Contraception and reproductive medicine最新文献

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.

Background: Botswana is one of the countries in SSA with the lowest total fertility rate. This study aimed to explore the uptake and correlates of modern contraceptive use among women of reproductive ages (15-49 years) in Botswana.

Methods: The study used secondary data from the 2017 Botswana Demographic Survey. The study used a weighted sample of 1,120,008 women aged 15-49 years, who successfully completed the Botswana Demographic Survey questionnaire. Logistic regression models were used to derive adjusted odd ratio as the measures of association between need, predisposing and enabling factors, and modern contraceptive use among women. All comparisons are considered statistically significant at p > 0.01.

Results: From the 1,120,008 women included in the analysis, contraceptive prevalence was estimated at 80.4%. The most used methods of contraception among the sampled women were condoms (64.2%), followed by injectables (17%) and pills (12.6%). After controlling for confounders, the odds of contraceptive use were significantly higher among women aged 15-24 years (AOR = 1.41; 95% CI: 1.36-1.46) and 25-34 years (AOR = 1.78; 95% CI: 1.73-1.83), compared to women aged 35-49 years. Other significant correlates of contraceptive use included residing in rural areas (AOR = 0.94; 95% CI: 0.91-0.96), having primary (AOR = 1.82; 95% CI: 1.59-2.08) or secondary education (AOR = 2.41; 95% CI: 2.21-2.62), and accessing contraceptives from health facilities (AOR = 1.28; 95% CI: 1.24-1.68), compared to their respective counterparts. Conversely, after adjusting for confounders, the odds of contraceptive use were significantly lower among women who identified as Christians (AOR = 0.91; 95% CI: 0.88-0.94), those of other non-Christian religions (AOR = 0.80; 95% CI: 0.75-0.86), married women (AOR = 0.85; 95% CI: 0.83-0.87), and women who reported experiencing complications (AOR = 0.27; 95% CI: 0.26-0.28), compared to their respective counterparts.

Conclusion: The study reveals a high contraceptive prevalence (80.4%) among women, with condoms being the most used method. Younger women (aged 15-34), those with formal education, and those accessing services from health facilities were more likely to use contraceptives. However, contraceptive use was significantly lower among women in rural areas, those identifying with religious affiliations (both Christian and non-Christian), married women, and those who had experienced complications. These findings highlight the need for targeted interventions that address religious beliefs, marital dynamics, healthcare access in rural areas, and management of contraceptive-related complications.

Background: Modern contraceptives have proven to be more scientifically effective at preventing unwanted pregnancies than the traditional methods. However, there is dearth of evidence on teenage girls' contraceptive use and associated factors in Ghana.

Objective: This study sought to examine teenage girls (15-19 years) contraceptive use and associated factors using a nationally representative data from the Ghana Living Standards Survey 7 (GLSS7).

Methods: The study analyzed data from GLSS7, involving 3233 15-19 year-old teenagers. Using a cross-sectional design, descriptive statistics, chi-square tests, and multiple regression were performed to analyze factors influencing contraceptive use. Stata software version 16 was used, with statistical significance set at p ≤ 0.001.

Results: Out of a total of 3,233 teenage girls aged 15-19years, the majority were in the primary level of education (71.59%). Furthermore, more than two-thirds of the participants were Christians (75.83%). The results showed that only 12.87% of teenage girls reported current contraceptive use. Religion, type of residence, region, wealth index and marital status was found to have a relationship with modern contraceptive use. Also, majority of the respondents preferred modern contraceptive methods (85.60%) as compared to traditional methods (14.40%). The region was significantly associated with preferences for modern contraceptive use. Teenage girls in the Central and Volta regions had 88% and 89% lower odds of preferring modern contraceptive use, respectively as compared with those in the western region. Moreover, marital status was found to have a significant association with barriers to contraceptive use. Teenage girls that were not married had 88% lower odds of having barriers to contraceptive use as compared to those that were married.

Conclusion: The study suggests that the government through the Ministry of Health (MOH) should establish targeted community-based awareness campaigns and enhance access to adolescent-friendly family planning services to increase contraceptive uptake.