17,765 research outputs found

    Contraceptive discontinuation and switching behavior among family planning clinic clients in Dalhatu Araf Specialist Hospital, Lafia

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    Background: Contraceptives are effective ways with which couples can limit or space the number of children they have. Several methods of contraception exist, both modern and traditional methods. Couples have a myriad of these from which to choose from. However, contraceptive discontinuation and switching are a reality. The dynamics of contraceptive use, discontinuation and switching are important markers of how well the programs are meeting the family planning needs of women and couples. The aim of the study was to ascertain the magnitude of women who wanted to discontinue or switch their present contraceptive methods and establish the reasons why. Methods: Our study was a cross sectional descriptive study of women attending the family planning clinic of Dalhatu Araf Specialist Hospital, Lafia over a 12 month period. A self-administered structured questionnaire was administered to the family planning clinic clients after obtaining a written informed consent. Results: Contraceptive discontinuation rate was 36.5%, and the switching rate was 5.2%. The commonest reasons for discontinuing contraception were; desirous of pregnancy (43%), side effects of method (28.2%), husband’s disapproval (16.7%), marital dissolution (4.2%), inconvenience of use (3.1%), failure of method (1.6%) and menopause (0.4%). The reasons for switching were also similar and include; side effects of the method (51.4%), inconvenience of use (16.2%), husband’s disapproval (8.1%), personal choice (5.4%) and marital dissolution (2.7%). Conclusions: We concluded that the contraceptive discontinuation rate was moderately high, while the switching rate was low. We recommend adequate counseling of clients before contraceptive uptake to forestall this

    Knowledge and attitudes of health care workers about monkeypox virus infection in Southern Italy

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    BackgroundThis present survey sought to investigate the level of knowledge and the attitudes pertaining the monkeypox (mpox) virus infection among a sample of health care workers (HCWs) in Italy, as well as the possible role of different factors on these outcomes.MethodsThe cross-sectional survey was performed from July through October, 2022 at four randomly selected hospitals located in Southern Italy.ResultsThe questionnaire was completed by 421 HCWs, for an overall 59% response rate. Less than two-thirds were able to define the disease and the correct answer of the transmission mechanisms ranged from 22.8% for contact with contaminated objects to 75.8% through close contact with body fluids. Only 4% and 12.8% indicated HCWs and elderly/frail/people with underlying immune deficiencies as risk groups. The mean overall score of the knowledge assessment on mpox was 3.4 (0–9). The multivariate logistic regression analysis showed that HCWs with a lower number of years of working experience and those who had acquired information about mpox from scientific journals were more likely to have a higher level of knowledge. The average score of the perception of the severity of the disease was 6.3. A similar score with a value of 6.1 has been observed for the statement that mpox is a serious problem for the population. Regarding the level of concern about contracting mpox, the mean score was 5.1. Only 10.5% reported that they feel that this disease can be prevented, with an overall mean score of 6.5. Almost all HCWs reported that they are still living as usual, with no modification of their behavior for fear of contracting the mpox. The results of the multivariate logistic regression model showed that women, HCWs with a higher level of knowledge about mpox, and those who needed additional information about mpox were more likely to have a higher level of perception of the severity of the disease.ConclusionThis survey has demonstrated that HCWs had an unsatisfactory level of knowledge toward mpox and only nearly half showed positive attitudes. Strategic health training programs should be made so that knowledge can be acquired

    COVID-19 Lockdown containment measures and women’s sexual and reproductive health in Zimbabwe

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    The devastating COVID-19 pandemic and its accompanying containment measures brought exceptional challenges to the health delivery system, and in particular, women’s sexual and reproductive healthcare (hereafter referred to as SRH). The re-routing of health resources and funding to mitigate the effects of the pandemic obstructed the provision of essential SRH services for women and girls. Coupled with the incessant socio-cultural and patriarchal norms and gender inequalities, the COVID-19 pandemic aggravated the pre-existing SRH disproportions already affecting women. By adopting a qualitative approach and drawing on the experiences of women from three high density suburbs in Harare. Firstly, the study sought to explore the implications of the COVID-19 pandemic on SRH for women and girls. Secondly, the research sought to determine key drivers that affect women’s SRH in the context of COVID-19. Participant responses indicated that the COVID-19 lockdown containment measures which confined spouses to the home setting for prolonged periods of time, which is in contrast to the norm, exposed women to SRH related challenges. Participants cited that (i) bruised male ego due to lack of employment as a result of downscaling of companies resulting from COVID-19 containment measures resulted in men asserting their masculinities through heightened sexual intercourse, (ii) restraint of movement resulted in limited time for men to visit their small houses and side-chicks or side dish (euphemisms for illicit sexual relations) therefore resulting in frequent and unprotected sex with their spouses, giving rise to unplanned pregnancies and increased exposure to STIs due to limited access to SRH services and, (iii) increased intimate partner violence (IPV) and sexual abuse. Therefore, the research sought to explore the response of religious leaders and faith-based actors to providing psycho-social support and safe spaces as ways of addressing intersectional injustices giving rise to SRH challenges for women and girls. Contribution: The intersecting crises of the COVID-19 pandemic have extensively hindered progress towards the promotion of women’s SRH. Relating to sustainable development goal 3 (SDG3), the article acknowledges the trust and respect of religious leaders within communities as change agents who can encourage shifts in behaviour, beliefs and practices in ways that promote holistic SRH for women

    Gender Mainstreaming at the European Court of Human Rights: The Need for A Coherent Strategy in Approaching Cases of Violence Against Women and Domestic Violence

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    Any assessment of the jurisprudence of the European Court of Human Right’s (ECtHR) in the field of violence against women and domestic violence must start with an acknowledgement of the ECtHR’s landmark judgments in this area and the positive practical impact those judgments have had upon the protection of women. However, much progress is still to be made. This article analyses three ECtHR cases from Russia and Georgia, and in so doing, highlights the need for greater transparency, proactivity, and coherency on the part of the Court. It considers in turn: a) the seemingly discriminatory impact of the ECtHR’s approach to applications for interim measures; b) the need for judicial proactivity in bringing a gender perspective and gender mainstreaming to cases brought before the Court; c) the lack of a reasoned and transparent approach with regard to redress. Ultimately, the article puts forward potential improvements which could be made to ensure that the ECtHR monitors its own practice and procedures in order to address the demonstrable need for a coherent gender mainstreaming strategy

    HIV treatment outcomes and their associated factors among adolescents and youth living with HIV in Tanzania

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    Introduction:  Despite improvements in access to Ante-Retroviral therapy in Tanzania, low ART initiation rate, low retention rate, lower viral load suppression, high loss to follow up and death rate among adolescents and youth living with HIV remain a challenge.  This study was conducted to identify factors affecting HIV treatment outcomes among adolescents and youths. Methods: A cross-sectional study was done in seven regions in Tanzania. A total of 1124 in and out of school ALYHIV were interviewed using a semi-structured questionnaire. Results: A total of 1120(99.6%) participants were on ART. Of those who were on ART, 606 (53.9%) participants had advanced HIV disease, 423(37.6 %) had switched to the second line of ART and 1761(7.7%) had a virological failure. After adjusting for confounders, death of both parents (APR= 1.3, 95%CI: 1.01-1.8); regions with high HIV prevalence (APR= 1.7, 95%CI: 1.2-2.3) and taking ARVs for three years and less (APR= 2.2, 95%CI: 1.4-3.6) were associated to have advanced HIV. Additionally, HIV regional prevalence level, level of perception, adherence status, ARV storage and supervision of ART use were independently associated with Virological failure.    Conclusion: This study has shown that despite an almost universal utilization of ART among adolescents and youth living with HIV unfavourable clinical ART outcomes such as advanced HIV disease, virological failure and ART switch to the second line remain a challenge, particularly among males and adolescents. Various factors at individual, community and health facility levels contribute to unfavorable ART clinical outcomes among AYLHIV. Therefore, an all-inclusive multidimensional and multi- stakeholders’ approach is needed to ensure the availability of sustainable, effective and quality care and treatment services prioritizing AYLHIV.&nbsp

    Equity in HIV/AIDS management and prophylaxis: How free is the free ART program in India?

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    The concern for most public health policies and decision-makers is the equitable distribution of the nation’s healthcare resources. Also, in the public health care system, the primary aim is assuaging the burden of the disease. This study captures and evaluates some important health equity aspects with its relevance with the ART (Antiretroviral Therapy) program in India. The study is an exploratory and descriptive study based on secondary data. The sources of secondary data are published official reports from NACO (National AIDS Control Organization), United Nations AIDS Program (UNAIDS), World Health Organization (WHO) etc. The roll-out of the ART program in 2004 by the Govt. of India made a paradigm shift in the HIV/AIDS scenario in the country. “The adult HIV prevalence at the national level has continued its steady decline from an estimated level of 0.41% in 2001 through 0.35% in 2006 to 0.27% in 2011”. Equity in plain words means fairness. In the sense of health policy and HIV/AIDS studies, the reduction in prevalence rate equates to positive health equity. The enervation of HIV infection by taking ART drugs had helped in curbing the prevalence and the fact that it is provided free of cost has proven this program to be the epitome of distributive justice in public health

    A Multi-level Analysis on Implementation of Low-Cost IVF in Sub-Saharan Africa: A Case Study of Uganda.

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    Introduction: Globally, infertility is a major reproductive disease that affects an estimated 186 million people worldwide. In Sub-Saharan Africa, the burden of infertility is considerably high, affecting one in every four couples of reproductive age. Furthermore, infertility in this context has severe psychosocial, emotional, economic and health consequences. Absence of affordable fertility services in Sub-Saharan Africa has been justified by overpopulation and limited resources, resulting in inequitable access to infertility treatment compared to developed countries. Therefore, low-cost IVF (LCIVF) initiatives have been developed to simplify IVF-related treatment, reduce costs, and improve access to treatment for individuals in low-resource contexts. However, there is a gap between the development of LCIVF initiatives and their implementation in Sub-Saharan Africa. Uganda is the first country in East and Central Africa to undergo implementation of LCIVF initiatives within its public health system at Mulago Women’s Hospital. Methods: This was an exploratory, qualitative, single, case study conducted at Mulago Women’s Hospital in Kampala, Uganda. The objective of this study was to explore how LCIVF initiatives have been implemented within the public health system of Uganda at the macro-, meso- and micro-level. Primary qualitative data was collected using semi-structured interviews, hospital observations informal conversations, and document review. Using purposive and snowball sampling, a total of twenty-three key informants were interviewed including government officials, clinicians (doctors, nurses, technicians), hospital management, implementers, patient advocacy representatives, private sector practitioners, international organizational representatives, educational institution, and professional medical associations. Sources of secondary data included government and non-government reports, hospital records, organizational briefs, and press outputs. Using a multi-level data analysis approach, this study undertook a hybrid inductive/deductive thematic analysis, with the deductive analysis guided by the Consolidated Framework for Implementation Research (CFIR). Findings: Factors facilitating implementation included international recognition of infertility as a reproductive disease, strong political advocacy and oversight, patient needs & advocacy, government funding, inter-organizational collaboration, tension to change, competition in the private sector, intervention adaptability & trialability, relative priority, motivation &advocacy of fertility providers and specialist training. While barriers included scarcity of embryologists, intervention complexity, insufficient knowledge, evidence strength & quality of intervention, inadequate leadership engagement & hospital autonomy, poor public knowledge, limited engagement with traditional, cultural, and religious leaders, lack of salary incentives and concerns of revenue loss associated with low-cost options. Research contributions: This study contributes to knowledge of factors salient to implementation of LCIVF initiatives in a Sub-Saharan context. Effective implementation of these initiatives requires (1) sustained political support and favourable policy & legislation, (2) public sensitization and engagement of traditional, cultural, and religious leaders (3) strengthening local innovation and capacity building of fertility health workers, in particular embryologists (4) sustained implementor leadership engagement and inter-organizational collaboration and (5) proven clinical evidence and utilization of LCIVF initiatives in innovator countries. It also adds to the literature on the applicability of the CFIR framework in explaining factors that influence successful implementation in developing countries and offer opportunities for comparisons across studies

    Early Shame, Self-Esteem, and Christian Women

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    The purpose of this phenomenological study was to gain a deeper understanding of the lived experiences surrounding the self-esteem of evangelical Christian women with early shame experiences. The theory guiding this study was attachment theory as it explains self-esteem being rooted in early childhood through trust building, unconditional love, and security. The theoretical framework further illustrates the impact of self-esteem as life progresses due to a combination of positive and negative self-evaluations. Early shame experiences affect one’s self-esteem adversely. Low self-esteem could breed isolation once people fail to see their self-worthy in establishing meaningful connections, without which individuals lack the nurture needed to grow and sustain their well-being. Data were collected through an unstructured interview. The study findings revealed that (1) poor parental bonds, (2) environmental stressors, and (3) identification with God were significant shared experiences. This study provided implications for community stakeholders in the field of education, healthcare, and ministry. It implied having an early secure attachment and a positive relationship with God as mitigators to adverse mental health, as they facilitate healthy coping among individuals who have faced trauma such as early shame experiences
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