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Narasimhan M, Hargreaves JR, Logie CH, Abdool-Karim Q, Aujla M, Hopkins J, Cover J, Sentumbwe-Mugisa O, Maleche A, Gilmore K. Self-care interventions for women's health and well-being. Nat Med 2024; 30:660-669. [PMID: 38454127 DOI: 10.1038/s41591-024-02844-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024]
Abstract
The human right to health is universal and non-exclusionary, supporting health in full, and for all. Despite advances in health systems globally, 3.6 billion people lack access to essential health services. Women and girls are disadvantaged when it comes to benefiting from quality health services, owing to social norms, unequal power in relationships, lack of consideration beyond their reproductive roles and poverty. Self-care interventions, including medicines and diagnostics, which offer an additional option to facility-based care, can improve the autonomy and agency of women in managing their own health. However, tackling challenges such as stigma is essential to avoid scenarios in which self-care interventions provide more choice for those who already benefit from access to quality healthcare, and leave behind those with the greatest need. This Perspective explores the opportunities that self-care interventions offer to advance the health and well-being of women with an approach grounded in human rights, gender equality and equity.
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Affiliation(s)
- Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, including the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
| | - James R Hargreaves
- Center for Evaluation, London School of Hygiene and Tropical Medicine, London, UK
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Mandip Aujla
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Jane Cover
- Sexual and Reproductive Health Program, PATH, Seattle, WA, USA
| | | | - Allan Maleche
- Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN), Nairobi, Kenya
| | - Kate Gilmore
- Department of International Development, London School of Economics and Political Science, London, UK
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Simbar M, Kiani Z, Nasiri Z, KhodaKarami N, Nazarpour S, Fakari FR, Keyvanfar S, Majd HA. The self-care situation analysis of reproductive-aged women in Tehran: a survey study. BMC Womens Health 2023; 23:624. [PMID: 38007431 PMCID: PMC10675894 DOI: 10.1186/s12905-023-02763-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/04/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Along with a global increase in the prevalence of infectious and non-communicable diseases, self-care with an emphasis on reproductive health Self-care has received special attention. Given the importance of women's health, assessment of their self-care status using a valid and reliable tool seems to be necessary to determine the needs for future women's reproductive health promotion interventions. The present study aimed to assess the women's self-care at reproductive age in Tehran, to determine women's health needs based on global guidelines for women's health. METHODS This was a descriptive cross-sectional study on 1051 women of reproductive age, living in Tehran. The Subjects were recruited using a multi-stage sampling method. The women completed a socio-demographic and valid and reliable questionnaire to assess their self-care status. The data were analyzed using SPSS 24 and by Pearson, Spearman, ANOVA, and regression tests. RESULTS The mean score of self-care was 49.57 ± 23.50% in the reproductive-aged women. The lowest scores were related to psychosocial health (32.12 ± 29.93%) and reproductive-sexual health (49.74 ± 27.99%) respectively. There were significant positive correlations between the self-care and women's education level (r = 0.180; p < 0.01), and husband's education level (r = 0.272; p < 0.01), while there was a negative significant correlation between the self-care and the family size (r = - 0.135; p < 0.01). CONCLUSION The findings showed inadequate self-care among reproductive-aged women in Tehran. The most important challenge in their self-care behaviors was related to psychosocial and reproductive-sexual health. It seems to provide a package for promoting women's self-care in four areas of physical, psychosocial, reproductive-sexual health, and screening tests, with an emphasis on the first two priorities, namely psychosocial and reproductive health necessary in Tehran.
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Affiliation(s)
- Masoumeh Simbar
- Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zahra Kiani
- Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zeinab Nasiri
- General Directorate of Health, The Deputy of Social and Cultural Affairs of Tehran Municipality, Tehran, Iran
| | - Nahid KhodaKarami
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Nazarpour
- Department of Midwifery, Chalous Branch, Islamic Azad University, Chalous, Iran
| | - Farzaneh Rashidi Fakari
- Department of Midwifery, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Sepideh Keyvanfar
- Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Alavi Majd
- Department of Biostatistics, School of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bonyadpour B, Maasoumi R, Nekoolaltak M. Development of self-care strategies to promote young Iranian women's sexual health: an explanatory sequential mixed method study protocol. Reprod Health 2023; 20:148. [PMID: 37798765 PMCID: PMC10557348 DOI: 10.1186/s12978-023-01692-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND In contemporary Iran, the nation's traditional and deeply religious society is currently experiencing swift transformations in its moral, cultural, and social aspects. It is, therefore, not surprising to observe shifts in people's attitudes toward sexuality, largely attributed to the profound impact of widespread social networks, the proliferation of information technology, and increased levels of education. Unmarried young women may potentially face adverse consequences from engaging in extramarital sexual relationships across various aspects of their lives. Acknowledging the pivotal role of self-care in influencing the sexual behaviors of young women, the objective of this study is to compile a comprehensive list of self-care strategies aimed at improving the sexual well-being of young, single Iranian women. METHODS The research will unfold in three distinct phases: Phase 1: Explanatory Sequential Mixed-Method Study This initial phase encompasses both quantitative and qualitative aspects. It begins with a cross-sectional survey, where we will gather data from 400 unmarried female students aged 18 to 29 years, utilizing a cluster random sampling method at Kerman University of Medical Sciences. Data collection will involve the use of a researcher-designed questionnaire. Subsequently, the qualitative phase will involve conducting in-depth, semi-structured interviews with female students from the University. To analyze this qualitative data, we will employ the content analysis approach. The findings obtained from both phases will be combined. Phase 2: Narrative Review In the second stage of the study, we will conduct an extensive narrative review to explore existing strategies related to the subject matter comprehensively. This review will serve as the foundational basis for our subsequent analysis. Phase 3: Strategy Prioritization In the final phase, we will prioritize the proposed strategies using a nominal group process, soliciting expert advice. This step will result in the definitive list of strategies that emerge from the study. DISCUSSION This study pioneers the field of sexual health, with the goal of developing a protocol for creating self-care strategies based on the perspectives of young, unmarried Iranian women. It offers potential evidence-based insights into current developments in the physical, psychological, and social aspects of sexual health within this demographic. Additionally, it aims to furnish essential information to healthcare policymakers regarding the sexual health of young women.
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Affiliation(s)
- Batool Bonyadpour
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, P.O. Box: 1419733171, Tehran, Iran
| | - Raziyeh Maasoumi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, P.O. Box: 1419733171, Tehran, Iran.
- Department of Reproductive Health, Nursing and Midwifery Care Research Centre, School of Nursing and Midwifery, Tehran University of Medical Sciences, P.O. Box: 1419733171, Tehran, Iran.
| | - Maryam Nekoolaltak
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, P.O. Box: 1419733171, Tehran, Iran
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Sedrati H, Bougdira A, Kamal N, Alidrissi N, Sehli S, Hamdi S, Mazti A, Elfazazi H, Aboutaib R, Rhalem W, Dini N, Assarrag B, Bezad N, Acharai L, Hachri H, Rabie R, Amzazi S, Nejjari C, Al-Shorbaji N, Ghazal H. Self-care intervention using mobile apps for sexual and reproductive health in the WHO Eastern Mediterranean Region. Inform Health Soc Care 2023; 48:333-352. [PMID: 37560900 DOI: 10.1080/17538157.2023.2239914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Sexual and reproductive health (SRH) concerns physical, mental, and social well-being as related to sexual and reproductive systems. Self-care, which is the ability to promote health without the support of a health-care provider, can advance SRH, especially for fragile populations. Mobile health (mHealth) solutions can be used to raise awareness about SRH. We performed a structured literature review and analysis of mHealth-based approaches for delivering self-SRH services and interventions in the WHO Eastern Mediterranean Region (EMR). A fuzzy-based framework for assessing those mHealth apps was proposed. We identified 6 out of 737 papers, and 23 (5.7%) out of 400 mHealth apps retrieved from app-stores, describing mHealth use for self SRH with only 10 apps developed in EMR countries, namely Morocco, Pakistan, Egypt, Iran, and Jordan. Our fuzzy-based framework proposes guidelines regarding the implementation of self-care interventions to help project leaders promote their adoption in the SRH systems.
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Affiliation(s)
- Hayat Sedrati
- ICES Team, ENSIAS College, Mohammed V University in Rabat, Rabat, Morocco
- National School of Public Health, Ministry of Health, Rabat, Morocco
| | - Abdesselam Bougdira
- Laboratory of Engineering Sciences, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Nabiha Kamal
- Biochemistry Laboratory, Ibn Rochd University Hospital Center, Casablanca, Morocco
| | - Najib Alidrissi
- Department of Genomics, Bioinformatics and Digital Health, School of Medicine, Mohammed VI University of Science and Health, Casablanca, Morocco
| | - Sofia Sehli
- Department of Genomics, Bioinformatics and Digital Health, School of Medicine, Mohammed VI University of Science and Health, Casablanca, Morocco
| | - Salsabil Hamdi
- Environnemental health lab, Teaching and research department, Institut pasteur du Maroc, Casablanca, Morocco
| | - Asmae Mazti
- Department of Pathology, Hassan II University Hospital, Fez, Morocco
- Faculty of Medicine, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Hicham Elfazazi
- Sexual and Reproductive Health Laboratory, School of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Rachid Aboutaib
- Sexual and Reproductive Health Laboratory, School of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Wajih Rhalem
- E2SN Research Team, ENSAM, Mohammed V University in Rabat, Morocco
- Association Marocaine pour l'Écoute et le Dialogue, Rabat, Morocco
| | - Nezha Dini
- Department of Genomics, Bioinformatics and Digital Health, School of Medicine, Mohammed VI University of Science and Health, Casablanca, Morocco
- School of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Bouchra Assarrag
- National School of Public Health, Ministry of Health, Rabat, Morocco
| | - Nadia Bezad
- Pan African Anti-Aids Organization, Rabat, Morocco
| | - Laila Acharai
- Rabat Office, United Nations Population Fund (UNFPA), Rabat, Morocco
| | - Hafid Hachri
- Health system unit, World Health Organization (WHO), Rabat, Morocco
| | - Redouane Rabie
- Department of Genomics, Bioinformatics and Digital Health, School of Medicine, Mohammed VI University of Science and Health, Casablanca, Morocco
| | - Saaid Amzazi
- Laboratory of Human Pathologies Biology, Department of Biology, Faculty of Sciences, Mohammed V University, Rabat, Morocco, and Genomic Center of Human Pathologies, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Chakib Nejjari
- Department of Epidemiology and Public Health, Faculty of Medicine, Pharmacy and Dental Medicine, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | | | - Hassan Ghazal
- Department of Genomics, Bioinformatics and Digital Health, School of Medicine, Mohammed VI University of Science and Health, Casablanca, Morocco
- Department of Sciences, National Centre for Scientific and Technical Research, Rabat, Morocco
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Sadeghi M, Jamshidimanesh M, Alimoradi Z. Predictors of sexual and reproductive health self-care based on demographic factors in adolescent girls. Int J Adolesc Med Health 2023:ijamh-2023-0049. [PMID: 37255179 DOI: 10.1515/ijamh-2023-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/09/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Global access to sexual and reproductive health is an essential human right, especially to adolescent girls. For improvement sexual and reproductive self-care needs to determine the related factors on utilization and acceptance by adolescents. Therefore, the aim of this study was to examine the SRH self-care and its predictors among adolescent girls in Neyshabur city at Northeast of Iran. METHODS The present study was a cross-sectional correlational study performed on 265 girl students from 15 girls' high schools in Neyshabour, in Razavi Khorasan province, Northeastern Iran. The sampling method was multistage probability sampling. Data were collected using demographic information and female adolescents' sexual reproductive self-care scale. Data were analyzed using descriptive, frequency, percentage, mean, standard deviation, and ANOVA, Pearson correlation coefficient, and multiple linear regression model. The significant level was p<0.05 using SPSS16. RESULTS The results of the present study showed that the mean score of the sexual reproductive health self-care was 61.23 of 100 ± 10.5, it had a significantly relationship with fathers education high school [B=-7.241 CI: (-11.088 to -3.393)], diploma [B=-7.221 CI: -10.707 to -3.735] than academic. The rank of children birth in the family first [B=6.012 CI: (0.931-11.092)] second [B=4.436 CI: (1.437-8.309)] than third and above. Economic status of household Excellent [B=3.159 CI: (2.193-8.511)], Favorable [B=5.866 CI: (1.355-10.378)], relatively favorable [B=2.705 CI: (1.802-7.213)] than poor level economic. CONCLUSIONS sexual and reproductive health is associated to father's education, the rank of children birth in the family, and economic status. So these variables will help to strategies and progress educational programs.
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Affiliation(s)
- Maryam Sadeghi
- MS, School of Nursing & Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mansoureh Jamshidimanesh
- Department of Reproductive Health and Midwifery, School of Nursing & Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Zainab Alimoradi
- Social Determinants of Health Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
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Tazinya RMA, Hajjar JM, Yaya S. Strengthening integrated sexual reproductive health and rights and HIV services programs to achieve sustainable development goals 3 and 5 in Africa. Reprod Health 2022; 19:223. [PMID: 36494750 PMCID: PMC9734483 DOI: 10.1186/s12978-022-01535-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Each year, over 200 million women globally cannot prevent pregnancy through modern contraceptive methods, with 70-80% of these women residing in sub-Saharan Africa. Consequently, almost 50% of pregnancies are unintended and 35 million unsafe abortions occur annually in the region. Further, sub-Saharan Africa has the highest burden globally of Human Immune-Deficiency Virus (HIV) infection, and over 57% of those affected are women. Women with a positive HIV status in sub-Saharan Africa experience higher rates of unintended pregnancy and unsafe abortion practices. In this commentary, we propose strategies to strengthen integrated sexual and reproductive health and rights (SRHR) and HIV services programs to improve the sexual and reproductive health of girls and women and to work towards achieving SDGs 3 and 5 in sub-Saharan Africa. We suggest a focus on capacity building, strengthening intersectoral collaborations, and improving governance and financial investment.
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Affiliation(s)
- Rose-Mary Asong Tazinya
- grid.28046.380000 0001 2182 2255Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Julia Marie Hajjar
- grid.28046.380000 0001 2182 2255Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Sanni Yaya
- grid.28046.380000 0001 2182 2255School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON K1N 6N5 Canada ,grid.7445.20000 0001 2113 8111The George Institute for Global Health, Imperial College London, London, UK
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Nyatela A, Nqakala S, Singh L, Johnson T, Gumede S. Self-care can be an alternative to expand access to universal health care: What policy makers, governments and implementers can consider for South Africa. Front Reprod Health 2022; 4:1073246. [PMID: 36545492 PMCID: PMC9760858 DOI: 10.3389/frph.2022.1073246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
As a result of collaboration amongst the various decision-makers in the field of healthcare, there has been an improvement in the access to healthcare and living conditions globally. Nonetheless, poorer communities continue to benefit the least from public investment. To bridge the gap, self-care can be a viable alternative as it allows individuals and communities to reduce their dependence on government healthcare solutions. Barriers to self-care do exist. Some of these are cost effectiveness, usability of self-care instruments, differentiated strategies and linkage to care. In identifying these obstacles, it is also worthwhile to investigate how they can be mitigated. To encourage sustained self-care in the HIV continuum, contextual factors as well as the manner in which individuals and communities engage with self-care must be considered. In South Africa, multiple variables come into play: literacy levels, cultural influences, socio-economic conditions and access to resources are some of these. Evidence demonstrates how self-care can be promoted by various stakeholders re-strategising to tweak and in some cases totally change existing structures. This paper explores some of the transformations, like at a governmental level where the supply of HIV self-testing kits is increased, at a production level where instructions for use are reformatting, in communities where sports programmes fulfil the dual purpose of developing sport skills and providing HIV education concurrently, and at an individual level where greater awareness invites greater participation in self-care. While self-care is a promising proposal, it is not a replacement for traditional health-care practices, but a complementary approach.
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Affiliation(s)
- Athini Nyatela
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Correspondence: Athini Nyatela
| | - Sizwe Nqakala
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Leanne Singh
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Taylor Johnson
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Siphamandla Gumede
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
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Ammerdorffer A, Laws M, Narasimhan M, Lucido B, Kijo A, Say L, Awiligwe A, Chinery L, Gülmezoglu AM. Reclassifying contraceptives as over-the-counter medicines to improve access. Bull World Health Organ 2022; 100:503-510. [PMID: 35923274 PMCID: PMC9306387 DOI: 10.2471/blt.21.287561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 11/27/2022] Open
Abstract
Self-care interventions include over-the-counter contraceptives, which enable individuals to make informed, autonomous decisions about fertility management. As there is a substantial unmet need for contraception in many countries, increasing access by establishing sound, affordable and effective regulation of over-the-counter contraceptives could help reduce unintended pregnancies and improve maternal health. We performed a review of 30 globally diverse countries: (i) to assess national regulatory procedures for changing oral contraceptives, emergency contraceptives and injectable contraceptives from prescription-only to over-the-counter products; and (ii) to determine whether national lists of over-the-counter medicines included contraceptives. Of the 30 countries, 13 (43%) had formal regulatory procedures in place for changing prescription-only medicines to over-the-counter medicines, 11 (36%) had national lists of over-the-counter medicines, and four (13%) included contraceptives on those lists. Changing from prescription-only to over-the-counter medicines presents challenges for national medicines regulatory authorities and manufacturers, involving, for example, reporting side-effects, quality control and the often poorly-defined process of switching to over-the-counter products. To facilitate the over-the-counter availability of contraceptives, countries should consider adopting a formal regulatory procedure for reclassifying prescription-only contraceptives as over-the-counter contraceptives. Although the availability of over-the-counter contraceptives can increase users’ independence and anonymity and improve access, there may also be disadvantages, such as higher out-of-pocket costs and the need for accurate self-assessment. Basic remedial actions to improve, harmonize and standardize regulatory procedures for the reclassification of contraceptives are proposed with the aim of enabling national medicines regulatory authorities to manage the switch to over-the-counter contraceptives and to control their quality.
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Affiliation(s)
- Anne Ammerdorffer
- Concept Foundation, Bâtiment F2F3, Avenue de Sécheron 15, Geneva, 1202, Switzerland
| | - Mark Laws
- Concept Foundation, Bâtiment F2F3, Avenue de Sécheron 15, Geneva, 1202, Switzerland
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Briana Lucido
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Agnes Kijo
- Regulatory Convergence and Networks Team, World Health Organization, Geneva, Switzerland
| | - Lale Say
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Arinze Awiligwe
- Concept Foundation, Bâtiment F2F3, Avenue de Sécheron 15, Geneva, 1202, Switzerland
| | - Lester Chinery
- Concept Foundation, Bâtiment F2F3, Avenue de Sécheron 15, Geneva, 1202, Switzerland
| | - A Metin Gülmezoglu
- Concept Foundation, Bâtiment F2F3, Avenue de Sécheron 15, Geneva, 1202, Switzerland
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Meherali S, Rahim KA, Campbell S, Lassi ZS. Does Digital Literacy Empower Adolescent Girls in Low- and Middle-Income Countries: A Systematic Review. Front Public Health 2022; 9:761394. [PMID: 34976923 PMCID: PMC8716589 DOI: 10.3389/fpubh.2021.761394] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background: The vast majority (90%) of the world's adolescents aged 10–19 live in low- and middle-income countries (LMICs); and in those resource-limited settings, girls face distinct challenges across multiple health, social, and economic domains. Gender equality and girls' empowerment are key goals in their own right and are central to all other development goals. Digital literacy is a great enabler for the empowerment of young girls. This systematic review aims to assess the range and nature of digital literacy interventions implemented to empower adolescent girls in LMICs and identify evidence about adolescent girls' access and use of digital technologies in LMICs. Methods: We conducted a systematic review of studies following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standards for systematic reviews. Two reviewers selected studies, conducted quality assessments, and extracted data by using standard forms. The collected data include the design of the study, type of digital literacy intervention, target audience, intervention received, intervention reach, data analysis, and study outcomes. The review is registered with PROSPERO (CRD42020216756). Results: Thirty-five studies met the eligibility for inclusion and of those, 11 were experimental studies (randomized controlled trial = 6; quasi-experimental = 2; before-after with no control = 3), 11 were cross-sectional/descriptive studies, seven studies used a mixed-method approach, and six were qualitative studies on digital literacy interventions to empower young girls in LMICs. The majority of digital literacy interventions were designed and implemented to improve sexual and reproductive health rights and decision-making of adolescent girls in LMICs (n = 33). Only three papers reported the use of digital media for health-related information and decision making, while only one reported on educational and social empowerment. Discussion: Our findings suggest that digital literacy interventions such as mobile phones, mobile health tools, media exposure, access to the internet, internet-based educational strategies, social media exposure are effective to empower adolescent girls to access health services and information and also enhance the access to educational resources. However, we found inconclusive evidence on the effectiveness of digital literacy to enhance girls' access to financial services and economic empowerment. More rigorous studies with long-term follow-ups to assess the effectiveness of such interventions to empower adolescent girls in LMICs are urgently needed.
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Affiliation(s)
- Salima Meherali
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | | | - Sandra Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Zohra S Lassi
- Department of Medicine, Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
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Nai D, Tobey E, Fuseini K, Kuma-Aboagye P, Jain A. What Distinguishes Women Who Choose to Self-Inject? A Prospective Cohort Study of Subcutaneous Depot Medroxyprogesterone Acetate Users in Ghana. Glob Health Sci Pract 2022; 10:GHSP-D-21-00534. [PMID: 35294390 PMCID: PMC8885352 DOI: 10.9745/ghsp-d-21-00534] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 01/05/2022] [Indexed: 11/15/2022]
Abstract
Depot medroxyprogesterone acetate administered subcutaneously (DMPA-SC) is an all-in-one injectable contraceptive administered every 3 months, either by a trained health care provider or community health worker or by training a client to self-inject. Using a prospective cohort of family planning (FP) clients in Ghana, this study explores patterns of DMPA-SC use and mode of injection administration over a 6-month period. This study also examines the predictors of self-injection adoption 6 months after initiating DMPA-SC. Our analysis focuses on 378 women who were using DMPA-SC at the 6-month interview. Adjusted odds ratios accounting for clustering show that clients who were new FP users, never married, or attended high school/attained higher education were significantly more likely to self-inject by the third injection. Results of this study suggest that in Ghana, adding DMPA-SC to the method mix may improve access to FP, especially among new users. Results of this study may inform FP projects and programs aiming to improve access to contraceptive methods and increase contraceptive prevalence by introducing or scaling up DMPA-SC self-injection. The findings also provide a sociodemographic profile of FP clients most likely to adopt DMPA-SC self-injection over time, which could serve as an evidence base for social marketing strategies.
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Affiliation(s)
- Dela Nai
- Population Council, Accra, Ghana.
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11
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Logie CH, Berry I, Ferguson L, Malama K, Donkers H, Narasimhan M. Uptake and provision of self-care interventions for sexual and reproductive health: findings from a global values and preferences survey. Sex Reprod Health Matters 2022; 29:2009104. [PMID: 35100942 PMCID: PMC8812803 DOI: 10.1080/26410397.2021.2009104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Self-care interventions hold the potential to improve sexual and reproductive health (SRH) and well-being. Yet key knowledge gaps remain regarding how knowledge and uptake vary across different types of self-care interventions. There is also limited understanding of health workers’ confidence in promoting SRH self-care interventions, and how this may differ based on personal uptake experiences. To address these knowledge gaps, we conducted a web-based cross-sectional survey among health workers and laypersons from July to November 2018. We investigated the following information about SRH self-care interventions: knowledge and uptake; decisions for use; and associations between health workers’ uptake and providing prescriptions, referrals, and/or information for these interventions. Participants (n = 837) included laypersons (n = 477) and health workers (n = 360) from 112 countries, with most representation from the WHO European Region (29.2%), followed by the Americas (28.4%) and African (23.2%) Regions. We found great heterogeneity in knowledge and uptake by type of SRH self-care intervention. Some interventions, such as oral contraception, were widely known in comparison with interventions such as STI self-sampling. Across interventions, participants perceived benefits of privacy, convenience, and accessibility. While pharmacies and doctors were preferred access points, this varied by type of self-care intervention. Health workers with knowledge of the self-care intervention, and who had themselves used the self-care intervention, were significantly more likely to feel confident in, and to have provided information or referrals to, the same intervention. This finding signals that health workers can be better engaged in learning about self-care SRH interventions and thereby become resources for expanding access.
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Affiliation(s)
- Carmen H Logie
- Associate Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Correspondence: .,Adjunct Professor, United Nations University Institute for Water, Environment and Health, Hamilton, Ontario, Canada
| | - Isha Berry
- Doctoral Candidate, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Laura Ferguson
- Adjunct Professor, United Nations University Institute for Water, Environment and Health, Hamilton, Ontario, Canada
| | - Kalonde Malama
- Associate Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Correspondence:
| | - Holly Donkers
- Associate Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. Correspondence:
| | - Manjulaa Narasimhan
- Scientist, Department of Sexual and Reproductive Health and Research, includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction - HRP, World Health Organization, Geneva, Switzerland
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12
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Yao PY, Lin CY, Ko NY, Zou H, Lee CW, Strong C. Predicting human papillomavirus vaccine uptake in men who have sex with men the influence of vaccine price and receiving an HPV diagnosis. BMC Public Health 2022; 22:28. [PMID: 34991553 DOI: 10.1186/s12889-021-12396-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To understand how human papillomavirus (HPV) screening results, HPV-related knowledge and attitudes are related to vaccination intention in three cost ranges and the actual vaccination behavior in a community sample of men who have sex with men (MSM). METHODS MSM aged 20 years of age or older were recruited between October 2015 and May 2016 from community health centers that provide HIV testing and consultation services in Southern Taiwan and on social media. MSM were seen at baseline and again at 6 months after baseline in a cohort study. The baseline study included 253 individuals; 182 of them returned for the 6th-month follow-up. At each visit, MSM were asked to receive HPV screening and filled out a questionnaire. Structural equation modeling was used to test whether attitudinal factors and HPV screening results from the baseline affect their self-reported actual vaccine uptake at the in 6th-month follow-up. RESULTS Our research included 171 participants from the cohort because they had full information of the study variables (mean ± SD age = 29.21 ± 6.18). Our model showed good model fit using indices such as the comparative fit index (value = 0.998) and root mean square error of approximation (value = 0.013). HPV knowledge can predict those who have intention to take up HPV vaccine no matter what the price (p = .02), and then predict vaccine uptake at the follow-up (p < .001). A positive HPV screening result can predict vaccine uptake at the follow-up (p = .004). CONCLUSION Our findings highlight the impact of vaccine price and HPV screening results on the intention and uptake of HPV vaccine. It is important to raise awareness of HPV in male populations. Clinicians and health educators should establish a safe and private environment for male patients for inquiring about HPV vaccine and HPV-related cancers.
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Hémono R, Packel L, Gatare E, Baringer L, Ippoliti N, McCoy SI, Hope R. Digital self-care for improved access to family planning and reproductive health services among adolescents in Rwanda: preliminary findings from a pilot study of CyberRwanda. Sex Reprod Health Matters 2022; 29:2110671. [PMID: 36083099 PMCID: PMC9467528 DOI: 10.1080/26410397.2022.2110671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Adolescents experience significant barriers, including stigma and discrimination, to accessing voluntary family planning and reproductive health (FP/RH) services in Rwanda. Self-care interventions have been shown to reduce social barriers to FP/RH care, but little is known about the effectiveness of digital self-care for adolescents, particularly in low-resource settings. This paper presents findings from a pilot study of CyberRwanda, a digital self-care intervention providing comprehensive sexuality education and confidential online ordering of contraceptives for school-aged youth in Rwanda through a rights-based approach. A mixed-methods pilot study was conducted from November 2019 to February 2020 to assess feasibility, acceptability, and engagement and to inform a future impact evaluation. Surveys were administered to a random sample of 158 students aged 12–19 years in three secondary schools. In-depth interviews were conducted with students, parents, teachers, pharmacists, district-level administrators, and youth centre staff. Descriptive statistics were calculated and qualitative data were analyzed using a thematic coding approach. One hundred and fifty-eight surveys and 28 interviews were conducted. Results revealed high demand for CyberRwanda in schools. Students were interested in engaging with the program and found the FP/RH content relevant to their needs. However, few purchased contraceptive products through the online ordering system. There are preliminary indications that CyberRwanda may improve access to FP/RH information. An extended implementation period and further research are needed to measure the long-term impacts of the program and evaluate whether this digital self-care intervention can increase uptake of contraceptive methods and reduce adolescent pregnancy among school-aged youth.
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Affiliation(s)
- Rebecca Hémono
- Research Manager, Division of Epidemiology, University of California, Berkeley, CA, USA
| | - Laura Packel
- Research Director, Division of Epidemiology, University of California, Berkeley, CA, USA
| | - Emmyson Gatare
- Research Lead, YLabs Rwanda, 2nd Floor, Golden Plaza, KG 546 St. Kacyiru, Kigali, Rwanda
| | - Laura Baringer
- Project Director, YLabs Rwanda, 2nd Floor, Golden Plaza, KG 546 St. Kacyiru, Kigali, Rwanda
| | | | - Sandra I. McCoy
- Evaluation Principal Investigator, Division of Epidemiology, University of California, Berkeley, CA, USA
| | - Rebecca Hope
- Chief Executive Officer, YLabs Rwanda, Berkeley, CA, USA
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Appleford G, RamaRao S, Bellows B. The inclusion of sexual and reproductive health services within universal health care through intentional design. Sex Reprod Health Matters 2021; 28:1799589. [PMID: 32787538 PMCID: PMC7887933 DOI: 10.1080/26410397.2020.1799589] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In this paper, we argue that how sexual and reproductive health (SRH) services are included in UHC and health financing matters, and that this has implications for universality and equity. This is a matter of rights, given the differential health risks that women face, including unwanted pregnancy. How traditional vertical SRH services are compensated under UHC also matters and should balance incentives for efficiency with incentives for appropriate provision using the rights-based approach to user-centred care so that risks of sub-optimal outcomes are mitigated. This suggests that as UHC benefits packages are designed, there is need for the SRH community to advocate for more than simple “SRH inclusion”. This paper describes a practical approach to integrate quality of SRH care within the UHC agenda using a framework called the “5Ps”. The framework emphasises a “systems” and “design” lens as important steps to quality. The framework can be applied at different scales, from the health system to the individual user level. It also pays attention to how financing and resource policies intended to promote UHC may support or undermine the respect, protection and fulfilment of SRH and rights. The framework was originally developed with a specific emphasis on quality provision of family planning. In this paper, we have extended it to cover other SRH services.
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Affiliation(s)
| | | | - Ben Bellows
- Associate, Population Council, Washington, DC, USA
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Narasimhan M, Logie CH, Gauntley A, Gomez Ponce de Leon R, Gholbzouri K, Siegfried N, Abela H, Ouedraogo L. Self-care interventions for sexual and reproductive health and rights for advancing universal health coverage. Sex Reprod Health Matters 2021; 28:1778610. [PMID: 32530386 PMCID: PMC7887951 DOI: 10.1080/26410397.2020.1778610] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
WHO's normative guidance on self-care interventions for sexual and reproductive health and rights (SRHR) promotes comprehensive, integrated and people-centred approaches to health service delivery. Implementation of self-care interventions within the context of human rights, gender equality, and a life course approach, offers an underused opportunity to improve universal health coverage (UHC) for all. Results from an online global values and preferences survey provided lay persons' and healthcare providers' perspectives on access, acceptability, and implementation considerations. This analysis examines 326 qualitative responses to open-ended questions from healthcare providers (n = 242) and lay persons (n = 70) from 77 countries. Participants were mostly women (66.9%) and were from the Africa (34.5%), America (32.5%), South-East Asia (5.6%), European (19.8%), Eastern Mediterranean (4.8%), and Western Pacific regions (2.8%). Participants perceived multiple benefits of self-care interventions for SRHR, including: reduced exposure to stigma, discrimination and access barriers, increased confidentiality, empowerment, self-confidence, and informed decision-making. Concerns include insufficient knowledge, affordability, and possible side-effects. Implementation considerations highlighted the innovative approaches to linkages with health services. Introduction of self-care interventions is a paradigm shift in health care delivery bridging people and communities through primary health care to reach UHC. Self-care interventions can be leveraged by countries as gateways for reaching more people with quality, accessible and equitable services that is critical for achieving UHC. The survey results underscored the urgent need to reduce stigma and discrimination, increase access to and improve knowledge of self-care interventions for SRHR for laypersons and healthcare providers to advance SRHR.
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Affiliation(s)
- Manjulaa Narasimhan
- Scientist, Department of Sexual and Reproductive Health and Research; UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme, World Health Organization, Geneva, Switzerland
| | - Carmen H Logie
- Associate Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Alice Gauntley
- Research Assistant, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | | | | | - Nandi Siegfried
- Independent Clinical Epidemiologist, Cape Town, South Africa
| | - Heather Abela
- Research Assistant, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Leopold Ouedraogo
- Regional Advisor, Reproductive and Women's Health (RWH), AFRO, Brazzaville, Congo
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Chattu VK, Lopes CA, Javed S, Yaya S. Fulfilling the promise of digital health interventions (DHI) to promote women's sexual, reproductive and mental health in the aftermath of COVID-19. Reprod Health 2021; 18:112. [PMID: 34088319 PMCID: PMC8177268 DOI: 10.1186/s12978-021-01168-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Vijay Kumar Chattu
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, M5G 2C4, Canada. .,Division of Occupational Medicine, Occupational Medicine Clinic, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, M5C 2C5, Canada.
| | - Claudia Abreu Lopes
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Sumbal Javed
- School of Public Health, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada.,The George Institute for Global Health, Imperial College London, London, UK
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Indravudh PP, Fielding K, Kumwenda MK, Nzawa R, Chilongosi R, Desmond N, Nyirenda R, Neuman M, Johnson CC, Baggaley R, Hatzold K, Terris-Prestholt F, Corbett EL. Effect of community-led delivery of HIV self-testing on HIV testing and antiretroviral therapy initiation in Malawi: A cluster-randomised trial. PLoS Med 2021; 18:e1003608. [PMID: 33974621 PMCID: PMC8112698 DOI: 10.1371/journal.pmed.1003608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 04/04/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Undiagnosed HIV infection remains substantial in key population subgroups including adolescents, older adults, and men, driving ongoing transmission in sub-Saharan Africa. We evaluated the impact, safety, and costs of community-led delivery of HIV self-testing (HIVST), aiming to increase HIV testing in underserved subgroups and stimulate demand for antiretroviral therapy (ART). METHODS AND FINDINGS This cluster-randomised trial, conducted between October 2018 and July 2019, used restricted randomisation (1:1) to allocate 30 group village head clusters in Mangochi district, Malawi to the community-led HIVST intervention in addition to the standard of care (SOC) or the SOC alone. The intervention involved mobilising community health groups to lead the design and implementation of 7-day HIVST campaigns, with cluster residents (≥15 years) eligible for HIVST. The primary outcome compared lifetime HIV testing among adolescents (15 to 19 years) between arms. Secondary outcomes compared: recent HIV testing (in the last 3 months) among older adults (≥40 years) and men; cumulative 6-month incidence of ART initiation per 100,000 population; knowledge of the preventive benefits of HIV treatment; and HIV testing stigma. Outcomes were measured through a post-intervention survey and at neighboring health facilities. Analysis used intention-to-treat for cluster-level outcomes. Community health groups delivered 24,316 oral fluid-based HIVST kits. The survey included 90.2% (3,960/4,388) of listed participants in the 15 community-led HIVST clusters and 89.2% (3,920/4,394) of listed participants in the 15 SOC clusters. Overall, the proportion of men was 39.0% (3,072/7,880). Most participants obtained primary-level education or below, were married, and reported a sexual partner. Lifetime HIV testing among adolescents was higher in the community-led HIVST arm (84.6%, 770/910) than the SOC arm (67.1%, 582/867; adjusted risk difference [RD] 15.2%, 95% CI 7.5% to 22.9%; p < 0.001), especially among 15 to 17 year olds and boys. Recent testing among older adults was also higher in the community-led HIVST arm (74.5%, 869/1,166) than the SOC arm (31.5%, 350/1,111; adjusted RD 42.1%, 95% CI 34.9% to 49.4%; p < 0.001). Similarly, the proportions of recently tested men were 74.6% (1,177/1,577) and 33.9% (507/1,495) in the community-led HIVST and SOC arms, respectively (adjusted RD 40.2%, 95% CI 32.9% to 47.4%; p < 0.001). Knowledge of HIV treatment benefits and HIV testing stigma showed no differences between arms. Cumulative incidence of ART initiation was respectively 305.3 and 226.1 per 100,000 population in the community-led HIVST and SOC arms (RD 72.3, 95% CI -36.2 to 180.8; p = 0.18). In post hoc analysis, ART initiations in the 3-month post-intervention period were higher in the community-led HIVST arm than the SOC arm (RD 97.7, 95% CI 33.4 to 162.1; p = 0.004). HIVST uptake was 74.7% (2,956/3,960), with few adverse events (0.6%, 18/2,955) and at US$5.70 per HIVST kit distributed. The main limitations include the use of self-reported HIV testing outcomes and lack of baseline measurement for the primary outcome. CONCLUSIONS In this study, we found that community-led HIVST was effective, safe, and affordable, with population impact and coverage rapidly realised at low cost. This approach could enable community HIV testing in high HIV prevalence settings and demonstrates potential for economies of scale and scope. TRIAL REGISTRATION Clinicaltrials.gov NCT03541382.
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Affiliation(s)
- Pitchaya P. Indravudh
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Katherine Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Moses K. Kumwenda
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Rebecca Nzawa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Nicola Desmond
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Rose Nyirenda
- Department of HIV and AIDS, Ministry of Health, Lilongwe, Malawi
| | - Melissa Neuman
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Cheryl C. Johnson
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organisation, Geneva, Switzerland
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rachel Baggaley
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organisation, Geneva, Switzerland
| | - Karin Hatzold
- Population Services International, Washington, District of Columbia, United States of America
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Elizabeth L. Corbett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Uzma Q, Hamid N, Chaudhri R, Mehmood N, Aabroo A, Thom E, Gholbzouri K, Mahaini R, Hemachandra N. The role of partners in promoting self-care for misoprostol and subcutaneous DMPA in Pakistan. Health Res Policy Syst 2021; 19:62. [PMID: 33882966 PMCID: PMC8058573 DOI: 10.1186/s12961-021-00714-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 12/03/2022] Open
Abstract
Background Pakistan is among a number of countries facing protracted challenges in addressing maternal mortality with a concomitant weak healthcare system complexed with inequities. Sexual and reproductive health and rights (SRHR) self-care interventions offer the best solution for improving access to quality healthcare services with efficiency and economy. This manuscript documents country experience in introducing and scaling up two selected SRHR self-care interventions. A prospective qualitative study design was used and a semi-structured questionnaire was shared with identified SRHR private sector partners selected through convenience and purposive sampling. The two interventions include the use of misoprostol for postpartum hemorrhage and the use of subcutaneous depomedroxyprogesterone acetate (DMPA) as injectable contraceptive method. Data collection was done through emails and telephone follow-up calls. Results Nine of the 13 partners consulted for the study responded. The two selected self-care interventions are mainly supported by private sector partners (national and international nongovernmental organizations) having national or subnational existence. Their mandates include all relevant areas, such as policy advocacy, field implementation, trainings, supervision and monitoring. A majority of partners reported experience related to the use of misoprostol; it was introduced more than a decade ago, is registered and is procured by both public and private sectors. Subcutaneous DMPA is a new intervention, having been introduced only recently, and commodity availability remains a challenge. It is being delivered through health workers/providers and is not promoted as a self-administered contraceptive. Community engagement and awareness raising is reported as an essential element of successful field implementation; however, no beneficiary data was collected for the study. Training approaches differ considerably, are standalone or integrated with SRHR topics and their duration varies between 1 and 5 days, covering a range of cadres. Conclusion Pubic sector ownership and patronage is essential for introducing and scaling up self-care interventions as a measure to support the healthcare system in delivering quality sexual and reproductive health services. Supervision, monitoring and reporting are areas requiring further support, as well as the leadership and governance role of the public sector. Standardization of trainings, community awareness, supervision, monitoring and reporting are required together with integration of self-care in routine capacity building activities (pre- and in-service) on sexual and reproductive health in the country.
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Affiliation(s)
- Qudsia Uzma
- Maternal, Newborn, Child, Adolescent Health, WHO Country Office, Islamabad, Pakistan.
| | - Nausheen Hamid
- Ministry of National Health Services, Regulations and Coordination, Government of Pakistan, Islamabad, Pakistan
| | | | - Nadeem Mehmood
- Rahnuma-Family Planning Association of Pakistan, Lahore, Pakistan
| | - Atiya Aabroo
- Ministry of National Health Services, Regulation & Coordination, Government of Pakistan, Islamabad, Pakistan
| | - Ellen Thom
- Lead for Promoting Health Through Life Course, WHO Country Office, Islamabad, Pakistan
| | - Karima Gholbzouri
- Reproductive and Maternal Health, Department of Health Promotion, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Ramez Mahaini
- Department of Health Promotion, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Nilmini Hemachandra
- Sexual and Reproductive Health and Rights,, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
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Tran NT, Tappis H, Moon P, Christofield M, Dawson A. Sexual and reproductive health self-care in humanitarian and fragile settings: where should we start? Confl Health 2021; 15:22. [PMID: 33827633 PMCID: PMC8024937 DOI: 10.1186/s13031-021-00358-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/22/2021] [Indexed: 11/28/2022] Open
Abstract
Recent crises have accelerated global interest in self-care interventions. This debate paper aims to raise the issue of sexual and reproductive health (SRH) self-care and invites members of the global community operating in crisis-affected settings to look at potential avenues in mainstreaming SRH self-care interventions. We start by exploring self-care interventions that could align with well-established humanitarian standards, such as the Minimum Initial Service Package (MISP) for Sexual and Reproductive Health in Crises, point to the potential of digital health support for SRH self-care in crisis-affected settings, and discuss related policy, programmatic, and research considerations. These considerations underscore the importance of self-care as part of the care continuum and within a whole-system approach. Equally critical is the need for self-care in crisis-affected settings to complement other live-saving SRH interventions-it does not eliminate the need for provider-led services in health facilities. Further research on SRH self-care interventions focusing distinctively on humanitarian and fragile settings is needed to inform context-specific policies and practice guidance.
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Affiliation(s)
- Nguyen Toan Tran
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia.
- Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1211, Geneva 4, Switzerland.
| | - Hannah Tappis
- Johns Hopkins Center for Humanitarian Health, 615 N. Wolfe St, Baltimore, MD, USA
| | - Pierre Moon
- Population Services International, 1120 19th St. NW, Suite 600, Washington, DC, 20036, USA
| | - Megan Christofield
- Self-Care Trailblazer Group, 1120 19th St. NW, Suite 600, Washington, DC, 20036, USA
| | - Angela Dawson
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia
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Gonsalves L, Martin Hilber A, Wyss K, Say L. Potentials and pitfalls of including pharmacies as youth-friendly contraception providers in low- and middle-income countries. BMJ Sex Reprod Health 2021; 47:6-8. [PMID: 32788181 PMCID: PMC7815634 DOI: 10.1136/bmjsrh-2020-200641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/03/2020] [Accepted: 06/10/2020] [Indexed: 05/20/2023]
Affiliation(s)
- Lianne Gonsalves
- Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Adriane Martin Hilber
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kaspar Wyss
- Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Lale Say
- Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Weinberger M, Hayes B, White J, Skibiak J. Doing Things Differently: What It Would Take to Ensure Continued Access to Contraception During COVID-19. Glob Health Sci Pract 2020; 8:169-175. [PMID: 32561528 PMCID: PMC7326519 DOI: 10.9745/ghsp-d-20-00171] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/02/2020] [Indexed: 11/15/2022]
Abstract
COVID-19 may fundamentally change women’s contraceptive use, meaning that the future we have been planning and procuring for, may not match these changes. In these unprecedented times, we must rethink how we link product and program in the short-term to ensure women’s changing needs are met.
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Affiliation(s)
| | | | - Julia White
- Reproductive Health Supplies Coalition, Brussels, Belgium
| | - John Skibiak
- Reproductive Health Supplies Coalition, Brussels, Belgium
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22
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Blumenberg C, Hellwig F, Ewerling F, Barros AJD. Socio-demographic and economic inequalities in modern contraception in 11 low- and middle-income countries: an analysis of the PMA2020 surveys. Reprod Health 2020; 17:82. [PMID: 32487182 PMCID: PMC7268403 DOI: 10.1186/s12978-020-00931-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/22/2020] [Indexed: 11/26/2022] Open
Abstract
Background Contraception is a key component of sustainable development, empowering women, reducing the risk of maternal and child mortality and promoting economic growth. It is part of the Sustainable Development Goals agenda, where the aim is to achieve universal access to sexual and reproductive health. Our objective was to evaluate trends and inequalities in modern contraceptive prevalence, and according to the type of modern contraceptive, in 11 low- and middle-income countries that are partners of the Family Planning 2020 initiative. Methods Analyses were performed using 62 Performance Monitoring and Accountability 2020 (PMA2020) surveys from 11 countries. Forty surveys were nationally representative, while 22 had regional coverage. Regional surveys were analyzed separately, totalizing 15 geographies from 11 countries. We described trends on modern contraceptive prevalence, and its subtypes (short- and long-acting reversible contraceptives, and permanent methods), by calculating absolute average annual changes. Absolute inequalities on the prevalence of modern contraceptives were assessed for the most recent survey of each geography using the slope index of inequality, and according to wealth, education and age. Results The overall prevalence of modern contraception increased in most geographies analyzed, reaching a 7.2 percentage points increase per year in Lagos, Nigeria. This increase was mostly influenced by the long-acting reversible contraceptives, which increased in 73% of the geographies. Although the largest share of modern contraception is represented by short-acting reversible contraceptives, these are reducing and giving space for the long-acting methods. The exception was Rajasthan, India, where the permanent methods accounted for 70% of the modern contraception share, and their prevalence was almost 40%. Inequalities were identified in favor of richer, older and better educated women. Conclusions Out of the 15 geographies analyzed, 11 demonstrated an increase in overall modern contraceptive use – mainly driven by the uptake of long-acting reversible contraception. However, even in the groups with the highest prevalence, modern contraceptive use was at most 60% in most geographies. So, we are far from reaching the desired universal coverage proposed by the Sustainable Development Goals.
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Affiliation(s)
- Cauane Blumenberg
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Rua Marechal Deodoro 1160, 3o piso, Pelotas, RS, 96020-220, Brazil.
| | - Franciele Hellwig
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Rua Marechal Deodoro 1160, 3o piso, Pelotas, RS, 96020-220, Brazil.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Fernanda Ewerling
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Rua Marechal Deodoro 1160, 3o piso, Pelotas, RS, 96020-220, Brazil
| | - Aluísio J D Barros
- International Center for Equity in Health (ICEH), Federal University of Pelotas, Rua Marechal Deodoro 1160, 3o piso, Pelotas, RS, 96020-220, Brazil.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
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23
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Bacchus LJ, Reiss K, Church K, Colombini M, Pearson E, Naved R, Smith C, Andersen K, Free C. Using Digital Technology for Sexual and Reproductive Health: Are Programs Adequately Considering Risk? Glob Health Sci Pract 2019; 7:507-514. [PMID: 31874936 PMCID: PMC6927830 DOI: 10.9745/ghsp-d-19-00239] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/22/2019] [Indexed: 02/06/2023]
Abstract
Digital technologies provide opportunities for advancing sexual and reproductive health and services but also present potential risks. We propose 4 steps to reducing potential harms: (1) consider potential harms during intervention design, (2) mitigate or minimize potential harms during the design phase, (3) measure adverse outcomes during implementation, and (4) plan how to support those reporting adverse outcomes.
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Affiliation(s)
| | - Kate Reiss
- London School of Hygiene & Tropical Medicine, London, England
| | | | | | | | | | - Chris Smith
- London School of Hygiene & Tropical Medicine, London, England
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | | | - Caroline Free
- London School of Hygiene & Tropical Medicine, London, England
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