Female sterilisation through mini-laparotomy at Gondar College of Medical Sciences

Uptake of permanent contraception among women in sub-Saharan Africa: a literature review of barriers and facilitators

OBJECTIVE

Uptake of permanent contraception among women remains low in sub-Saharan Africa compared to other regions. We aimed to synthesize available evidence on barriers to, and facilitators of permanent contraception with regards to tubal ligation among women in sub-Saharan Africa.

STUDY DESIGN

We reviewed literature on tubal ligation among African women published between January 1, 2000 and October 30, 2017. We searched PubMed, Global health, EMBASE, Web of science, and Google scholar for quantitative, qualitative, and mixed methods studies which reported on barriers and/or facilitators to uptake of tubal ligation in sub-Saharan Africa. Finally, we conducted a narrative synthesis and categorized our findings using a framework based on the social ecological model.

RESULTS

We included 48 articles in the review. Identified barriers to tubal ligation among women included individual-level (myths and misconceptions, fear of surgery, irreversibility of procedure, religious beliefs), interpersonal-level (male partner disapproval), and organizational-level (lack of healthcare worker expertise and equipment) factors. Facilitating factors included achievement of desired family size and perceived effectiveness (individual-level), supportive male partners and knowing other women with permanent contraception experience (interpersonal-level), and finally, subsidized cost of the procedure and task-sharing with lower cadre healthcare workers (organizational-level).

CONCLUSIONS

Barriers to, and facilitators of permanent contraception among women in sub-Saharan Africa are multilevel in nature. Strategies countering these barriers should be prioritized, as effective contraception can promote women's health and economic development in sub-Saharan Africa. In addition to these strategies, more quantitative research is needed to further understand patient-level factors associated with uptake of permanent contraception among women.

Safety of tubal ligation by minilaparotomy provided by clinical officers versus assistant medical officers: study protocol for a noninferiority randomized controlled trial in Tanzanian women

Background

Female sterilization by tubal ligation is a safe, extremely effective, and permanent way to limit childbearing. It is the most popular modern contraceptive method worldwide. The simplest way to provide tubal ligation is by a procedure called minilaparotomy, generally performed with the client under local anesthesia with systemic sedation and analgesia. In Tanzania, unmet need for family planning is high and has declined little in the past decade. Access to tubal ligation is limited throughout the country, in large part because of a lack of trained providers. Clinical officers (COs) are midlevel health workers who provide diagnosis, treatment, and minor surgeries. They are more prevalent than physicians in poorer and rural communities. Task shifting—the delegation of some tasks to less-specialized health workers, including task shifting of surgical procedures to midlevel cadres—has improved access to lifesaving interventions in resource-limited settings. It is a cost-effective way to address shortages of physicians, increasing access to services. The primary objective of this trial is to establish whether the safety of tubal ligation by minilaparotomy provided by COs is noninferior to the safety of tubal ligation by minilaparotomy provided by physicians (assistant medical officers [AMOs]), as measured by rates of major adverse events (AEs) during the procedure and through 42 days of follow-up.

Methods/design

In this facility-based, multicenter, noninferiority randomized controlled trial, we are comparing the safety of tubal ligation by minilaparotomy performed by trained COs versus by trained AMOs. The primary outcome is safety, defined by the overall rate of major AEs occurring during the minilaparotomy procedure and through 42 days of follow-up. The trial will be conducted among 1970 women 18 years of age or older presenting for tubal ligation at 7 study sites in northern Tanzania.

Discussion

If no major safety issues are identified, the data from this trial may facilitate changes in the Tanzanian government’s regulations, allowing appropriately trained COs to provide tubal ligation by minilaparotomy. Positive findings may have broader implications. Task shifting to provide long-acting contraceptives, if proven safe, may be an effective approach to increasing contraceptive access in low- and middle-income countries.

Trial registration

ClinicalTrials.gov, NCT02944149. Registered on 14 October 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2235-6) contains supplementary material, which is available to authorized users.

Removal of uterine fibroids by mini-laparotomy technique in women who wish to preserve their uterus and fertility

INTRODUCTION

The minilaparotomy is considered to be a safe and effective alternative to laparoscopy and abdominal laparotomy in myomectomy cases.

AIM

To perform a retrospective analysis of pre-surgical assessment, surgical course and post-operational parameters in women wishing to preserve their uterus and fertility who underwent myomectomy by minilaparotomy in the Department of Gynecology and Gynecological Oncology at the Polish Mother's Memorial Hospital - Research Institute in Lodz in the years 2008-2014.

MATERIAL AND METHODS

A total of 76 patients were qualified for minilaparotomy due to a benign gynecological pathology. Only 21 patients with uterine fibroids who wanted to preserve their uterus and fertility were appropriate for this study. Patients' records were analyzed in terms of: epidemiological history, surgical course, postoperative stay and pathological data. All studied patients were asked in 2014 about conception and pregnancy after minilaparotomy.

RESULTS

The median age was 35.7 years. The median patient body mass index (BMI) was 24 kg/m(2). The average decrease of hemoglobin was 1.5 g/dl. The size of the myoma was between 1.5 and 15 cm. There were no serious post-surgical complications. The size of the myoma did not correlate significantly with operation time, BMI or blood loss. There was no statistically significant dependence between operation time and average hematocrit and hemoglobin decrease. In our group 7 patients who had undergone myomectomy tried to achieve conception. Four of them succeeded in pregnancy and gave birth to healthy infants.

CONCLUSIONS

Myomectomy performed via minilaparotomy is a safe procedure for patients willing to preserve their uterus and fertility, and it combines some advantages of both laparotomy and laparoscopy.