Menstrual disorders in rural Gambia.

As part of a community-based reproductive morbidity survey in rural Gambia, the prevalence and association of menstrual disorders with sociodemographic characteristics and other reproductive morbidities, and with knowledge, attitudes, and beliefs concerning menstrual problems were assessed. A questionnaire was administered by a field-worker and by a gynecologist, who also examined the women. Semistructured interviews were conducted to assess knowledge, attitudes, and beliefs in a subsample. Of 607 menstruating women not using hormonal contraceptives, 16 percent complained to the gynecologist of irregular cycles, 14 percent of dysmenorrhea, 8 percent of spotting, and 4 percent of heavy or prolonged bleeding. Each complaint was associated with other reproductive morbidities. A minority of women with menstrual problems had sought health care, and menstruation was revealed to be a highly personal and secretive topic in this population. Menstrual disorders constitute an important unaddressed area of reproductive health service needs in developing countries for which relatively simple and inexpensive therapies are often available. Information, education, and support combined with clinical management of menstrual problems should be core elements of reproductive health programs

Socioeconomic factors and the evaluation of HIV/AIDS prevention programs: A psychometric analysis of an instrument

Introduction: Research has documented the prevalence of different HIV/AIDS prevention programs launched to reduce the spread of the virus. However, the extent to which the success or otherwise of these programs are achieved is rarely discussed. This study addresses this gap by analyzing the impact of three socioeconomic parameters on the evaluation of HIV/AIDS prevention programs in the Southern Senatorial District of Cross River State, Nigeria. Methods: A sample of 239 health care employees selected using the proportional stratified random sampling technique participated in the study. A priori power analysis (using G*power) indicated that the sample size was large enough to achieve a 96.7% statistical power. Data was collected using a structured questionnaire. Exploratory factor analysis assessed the dimensionality of the instrument. Acceptable construct and discriminant validity and composite reliability coefficients were obtained. At the .05 alpha level, the null hypotheses were tested using a one-way analysis of variance. Findings: Findings indicated that the evaluation of HIV/AIDS prevention programs significantly varied with the level of funding provided (F[2, 236]=81.11, p\u3c.001), human capacity available (F[2, 236]=40.91, p\u3c.001), and stigmatization to people living with AIDS (F[2, 236]=40.79, p\u3c.001). Health facilities with higher funding and human capacity successfully evaluated HIV/AIDS prevention programs. However, the evaluation of HIV/AIDS prevention programs was lower in areas with a high level of stigmatization. Conclusion and implication: This study’s findings provided evidence that funding, human capacity, and stigmatization affect how HIV/AIDS pandemic can be effectively evaluated. This study implies that additional responsibility is required for public health workers to promote quality service delivery across different health facilities. Keywords

Mixed-methods evaluation of integrating female genital schistosomiasis management within primary healthcare: a pilot intervention in Ogun State, Nigeria

Background: Detection and management of female genital schistosomiasis (FGS) within primary healthcare is crucial for achieving schistosomiasis elimination, however, current technical strategies are not feasible in many settings. In Nigeria, there are currently no established standard operating procedures to support front-line health workers. This article presents an evaluation of piloting an FGS care package in two LGAs of Ogun State, Nigeria. Methods: We used quantitative and qualitative analysis, including 46 interviews with patients, health workers and the quality improvement team; observations of training, learning sessions and supervision across 23 heath facilities; and records of patients detected and managed. Results: Of 79 women and girls who were screened, 66 were treated and followed up. Health workers assimilated knowledge of FGS and effectively diagnosed and managed patients, demonstrating the feasibility of using symptomatic screening and treatment tools to diagnose and care for women or girls with suspected FGS. Challenges included establishing a referral pathway to tertiary care for patients with complications, insecurity, gender norms that limited uptake and sensitization, the limited capacity of the workforce, conflicting priorities and praziquantel acquisition. Conclusions: Simple tools can be used in primary healthcare settings to detect and manage women and girls with FGS. Contextual challenges must be addressed. Sustainability will require political and financial commitments