scoping review explores barriers to maternity care accessibility among women with disabilities in SSA, highlighting gaps in research necessary for developing interventions that align with global health goals, such as reducing maternal mortality by 2030.

Methods: This current scoping review was informed by the methodological framework proposed by Arksey and O'Malley. Exploratory searches were conducted in JSTOR, PubMed, PsycINFO, African Journals Online, and Web of Science, etc., to identify studies conducted in SSA that focused on access, utilisation, and barriers to maternity services such as antenatal care (ANC) visits, facility delivery, and postnatal care visits among women with disabilities in SSA since the introduction of the sustainable development goals (SDGs). Twenty-two studies were included, spanning from June 1st 2016 to 30th May 2024.

Results: Of the 22 eligible studies out of 416 identified studies published between 2016 and 2024, 20 were conducted across eight countries in SSA. Eight studies employed quantitative methods, 12 used qualitative approaches, and two used mixed-methods analysis. These studies focused on all or either of the maternal health services measured in this study, which include antenatal care (ANC), facility delivery, and postnatal care (PNC) among women with disabilities. Findings indicate that, despite a strong desire for ANC, physical impairments, mobility issues, and unsupportive infrastructure hinder access. Although facility deliveries were high, support gaps and negative provider attitudes were common. The WHO health system framework categorisation shows that more barriers are within the service delivery and health workforce domains.

Conclusion: The review found limited studies on access to and utilisation of ANC, facility delivery, and PNC for women with disabilities in SSA. This gap restricts understanding of the issue and hampers interventions, increasing risks to maternal and child health. Urgent research and interventions are needed to address equity challenges in these services for disabled women in SSA.

Premature ovarian Insufficiency (POI) is characterized by amenorrhea, hypergonadotropic hypogonadism, estrogen deficiency, and reduced follicle counts leading to infertility under the age of 40. It occurs in 1 to 3% of women. Several therapeutic strategies have been explored in clinic for POI. Platelet Rich Plasma (PRP) a blood product applied in regenerative medicine, which is based on the releasing of the growth factors present in platelet. Mesenchymal Stem Cells derived from Bone marrow, adipose tissue or cord blood tissue are undifferentiated cells with a potential for self-renewal and differentiation into multiple mature cell type. Mesenchymal stem cells secretome can stimulate cellular process and activate multipotent stem cells to generate new younger tissue and blood vessels relevant to ovarian rejuvenation and endometrial regeneration. This review provides a critical analysis on novel treatments that have not achieve routine clinical practice status yet but have recently emerged as promising potential therapy.

Background: Contraceptive use is a major global public health priority, contributing to improved maternal and child health, gender equality, and sustainable development. Despite advancements, women with sensory disabilities in low- and middle-income countries continue to face challenges in accessing modern contraceptives, leading to low utilisation. Despite this, no research has examined the influence of sensory disability status on modern contraceptive use among women of reproductive age in South Africa. Thus, this study explored the association between sensory disability status and other individual and community-level factors and modern contraceptive utilisation in South Africa.

Methods: Data were drawn from the 2016 South Africa Demographic and Health Survey (SADHS). A sample of 7,040 sexually active women aged 15-49 years was used in the analysis. A two-level multilevel binary logistic regression model was used to examine the association between sensory disability status and other individual and community-level factors and modern contraceptive use.

Results: The prevalence of modern contraception among sexually active women in South Africa was 57.32% [95% CI = 55.59-59.03]. Women with sensory disabilities [aOR = 0.81, CI = 0.67-0.98] were less likely to use contraceptives. Other factors negatively associated with use included desiring five or more children [aOR = 0.67, 95% CI = 0.47-0.97] and living in communities with a high ideal number of children [aOR = 0.75, 95% CI = 0.63-0.90]. Factors positively associated with contraceptive use included mobile phone ownership [aOR = 1.45, 95% CI = 1.15-1.82] and living in communities with high employment [aOR = 1.32, 95% CI = 1.06-1.64].

Conclusion: Sensory disability status influenced women's contraceptive behaviour in South Africa. Current family planning interventions should target women with sensory disabilities by prioritising accessible communication methods (e.g., braille, sign language), disability awareness training for healthcare workers, and integration of reproductive health services into disability support programmes.

Background: The progestin norethisterone (NET), which is structurally related to testosterone, and its enanthate form (NET-EN), are used in contraception in women. Oral NET has been shown to interfere with testosterone measurements by some chemiluminescence microparticle immunoassays (CMIA). However, whether serum NET in NET-EN users interferes with these assays is unknown.

Methods: Serum samples were obtained from women randomized to the injectable contraceptives NET-EN or depo medroxyprogesterone acetate intramuscular (DMPA-IM) in a clinical trial conducted in South Africa. Testosterone concentrations were compared after measurement by Abbott Architect CMIA and ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS), from matched samples collected at baseline (D0) and 25 weeks (25W) after initiation.

Results: At 25W, testosterone concentrations in the NET-EN arm were significantly higher (271%) using the CMIA compared to the UHPLC-MS/MS method. Contrary to the UHPLC-MS/MS results showing a significant decrease in testosterone concentrations in the NET-EN arm from D0 to 25W, a significant increase was determined by CMIA. Conversely, in the DMPA-IM arm at 25W, no significant difference in testosterone concentrations between the two methods was detected, and both methods showed a significant decrease in testosterone from D0 to 25W.

Conclusions: We show for the first time that physiological concentrations of NET in premenopausal NET-EN users interfere with testosterone quantification using a CMIA method. The degree of interference is much higher and occurs at lower concentrations of NET than has previously been reported for oral NET and confounds the biological outcome of NET-EN use on testosterone concentrations, individually and relative to DMPA-IM.

Trial registration: The WHICH trial was retrospectively registered with the Pan African Clinical Trials Registry (PACTR 202009758229976).

Background: Family planning (FP) promotes sustainable population growth and enhances societal well-being. Despite its recognized importance, the quality of life (QoL) of women utilizing modern FP methods in Rwanda remains underexplored. Women's experiences and perceptions of contraceptive methods significantly influence their uptake and continued use.

Objective: This study aimed to assess the QoL of women using modern FP methods in Rwanda.

Methodology: A multicenter cross-sectional study was conducted involving 415 women who had been using modern FP methods for at least six months. Participants were recruited from the University Teaching Hospital of Kigali (CHUK) and four selected Health Centers in Rwanda. The Short-Form 36 (SF-36) Health Survey was used to evaluate the QoL. Data analysis was performed using the R programming version 4.0.2.

Results: Participants reported overall favorable QoL across all domains. Social functioning scored the highest (94.16%, SD = 17), while physical functioning scored the lowest (80.6%, SD = 34.45). Women aged 32-38 had significantly higher QoL scores in role functioning, including social functioning, role functioning due to physical issues, and role functioning due to emotional issues (p < 0.001, p = 0.014, and p = 0.034, respectively). The type of FP Method was strongly associated with QoL outcomes in all domains, with Intrauterine Devices (IUDs) correlating with the highest scores, particularly in physical functioning (p < 0.001). Rural women reported better general health (p < 0.001) compared to their urban counterparts.

Conclusion: Women using modern FP methods in Rwanda generally reported a high QoL. Both the FP method type and age significantly influenced QoL outcomes. Thus, there is a need to promote the universal use of Modern FP methods among women of reproductive age in Rwanda.

Background: Copper Intrauterine contraceptive devices (IUDs) and hormonal implants are the two most known safe, convenient, highly effective and long-acting reversible contraceptive methods worldwide that prevent pregnancy for all ages without demanding user action. Regardless of these advantages, its utilisation are low among sexually active women in Nigeria. Thus, this study examines trends, levels and predictors of long-acting reversible contraceptives (LARC) among married women of reproductive age in Nigeria.

Methods: The study used pooled four (4) round of the individual women recode (IR) datasets of the Nigeria Demographic and Health Surveys (NDHS) across four-time points (2003-2018). A weighted sample size of 17,483 sexually active married women of reproductive age (15-49 years) comprising 962, 4839, 5963, and 5719 respondents for 2003, 2008, 2013, and 2018 respectively. Data were analysed using frequency tables, charts, chi-square test of independence and binary logistic regression at 95% confidence intervals (CI) and p < 0.05 to determine predictors of LARC use among respondents in Nigeria.

Results: There was a monotonic upward trend using LARC from 4.7 to 21.7% across the survey years (2003-2018). Generally, LARC use within the reference period (2003-2018) increased by 51.1%. Remarkably, in the same period, the use of IUDs decreased by 12.8% while the use of Implant/Norplant increased by 17,500%. Sexually active married women (15-49) who were working (aOR = 1.4, [95% CI = 1.1, 1.7]; p < 0.01), and those who were exposed to mass media (aOR = 1.2, [95% CI = 1.1, 1.4]; p < 0.05) want more children (aOR = 2.2, [95% CI = 1.8, 2.6]; p < 0.001), visit to health care centres in the last 12 months (aOR = 1.2, [95% CI = 1.0, 1.4]; p < 0.01), within the middle wealth quintiles (aOR = 1.4, [95% CI = 1.0, 1.9]; p < 0.05), and from the North West (aOR = 1.9, [95% CI = 1.5, 2.5]; p < 0.001) had statistically significant higher odds of LARC use compared with those who were not working, exposed to mass media, want no more children, visit health care services, poorest wealth quintiles, and from the North Central respectively.

Conclusion: Even though there is evidence of improvement in the use of LARC, policies and programmes should be directed towards the identified groups to increase the availability, accessibility, and uptake of LARC in Nigeria. Uptake of IUDs and the use of Implant/Norplant should be encouraged through the support and training of private healthcare providers by governmental and non-profit governmental organizations.