A new approach to assess the capability of health facilities to provide clinical care for sexual violence against women: a pilot study.

Several tools have been developed to collect information on health facility preparedness to provide sexual violence response services; however, little guidance exists on how this information can be used to better understand which functions a facility can perform. Our study therefore aims to propose a set of signal functions that provide a framework for monitoring the availability of clinical sexual violence services. To illustrate the potential insights that can be gained from using our proposed signal functions, we used the framework to analyse data from a health facility census conducted in Central Province, Zambia. We collected the geographic coordinates of health facilities and police stations to assess women's proximity to multi-sectoral sexual violence response services. We defined three key domains of clinical sexual violence response services, based on the timing of the visit to the health facility in relation to the most recent sexual assault: (1) core services, (2) immediate care, and (3) delayed and follow-up care. Combining information from all three domains, we estimate that just 3% of facilities were able to provide a comprehensive response to sexual violence, and only 16% could provide time-sensitive immediate care services such as HIV post-exposure prophylaxis and emergency contraception. Services were concentrated in hospitals, with few health centres and no health posts fulfilling the signal functions for any of the three domains. Only 23% of women lived within 15 km of comprehensive clinical sexual violence health services, and 38% lived within 15 km of immediate care. These findings point to a need to develop clear strategies for decentralizing sexual violence services to maximize coverage and ensure equity in access. Overall, our findings suggest that our proposed signal functions could be a simple and valuable approach for assessing the availability of clinical sexual violence response services, identifying areas for improvement and tracking improvements over time

Sexual and Reproductive Health Research and Research Capacity Strengthening in Africa: Perspectives from the region.

Developing the capacity to effectively carry out public health research is an integral part of health systems at both the national and global levels and strengthening research capacity is recognized as an approach to better health and development in low- and middle-income countries (LMICs). Especially fields such as sexual and reproductive health (SRH) would require inter-disciplinary teams of researchers equipped with a range of methodologies to achieve this. In November 2013, as part of the International Family Planning Conference in Addis Ababa, Ethiopia, a group of African researchers came together to discuss the gaps and strategies to improve sexual and reproductive health research and research capacity strengthening in Africa. This commentary summarizes the three broad areas where the issues and proposed solutions have concentrated around: 1) Addressing research gaps that are most relevant to policies and programmes in SRH, 2) Carrying out high quality and collaborative research, and 3) Translating research findings into SRH policies and programmes. Even though the focus of the discussions was Africa, the issues and proposed solutions can also be applied to other regions facing a high burden of disease with limited resources. The time is now and these can be achieved through synergistic commitment of African and global researchers, funders and organization

Defining Research to Improve Health Systems

Robert Terry and colleagues present working definitions of operational research, implementation research, and health systems research within the context of research to strengthen health systems

Standards in semen examination:publishing reproducible and reliable data based on high-quality methodology

Biomedical science is rapidly developing in terms of more transparency, openness and reproducibility of scientific publications. This is even more important for all studies that are based on results from basic semen examination. Recently two concordant documents have been published: the 6th edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen, and the International Standard ISO 23162:2021. With these tools, we propose that authors should be instructed to follow these laboratory methods in order to publish studies in peer-reviewed journals, preferable by using a checklist as suggested in an Appendix to this article.Peer reviewe

Promoting Safe Motherhood in the Community: The Case for Strategies that Include Men

Although a decade has now passed since the launching of the Safe Motherhood Initiative, maternal mortality continues to be the health indicator showing the greatest disparity between developed and developing countries. Recently revised WHO and UNICEF figures indicate that an estimated 90% of the 585,000 worldwide maternal deaths that occur each year take place in sub-Saharan Africa and Asia. In terms of the lifetime risk of maternal death, this disparity remains striking: 1 in 12 women in parts of sub-Saharan Africa, compared with 1 in 4,000 women in Northern Europe. In addition, for every woman who dies, an estimated 16-17 will suffer from pregnancy-related complications. Research suggests that, in addition to biomedical interventions and the strengthening of health care services, improving awareness of obstetric complications among members of a pregnant woman's immediate and wider social network is an important step in improving her chances of survival when such complications occur. Many of the interventions implemented so far have focused exclusively on improving women's knowledge and practices as they relate to maternal health issues. Nevertheless, it is now increasingly being recognised that the actions required to achieve improvements in reproductive health outcomes in general, and maternal health in particular, should involve communities in the process and encourage men's active participation. Despite this, very few studies on risk perceptions or interventions to raise community awareness of obstetric risk factors, their complications and their consequences have targeted men. The present article argues for the development and testing of risk awareness interventions, which, in addition to women, target men in their familial and social roles within communities and as workers within health care services as a means of improving maternal health outcomes. (Afr J Reprod Health 2001; 5[2]:10-21) RÉSUMÉ L'avancement de la maternité sans risque dans la communauté: plaidoyer en faveur des stratégies qui s'adressent aussi aux Hommes. Quoique la Safe Motherhood Initiative ait été lancée il y a maintenant une décennie, la mortaité maternelle reste toujours l'indice de la santé qui montre la plus grande disparité entre les pays développés et les pays en voie de développement. Dernièrement, les chiffres revus qui émanent de l'OMS et du FISE montrent qu'environ 90% des 585000 décès maternels partout dans le monde qui ont lieu chaque année, se trouvent en Afrique subsaharienne et en Asie. En ce qui concerne le risque de toute une vie du décès maternel, cette disparité reste frappante: I femme sur 12 dans certaines régions de l'Afrique subsaharienne, par rapport à I femme sur 4000 en Europe du nord. De plus, pour chaque femme qui meurt, il y en aura à peu près 16-17 qui seront atteintes des complications liées à la grossesse. La recherche laisse supposer qu'en plus des interventions biomédicales et l'amélioration des prestations de santé, l'amélioration au niveau de la sensibilisation aux complications obstétriques parmi les membres du reseau proche et plus large d'une femme enceinte est une démarche importante pour améliorer les possibilités de sa survie quand telles complications se produisent. Beaucoup d'interventions qui ont été mises à exécution jusqu'ici, ont concentré exclusivement sur l'amélioration de la connaissance et les pratiques chez les femmes en ce qui concerne les problèmes de la santé maternelle. Néanmoins, il est maintenant de plus en plus reconnu que les mesures nécessaries pour accomplir des améliorations par rapport aux issues dans la santé reproductive en général et par rapport à la santé maternelle en particulier doivent s'adresser aux communautés en même temps et doivent encourager la participation active des hommes. Malgré ceci, très peu d'études sur la perception de risque ou des interventions destinées à augmenter la conscience de la communauté des facteurs de risque obstétrique, leur complications et leurs conséquences, ont visé les hommes. Le présent article préconise le développement et l'évaluation des interventions de la sensibilisation au risque, qui en plus des femmes, visent les hommes dans leurs rôles familiaux et sociaux au sein des communautés et en tant que membres du personnel des services de santé comme moyen de l'amélioration des issues de la santé maternelle. (Rev Afr Santé Reprod 2001; 5[2]:10-21) KEY WORDS: Safe motherhood, risk factors, interventions, community, me

Maternal mortality in rural and urban Zimbabwe: Social and reproductive factors in an incident case-referent study

A community-based incident case-referent study was undertaken in a rural and an urban setting in Zimbabwe in order to define risk factors associated with maternal deaths at family, community, primary and referral health care levels. Referent subjects were drawn from place or area of delivery for each consecutive maternal death. Using a multiple source confidential reporting network for all maternal deaths, the maternal mortality rate for the rural setting was 168/100,000 live births and that for the urban setting was 85/100,000 live births. A model for interacting factors contributing to maternal mortality was designed. Haemorrhage and abortion sepsis were the major direct causes while malaria was the leading indirect cause in the rural setting. In the urban setting, eclampsia, abortion and puerperal sepsis were the leading causes of maternal deaths. It was found that all situations associated with diminished, or absent social support, that is, being single (OddsRatio = 4.7, 95% CI = 2.2-9.8) divorced, widowed, one of several wives, cohabiting, or self-supporting carried an increased risk for maternal mortality, especially in the rural area. Income and level of education for index and referent subjects were comparable, probably because of the limited part of the population under study that belonged to a more affluent class. Distribution of cases and referents by religious-affiliation was also comparable. Age > 35 years and parity > 6 were significant risk factors for maternal mortality in the rural setting, whereas bad reproductive history with reported stillbirth or abortion constituted a high risk both in the city and in the rural areas (Odds Ratios 4-6). Especially dramatic was the risk increase for mothers with no reported live births (Odds Ratio 20 and 22). The pregnancy was reported as unwanted for nearly half of both index cases and referents, with four suicides resulting, clearly illustrating the large unmet need for family planning and its tragic consequences.maternal mortality case-referent biosocial risk factors

Knowledge of STIs and AIDS, condom use, and risk awareness /

"October 1997."Includes bibliographical references (p. 40-41)