Identifying barriers to accessing information and treatment for obstetric fistula in Niamey, Niger

Objective: To identify barriers to accessing information and treatment regarding obstetric fistula (OF) unique to Niger encountered by women referred to the National Referral Fistula Center. Method: A questionnaire was administered at the National Referral Fistula Center to 29 women with OF. Qualitative and quantitative statistics were computed. Results: The average individual was 30.4 years old, illiterate and from a rural area. 76.0% had antenatal care, the average labor time was 3.04 days, and 88.0% had a physician-assisted delivery. Barriers to information included rural dwelling, lack of education, lack of understanding of cause despite contact with health care workers, lack of knowledgeable resources to seek advice from or lack of ability/interest, not given specific information about availability of treatment, and not utilizing available resources to disseminate information. Barriers to treatment included lack of information regarding condition and treatment, traditional healer utilization, inability to access adequate care for condition, delay for childbirth recovery, permission needed to seek treatment, cost, timely treatment unavailable, and lack of social support. Conclusion: Improving efficiency of getting women to the hospital at time of delivery, prompt referrals for OF, and using cell phones for disseminating information or accessing transport may benefit women with OF in Niger

Unique health needs and characteristics of homeless women in Iowa City, Iowa

Context: Homeless individuals have comparatively poorer health, however few gender specific assessments exist. Purpose: This cross-sectional survey of homeless individuals assesses gender-specific health needs. Procedure: 68 Homeless adults were surveyed at a shelter from March to April, 2015 in Iowa City, IA. Descriptive statistics were computed to compare gender-subgroup responses. Main Findings: The study population was predominately male (45, 67.2%), white (37, 54.4%), and averaged 42.35 years old (range 21-74). Males were more likely to be veterans (13, 28.9% vs. 1, 4.5%, p=0.025). Women were more likely to have dependents (9, 47.4% vs. 1, 4%, p=0.001) and access to dental coverage (16, 80% vs. 12, 30.8%, p=0.001). Similar rates of chronic disease, primary care access, and unmet health needs were noted. Conclusions: Homeless women and men have unique needs and would benefit from gender-specific health interventions. Resources for child-care may be important for women who are homeless, while dental health care may be particularly beneficial for men

Client satisfaction and experience of telemedicine and home use of mifepristone and misoprostol for abortion up to 10 weeks' gestation at British Pregnancy Advisory Service: A cross-sectional evaluation.

OBJECTIVE: Evaluate satisfaction and experience with telemedicine consultation and home use of mifepristone and misoprostol for abortion to 10 weeks' gestation. STUDY DESIGN: Cross-sectional evaluation of British Pregnancy Advisory Service (BPAS) clients who used mifepristone and misoprostol at home from 11 May to 10 July 2020. We sent a text message with a link to a web-survey 2 to 3 weeks postabortion. Questions assessed satisfaction and experiences with a service model including telephone consultation and provision of medicines by mail or collection from the clinic. We used bivariate and multivariate regression to explore associations between client characteristics and outcomes. Our primary outcomes were overall satisfaction (5-point Likert scale) and reported contact with a health care provider. RESULTS: A total of 1,333 clients participated. Respondents described home use of medications as "straightforward" (75.8%) and most were "very satisfied" (78.3%) or "satisfied" (18.6%) overall. Being "very satisfied" was associated with parity (aOR 1.53, 95% CI 1.09-2.14) and pain control satisfaction (aOR 2.22, 95% CI 1.44-3.44). Health care provider contact was reported by 14.7%; mainly to BPAS' telephone aftercare service (76.8%). Dissatisfaction with pain control (aOR 3.62, 95% CI 1.79-7.29) and waiting >1 week to use mifepristone (aOR3.71, 95% CI 1.48-9.28) were associated with health care provider contact. If needed in the future, most would prefer consultation by phone (74.3%) and home use of mifepristone and misoprostol (77.8%). CONCLUSIONS: Satisfaction with telemedicine and home use of mifepristone and misoprostol is high. Most clients do not need health care provider support when administering medicines at home or post abortion