Integration of family planning services with HIV treatment for women of reproductive age attending ART clinic in Oromia regional state, Ethiopia

Abstract Background In settings where HIV prevalence is high, management of sexual and reproductive health is critical to reducing HIV transmission and maternal mortality. Integration of family planning with HIV services is appropriate for HIV therapy, HIV prevention, and care in a resource-limited country s like Ethiopia. The study aimed at examining the status of integration of family planning services with HIV treatment and factors associated with successful integration of family planning and HIV services for women of reproductive age in Oromia, Ethiopia for better health outcomes. Methods The research design of this study was a quantitative survey, non-experimental, explorative and descriptive. A questionnaire was used to collect data from women living with HIV attending ART clinics in the special zone of surrounding Finfinne, Oromia Region in five health centers. Simple random sampling was used to select 654 respondents. Data was analysed through the use of Statistical Package for Social Sciences version 23.0. Bivariate and multivariate logistic regressions were performed to identify factors associated integration of family planning with HIV services with the significant association at an adjusted odds ratio (AOR) with a 95% confidence interval (CI) to controlled effects of possible confounders from the final model. Result The response rate of this study was 97.6% (654/670). The ages of those who responded to the administered questionnaires ranged between 18 and 49 years. The mean age of the respondents was 31.86 years with an SD of ± 6.0 years. Most of the respondents in the sample were in the age group 26–35 (n = 374, 57%), and only 96 (14.7%) were in the age group 18–25. This overall integration of FP-HIV services among reproductive-age women living with HIV in Oromia regional state of special zone health centers was found to be 55.8%. Almost all respondents (n = 635, 97.1%) preferred integrated family planning and HIV services from the same facility and the same providers. the study found that 622 (95%) were most satisfied with the utilization of integrated family planning/HIV services. Conclusion This study established that in overall, the integration of family planning/HIV services was relatively moderate among women of reproductive age living HIV. The identified factors that affected the integration of family planning with HIV services were the level of education, occupational status, residence, discussion of family planning with healthcare providers, fertility desire and CD4 counts.Plain language summary These study findings are strongly in favour of integrated services offering multiple health services at the same facility by the same provider. Service integration based on the needs of women of reproductive age was found to be necessary in public health facilities where people have access only to primary healthcare facilities. Integrated family planning with HIV (FP-HIV) services contribute to women’s wellbeing by addressing a wide range of health needs and offering convenience of receiving multiple services a single visit. Integrated FP-HIV services further address women’s vulnerability to other sexual reproductive health problems. Integrated FP-HIV services should contribute to comprehensive national family planning programs to enable the provision of full access to a variety of contraceptive methods. The latter should enable couples and individuals to obtain services at a one-stop supermarket to achieve optimal reproductive and sexual health to meet their needs. The findings from study generated adequate knowledge and equipped managers with skills integrating family planning with HIV services among women of reproductive age in Oromia regional state, Ethiopia. The study’s findings have emphasized the urgent need to fully implement action focusing on integrating family planning/HIV services for women of reproductive age living HIV and attending ART clinics. The study prioritized the need to strengthen the capacity of health centers to provide quality FP-HIV

Neonatal Survival in Sub-Sahara: A Review of Kenya and South Africa

Introduction: The majority (99%) of the children who die during the first 4 weeks of life do so in the poorer parts of the world, especially in sub-Saharan Africa and South Asia. In 2018, sub-Saharan Africa had a neonatal mortality rate of 28 deaths per 1000 live births. The purpose of the review was to explore and describe the trends of neonatal mortality within the two sub-Saharan countries. Methods: We did a literature search in biomedical databases of data published, in English, between Jan 1, 1975, and November 30, 2019. The databases included Scopus, Web of Science, Science Direct, Cochrane Library, PUBMED, OVID and Google scholar. The keywords used in the search: “Neonatal Survival”, “Sub-Sahara”, “Kenya” and “South Africa”. Results: The search generated 2209 articles of which only 27 met the inclusion criteria. The present study qualitatively analysed data. Data were presented and organized under two thematic domains: 1) trends of national neonatal mortality rates in South Africa and Kenya and 2) causes of neonatal mortality. Conclusion: The current review results noted that in 2018, the neonatal mortality rate for Kenya was 19.6 deaths per 1000 live births. The neonatal mortality rate has fallen gradually from 35.4 deaths per 1000 live births in 1975. On the other hand, South Africa has had its neonatal mortality rate fall from 27.9 deaths per 1000 live births in 1975 to 10.7 deaths per 1000 live births in 2018. Most neonatal deaths resulted in preterm birth complications followed by intrapartum-related events for the two countries. Within the sub-Saharan region, disparities exist as neonates born in South Africa are more likely to survive during the neonatal period compared to Kenya.Health Studie

Determinants of High Neonatal Mortality Rates in Migori County Referral Hospital in Kenya

Background: Neonatal mortality is a significant public health problem worldwide. In Kenya, neonatal mortality rates are unacceptably high within the sub-Saharan region. In 2017 the country had 20.9 deaths per 1000 live births above the WHO target of 12 deaths per 1000 live births. Purpose: The purpose of this study was to investigate the determinants of high neonatal mortality rates in Migori County, Kenya. The neonatal mortality cases were utilised as the target population to the study. Method: A quantitative, descriptive, cross-sectional, non-experimental research design was used. A systematic sampling technique was employed to draw a sample of 201 archived neonatal cases out of 420 neonatal mortality medical records, which constituted the study population. Data were collected by means of a developed questionnaire. The Statistical Package for Social Sciences (SPSS) Version 21 was used to analyse data. Results: The main findings revealed the leading determinants of neonatal mortality were early neonatal period, prematurity, low birth weight, neonates with intrapartum complications and poor 1st Apgar score. Obstetrical haemorrhage and HIV were the main maternal complications associated to neonatal mortalities, while the leading direct causes of death in this study were birth asphyxia and sepsis. Conclusions: To reduce mortalities, a multifaceted approach is needed to establish quality improvement in neonatal intensive care and reduce preterm birth incidences in Migori County.Health Studie

Reproductive health outcomes: Insights from experts and verbal autopsies

Background: Reproductive health outcomes are a measure of maternal and neonatal health. South Africa’s state of maternal health is of particular concern because of the two Millennium Development Goals (MDGs) targets for monitoring maternal health, namely MDG 5a, to reduce the maternal mortality rate by three-quarters, and MDG 5b, to achieve universal access to reproductive health by 2015. Maternal mortality ratio and universal access to reproductive health receive unequal responsiveness from government. Monitoring the maternal mortality ratio has received favourable attention compared to ensuring universal access to reproductive health, hence the limited published research findings on the latter. Objectives: The purpose of this article is to report on the insights from reproductive health experts and verbal autopsies on the determinants of poor reproductive health outcomes. Method: Individual interviews with a purposively selected sample of six reproductive health experts were conducted, augmented by verbal autopsies of 12 next of kin of women and newborn babies who died within the previous 2 years period of the study. Burnard’s (1995) approach of content analysis was used to analyse the data. Results: The findings revealed lack of empowerment, inaccessible reproductive health services and separation of patients living with human immune deficiency virus and those patients diagnosed with acquired immune deficiency syndrome. Conclusion: To meet the reproductive health needs, especially of the rural population, urgent attention is needed to reduce their vulnerability to the risks of poor reproductive outcomes

Barriers to and Opportunities for Male Partner Involvement in Antenatal Care in Efforts to Eliminate Mother-to-child Transmission of Human Immuno-deficiency Virus in Kenya: Systematic Review

Introduction: Men’s involvement in antenatal care (ANC) is intended to encourage husbands to support women’s care and associated interventions, including prevention of mother-to-child transmission from pregnancy to delivery, and throughout the postnatal period. The present study aimed to systematically review the barriers and opportunities for male partner involvement in antenatal care in efforts to eliminate mother-to-child transmission of Human Immunodeficiency virus (HIV) in Kenya. Methods: A systematic search of articles was from the following databases; Scopus, Science Direct, PUBMED, OVID, and Google scholar. The reference list of included studies was manually searched for possible additional eligible articles. The searches were conducted from May 2019 to April 2020. Qualitative analysis was done and data were presented in thematic domains. Results: The search generated 2208 articles, of which only 19 met the inclusion criteria. The major findings were discussed under two thematic domains: 1) Barriers: Knowledge, Social-cultural/economic factors, Institutional factors, and Age. 2) Opportunities: Skilled Birth Attendant, Human Immunodeficiency virus-free infant and Human Immunodeficiency virus testing. Conclusion: The review notes that the main barriers to male partner involvement in antenatal care in efforts to eliminate mother-to-child transmission of Human Immunodeficiency virus in Kenya include; socio-cultural factors, the low maternal-child health education by the male partner, and institutional factors. It further provides insight on the opportunities associated with male partner involvement in antenatal care/prevention of mother-to-child transmission, which includes; having Human Immunodeficiency virus-free infants and increased, skilled birth deliveries. The review strongly calls out for sustainable initiatives to incorporate males into the antenatal care/prevention of mother to child transmission programs.Health Studie

Respectful maternity care in health centers of Addis Ababa city: a mixed method study

Abstract Objective The study aims to assess quality of obstetric and newborn care including respectfulness of the maternity care. Design The study used explanatory sequential mixed methods design . Setting This study was conducted in 50 health centres in Addis Ababa city administration January 25 to April 31, 2021. Methods During the quantitative phase 500 women in postpartum period were interviewed using structured questionnaire. In the second phase in-depth interview was conducted with 20 midwives and 13 health centre managers. The quantitative data was analysed using Statistical Package for Social Sciences (SPSS). The qualitative data was analysed using Colaizzi’s seven step process. Results Only 24.6% of women had respectful maternity care (RMC). Only 46% of women had effective communication during child birth. Only 9.6% of women had emotional support during child birth. Majority of women were encouraged to mobilize, take food and be on labor position of their choice. However, only 22.4 and 18.8% of women respectively had a companion of choice and any pharmacologic pain relief during child birth. One in seven women (15%) had one form of disrespect and abuse during child birth. Conclusion Ensuring respectful maternity care needs strong policy direction to health facilities, public education on their right to respectful maternity care, training of care givers and monitoring care through engagement of frontline staff and clients

PARENTS AND COMMUNITY LEADERS’ PERCEPTIONS OF TEENAGE PREGNANCY: A QUALITATIVE STUDY

The purpose of this qualitative study was to understand the perceptions and experiences of parents and community leaders of two communities in Nigeria regarding teenage pregnancy and their understanding of teenage sexuality and contraception. In addition, the study set out to ascertain whether teenage pregnancy prevention programmes were available within the communities. The study was qualitative, contextual and exploratory utilising the Community-as-Partner Model. Eighty participants who were parents and community leaders responded to the semi-structured interview and completed a questionnaire on demographic data. Tesch’s approach of data analysis was used, and descriptive statistics were used to display demographic data as well as the count of data segments that constitute categories. The fi ndings reveal that although limited teenage pregnancy prevention initiatives were in existence, most of the participants, especially those from the North Central (NC) region of Nigeria, were not informed about them. Almost half of the participants viewed teenage pregnancy as a common occurrence in their communities of which most were from the NC region. More than two-thirds of the participants discouraged teenagers from using contraceptives. Teenage pregnancy intervention programmes and strategies must be sensitive to differences among various ethnic and religious groups. The involvement of religious and community leaders in teenage pregnancy intervention programmes and initiatives is indispensable in curtailing the high incidence of teenage pregnancies and childbirths among teenagers

Experiences of Former Markers of Undergraduate Assignments and Examinations at A University: A Case Study

Purpose The present study explored experiences of former markers of undergraduate assignments and examinations at the University of South Africa (Unisa). Methodology Qualitative method of research was used to gather data. Colaizzi’s method (1978) was used to analyze and interpret data. The article’s frame of reference was informed by Mezirow’s transformative learning theory which is aligned to critical theory (Mezirow 2009). Findings Findings were based on the following: Demographic information, markers’ experiences in marking assignments and exam books, content knowledge, markers’ meetings, duration of marking assignments and examination books as well as students support, and suggestions are the themes that emerged from the data that was gathered. Originality It is recommended that the university must develop a policy for external markers for marking assignments and examinations of undergraduate program. All E-tutors must be trained to support students after the official closure of registration and before examinations are set. All markers must be trained - through a markers’ guide - to mark assignments and examination books.Teacher Educatio

The healthcare system and client failures contributing to maternal mortality in rural Kenya

Background The global maternal mortality ratio is estimated at 211/100 000 live births in 2017. In Kenya, progress on reducing maternal mortality appears to be slow and persistently higher than the global average, despite efforts by the government’s provision of free maternity services in both private and public facilities in 2013. We aimed to explore and describe the experiences of midwives on maternal deaths that are associated with the healthcare system and client failures in Migori, Kenya. Methods An explanatory, qualitative approach method was adopted. In-depth interviews were conducted with the purposively selected midwives working in peripartum units of the three sampled hospitals within Migori County in Kenya. The hospitals included two county referral hospitals and one private referral hospital. Saturation was reached with 37 respondents. NVivo 11 software was used for analysis. Content analysis using a qualitative approach was adopted. Accordingly, the data transcripts were synthesised, coded and organised into thematic domains. Results Identified sub-themes: sub-optimal care, staff inadequacy, theatre delays, lack of blood and essential drugs, non-adherence to protocols, staff shortage, inadequate equipment and supplies, unavailable ICU wards, clients’ ANC non-adherence. Conclusion In conclusion, the study notes that the healthcare system and client failures are contributing to maternal mortality in the study setting. The major failures are across the pregnancy continuum starting from antenatal care, and intrapartum to post-natal care. This can illustrate that some pregnant mothers are getting sub-optimal care reducing their survival chances. To reduce maternal mortality in Migori County, the key highlighted healthcare system and client failures should be addressed through a multidisciplinary approach mechanism.Health Studie