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Schwandt H, Boulware A, Corey J, Herrera A, Hudler E, Imbabazi C, King I, Linus J, Manzi I, Merritt M, Mezier L, Miller A, Morris H, Musemakweli D, Musekura U, Mutuyimana D, Ntakarutimana C, Patel N, Scanteianu A, Shemeza BE, Sterling-Donaldson G, Umutoni C, Uwera L, Zeiler M, Feinberg S. “She is courageous because she does not care what people think about her…”: attitudes toward adolescent contraception use among Rwandan family planning providers and adult female modern contraceptive users. Reprod Health 2022; 19:204. [PMID: 36333785 PMCID: PMC9636625 DOI: 10.1186/s12978-022-01517-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction In Rwanda, only 20% of sexually active unmarried young women use family planning as compared to 64% of married women. Adolescence is an important time of growth and development that often includes the initiation of sexual activity. Sexually active adolescents need support in accessing contraceptive services to prevent negative health outcomes. In sub-Saharan Africa, the adolescent population represents a large share of the total population and that proportion is predicted to expand over time. Adolescent contraceptive needs have largely been unmet, and with growing numbers, there is increased potential for negative health sequelae. Due to the low use of contraception by adolescents in Rwanda, and the growing population of adolescents, this study aims to explore the perspectives of family planning providers and adult modern contraceptive users on adolescent contraceptive use. Inclusion of adult community members in the study is a unique contribution, as research on adolescent contraceptive use in sub-Saharan Africa relies primarily on perspectives from adolescents and family planning providers. Methods This qualitative study in 2018 utilized 32 in-depth interviews with modern contraceptive users and eight focus group discussions with family planning providers. Respondents were from Musanze and Nyamasheke districts in Rwanda, the districts with the highest and lowest modern contraceptive use among married women, respectively. Coding was conducted in Atlas.ti. Results Stigma regarding premarital sex results in barriers to adolescent access to contraceptive services. Family planning providers do provide services to adolescents; however, they often recommend secondary abstinence, offer a limited method selection, and accentuate risks associated with sexual activity and contraceptive use. Providers support adolescent clients by emphasizing the need for privacy, confidentiality, and expedient services, particularly through youth corners, which are spaces within health facilities designed to meet youth needs specifically. Modern contraceptive-using adult female community members advocate for youth access to contraception, however mothers have mixed comfort discussing sexual health with their own youth. Conclusion To destigmatize premarital sexual activity, government efforts to initiate communication about this topic must occur at national and community levels with the goal of continued conversation within the family. The government should also train family planning providers and all health personnel interacting with youth on adolescent-friendly health services. Dialogue between community members and family planning providers about adolescent access to contraceptive services could also reduce barriers for adolescents due to community members’ generally supportive views on adolescent contraceptive use. Efforts to engage adolescent caregivers in how to talk to youth about sex could also contribute to expanded use. In Rwanda, youth who are having sex use family planning less than married women. This study involved asking family planning providers and adults what they think about youth using family planning. Data for this study was collected in 2018, and included 32 interviews with adult family planning users and eight group discussions with family planning providers in two areas of Rwanda. The findings show that Rwandans believe youth should not have sex before they are married. Family planning providers do provide youth with services; however, they often push stopping sexual activity, offer a smaller selection of family planning methods, and exaggerate risks associated with sex and family planning use. Family planning providers support youth by honoring their need for privacy, keeping their secrets, and providing fast services so fewer people see them at the clinic. Providers like to help adolescents in youth corners, which are special spaces within health facilities just for youth. Importantly, adult women who use family planning want youth in their community to be able to use family planning, too. In order to respond to the issues raised, the Rwandan government can start conversations in villages and more broadly about the need for youth to have access to family planning. The government should also teach family planning providers and anyone who comes into contact with youth to offer helpful and friendly services. Setting up spaces for adults to talk with family planning providers about youth access to family planning could also contribute to fewer barriers to services for adolescents.
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Affiliation(s)
- Hilary Schwandt
- grid.281386.60000 0001 2165 7413Western Washington University, Bellingham, WA USA
| | - Angel Boulware
- grid.263934.90000 0001 2215 2150Spelman College, Atlanta, USA
| | - Julia Corey
- grid.422659.e0000 0000 9111 4134Wheaton College, Norton, USA
| | - Ana Herrera
- Northwest Vista Community College, San Antonio, USA
| | - Ethan Hudler
- grid.422656.10000 0000 9839 7069Whatcom Community College, Bellingham, USA
| | | | - Ilia King
- grid.268355.f0000 0000 9679 3586Xavier University, New Orleans, USA
| | - Jessica Linus
- grid.266673.00000 0001 2177 1144University of Maryland Baltimore County, Baltimore, USA
| | | | - Madelyn Merritt
- grid.281386.60000 0001 2165 7413Western Washington University, Bellingham, WA USA
| | - Lyn Mezier
- grid.264273.60000 0000 8999 307XSUNY Oswego, Oswego, USA
| | - Abigail Miller
- grid.281386.60000 0001 2165 7413Western Washington University, Bellingham, WA USA
| | - Haley Morris
- grid.268194.00000 0000 8547 0132Western Oregon University, Monmouth, USA
| | | | - Uwase Musekura
- grid.255407.10000 0001 0579 3386Eastern Oregon University, La Grande, USA
| | | | | | - Nirali Patel
- grid.252353.00000 0001 0583 8943Arcadia University, Glenside, USA
| | | | | | | | | | - Lyse Uwera
- grid.442742.30000 0004 0435 552XINES, Ruhengeri, Rwanda
| | - Madeleine Zeiler
- grid.281386.60000 0001 2165 7413Western Washington University, Bellingham, WA USA
| | - Seth Feinberg
- grid.281386.60000 0001 2165 7413Western Washington University, Bellingham, WA USA
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2
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Corey J, Schwandt H, Boulware A, Herrera A, Hudler E, Imbabazi C, King I, Linus J, Manzi I, Merrit M, Mezier L, Miller A, Morris H, Musemakweli D, Musekura U, Mutuyimana D, Ntakarutimana C, Patel N, Scanteianu A, Shemeza BE, Sterling-Donaldson G, Umutoni C, Uwera L, Zeiler M, Feinberg S. Family planning demand generation in Rwanda: Government efforts at the national and community level impact interpersonal communication and family norms. PLoS One 2022; 17:e0266520. [PMID: 35390080 PMCID: PMC8989356 DOI: 10.1371/journal.pone.0266520] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 03/22/2022] [Indexed: 11/26/2022] Open
Abstract
Between 2005 and 2020, total contraceptive use among married women in Rwanda increased from 17% to 64%. The aim of this study is to better understand how the Rwandan government’s mobilization and demand generation efforts have impacted community norms and interpersonal discourse surrounding family planning. Eight focus group discussions with family planning providers and 32 in-depth interviews with experienced modern contraceptive users were conducted in 2018 in the two Rwandan districts with the highest and the lowest contraceptive prevalence rates. Results suggest that outspoken government support, mass media, and community meetings were valuable sources of information about family planning. Information received through these channels generated interpersonal dialogue about contraceptives through both conversation and observation; however, rumors and misinformation remained a significant barrier to use. A once taboo subject is now normative among married couples. Continuing to address common fears and misinformation through communication channels such as mass media and community meetings may help to further increase contraceptive uptake in Rwanda.
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Affiliation(s)
- Julia Corey
- Wheaton College, Norton, Massachusetts, United States of America
- * E-mail:
| | - Hilary Schwandt
- Fairhaven College, Western Washington University, Bellingham, Washington, United States of America
| | - Angel Boulware
- Spelman College, Atlanta, Georgia, United States of America
| | - Ana Herrera
- Northwest Vista Community College, San Antonio, Texas, United States of America
| | - Ethan Hudler
- Whatcom Community College, Bellingham, Washington, United States of America
| | | | - Ilia King
- Xavier University, New Orleans, Louisiana, United States of America
| | | | | | - Madelyn Merrit
- Department of Sociology, Western Washington University, Bellingham, Washington, United States of America
| | - Lyn Mezier
- SUNY Oswego, Oswego, New York, United States of America
| | - Abigail Miller
- Fairhaven College, Western Washington University, Bellingham, Washington, United States of America
| | - Haley Morris
- Western Oregon University, Monmouth, Oregon, United States of America
| | | | - Uwase Musekura
- Eastern Oregon University, La Grande, Oregon, United States of America
| | | | | | - Nirali Patel
- Arcadia University, Glenside, Pennsylvania, United States of America
| | | | | | | | | | | | - Madeleine Zeiler
- Fairhaven College, Western Washington University, Bellingham, Washington, United States of America
| | - Seth Feinberg
- Department of Sociology, Western Washington University, Bellingham, Washington, United States of America
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Scanteianu A, Schwandt HM, Boulware A, Corey J, Herrera A, Hudler E, Imbabazi C, King I, Linus J, Manzi I, Merritt M, Mezier L, Miller A, Morris H, Musemakweli D, Musekura U, Mutuyimana D, Ntakarutimana C, Patel N, Shemeza BE, Sterling-Donaldson G, Umutoni C, Uwera L, Zeiler M, Feinberg S. "…the availability of contraceptives is everywhere.": coordinated and integrated public family planning service delivery in Rwanda. Reprod Health 2022; 19:22. [PMID: 35090506 PMCID: PMC8796398 DOI: 10.1186/s12978-022-01325-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background Contraceptive use in Rwanda tripled since 2005. This study aims to understand the role of coordinated and integrated public family planning service delivery in achieving this increase in contraceptive use in Rwanda.
Methods This qualitative study in 2018 included eight focus group discussions with family planning providers and 32 in-depth interviews with experienced family planning users. Results Results indicate a well-coordinated public family planning service delivery system with community health workers and nurses filling different and complementary roles in meeting family planning client needs at the local level. In addition, integration of family planning into other maternal and child health services is the norm.
Conclusions The coordination and integration of family planning across both providers and services may help explain the rapid increase in Rwanda’s contraceptive use and has potential applications for enhancing family planning service delivery in other settings.
Family planning use increased from 17 to 53% in Rwanda in between 2005 and 2015. The purpose of this study is to understand the roles of two types of family planning workers in providing family planning services, how those providers work together to achieve the goal to provide public services, and how the Rwandan health system includes family planning services in a variety of other types of health services. To achieve the study purpose, 32 women with experience using modern methods of contraception were interviewed. In addition, 88 providers participated in eight group discussions to discuss these topics. The results from the interviews and group discussions showed that family planning services are easy to access for Rwandans—due to two types of family planning providers filling different roles to assist Rwandans start and keep using family planning methods. Family planning services are included in services for pregnant, delivering, and postpartum mothers—as well as services for infants and children. These are all times when those adults using the services would also be in need of family planning services. The family planning service delivery team approach—as well as including family planning services in mother’s and children’s health services likely helps explain the increase in family planning use in Rwanda. Other nations might learn from Rwanda’s service delivery approach to family planning to also increase access to family planning for their citizens.
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Affiliation(s)
| | - Hilary M Schwandt
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA.
| | | | | | - Ana Herrera
- Northwest Vista Community College, San Antonio, USA
| | | | | | | | - Jessica Linus
- University of Maryland-Baltimore County, Baltimore, USA
| | | | - Madelyn Merritt
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | | | - Abigail Miller
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | | | | | | | | | | | | | | | | | | | | | - Madeleine Zeiler
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | - Seth Feinberg
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
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Baller A, Padoveze MC, Mirindi P, Hazim CE, Lotemo J, Pfaffmann J, Ndiaye A, Carter S, Chabrat MAD, Mangala S, Banzua B, Umutoni C, Niang NR, Kabego L, Ouedraogo A, Houdjo B, Mwesha D, Ousman KB, Kolwaite A, Blaney DD, Choi MJ, Pallawo R, Legand A, Park B, Formenty P, Montgomery JM, Gueye AS, Allegranzi B, Yao NKM, Fall IS. Ebola virus disease nosocomial infections in the Democratic Republic of the Congo: a descriptive study of cases during the 2018-2020 outbreak. Int J Infect Dis 2021; 115:126-133. [PMID: 34883237 PMCID: PMC8755545 DOI: 10.1016/j.ijid.2021.11.039] [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: 09/21/2021] [Revised: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 12/03/2022] Open
Abstract
Health workers were among those most affected by nosocomial Ebola virus disease (EVD) in this outbreak. Children had a higher case fatality rate compared with other patients with nosocomial EVD. Referral health facilities and privately owned health facilities had the highest number of nosocomial infections (NI). Clear case definition of NI is required to prompt transmission chain interruption.
Objectives To describe the characteristics of nosocomial cases of Ebola virus disease (EVD) in the Democratic Republic of the Congo between July 2018 and May 2020 in order to inform future interventions. Methods Nosocomial cases of EVD were identified during outbreak response surveillance, and a retrospective analysis of cases was conducted according to demographic characteristics and type of health facility (HF). Results Of 3481 cases of EVD, 579 (16.6%) were nosocomial. Of these, 332 cases occurred in women (57.3%). Patients and visitors accounted for 419 cases (72.4%), of which 79 (18.9%) were aged 6–≤18 years and 108 (25.8%) were aged ≤5 years. Health workers (HWs) accounted for the remaining 160 (27.6%) nosocomial cases. The case fatality rate (CFR) for HWs (66/160, 41.3%) was significantly lower than the CFR for patients and visitors (292/419, 69.7%) (P<0.001). The CFR was higher among cases aged 6–≤18 years (54/79, 68.4%) and ≤5 years (89/108, 82.4%). Referral HFs (>39 beds) had the highest prevalence of nosocomial EVD (148/579, 25.6%). Among HFs with at least one case of nosocomial infection, 50.0% (98/196) were privately owned. Conclusions Nurses and traditional healers should be targeted for infection prevention and control training, and supportive supervision should be provided to HFs to mitigate EVD transmission.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Berthe Banzua
- Ministry of Health, Democratic Republic of the Congo
| | | | | | | | | | | | | | | | - Amy Kolwaite
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David D Blaney
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary J Choi
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Benjamin Park
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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5
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Schwandt H, Boulware A, Corey J, Herrera A, Hudler E, Imbabazi C, King I, Linus J, Manzi I, Merritt M, Mezier L, Miller A, Morris H, Musemakweli D, Musekura U, Mutuyimana D, Ntakarutimana C, Patel N, Scanteianu A, Shemeza BE, Sterling-Donaldson G, Umutoni C, Uwera L, Zeiler M, Feinberg S. Family planning providers and contraceptive users in Rwanda employ strategies to prevent discontinuation. BMC Womens Health 2021; 21:361. [PMID: 34635111 PMCID: PMC8504084 DOI: 10.1186/s12905-021-01503-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In Rwanda, nearly a third of contraceptive users discontinue within the first year of use. Family planning programs often focus more on recruitment of new users as opposed to maintaining use among current users. A focus on sustaining users and minimizing discontinuation is imperative for long-term family planning program success. This study explores the efforts providers and contraceptive users in Rwanda employ to prevent one of the greatest challenges to family planning programs: contraceptive discontinuation. METHODS This was a qualitative study conducted in Rwanda between February and July 2018. It included eight focus group discussions with 88 family planning providers and 32 in-depth interviews with experienced modern contraceptive users. Data were collected in two districts with the highest (Musanze) and lowest (Nyamasheke) rates of contraceptive use. Data were analyzed using thematic content approach. RESULTS Family planning providers in this study used the following strategies to prevent discontinuation: counseling new users on the potential for side effects and switching, reminding clients about appointments for resupply, as well as supporting dissatisfied users by providing counseling, medicine for side effects, and discussing options for switching methods. Users, on the other hand, employed the following strategies to prevent discontinuation: having an understanding that experiences of side effects vary by individuals, supporting peers to sustain use, persisting with use despite experiences of side effects, and switching methods. CONCLUSIONS The strategies used by family planning providers and users in Rwanda to prevent discontinuation suggest the possibility of long-term sustained use of contraception in the country. Harnessing and supporting such strategies could contribute to sustaining or improving further contraceptive use in the country.
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Affiliation(s)
- Hilary Schwandt
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA.
| | | | | | - Ana Herrera
- Northwest Vista Community College, San Antonio, USA
| | | | | | | | - Jessica Linus
- University of Maryland-Baltimore County, Baltimore, USA
| | | | - Madelyn Merritt
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | | | - Abigail Miller
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Madeleine Zeiler
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | - Seth Feinberg
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
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Carter SE, Ahuka-Mundeke S, Pfaffmann Zambruni J, Navarro Colorado C, van Kleef E, Lissouba P, Meakin S, le Polain de Waroux O, Jombart T, Mossoko M, Bulemfu Nkakirande D, Esmail M, Earle-Richardson G, Degail MA, Umutoni C, Anoko JN, Gobat N. How to improve outbreak response: a case study of integrated outbreak analytics from Ebola in Eastern Democratic Republic of the Congo. BMJ Glob Health 2021; 6:bmjgh-2021-006736. [PMID: 34413078 PMCID: PMC8380808 DOI: 10.1136/bmjgh-2021-006736] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022] Open
Abstract
The emerging field of outbreak analytics calls attention to the need for data from multiple sources to inform evidence-based decision making in managing infectious diseases outbreaks. To date, these approaches have not systematically integrated evidence from social and behavioural sciences. During the 2018–2020 Ebola outbreak in Eastern Democratic Republic of the Congo, an innovative solution to systematic and timely generation of integrated and actionable social science evidence emerged in the form of the Cellulle d’Analyse en Sciences Sociales (Social Sciences Analytics Cell) (CASS), a social science analytical cell. CASS worked closely with data scientists and epidemiologists operating under the Epidemiological Cell to produce integrated outbreak analytics (IOA), where quantitative epidemiological analyses were complemented by behavioural field studies and social science analyses to help better explain and understand drivers and barriers to outbreak dynamics. The primary activity of the CASS was to conduct operational social science analyses that were useful to decision makers. This included ensuring that research questions were relevant, driven by epidemiological data from the field, that research could be conducted rapidly (ie, often within days), that findings were regularly and systematically presented to partners and that recommendations were co-developed with response actors. The implementation of the recommendations based on CASS analytics was also monitored over time, to measure their impact on response operations. This practice paper presents the CASS logic model, developed through a field-based externally led consultation, and documents key factors contributing to the usefulness and adaption of CASS and IOA to guide replication for future outbreaks.
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Affiliation(s)
| | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale, Kinshasa, The Democratic Republic of the Congo
| | | | | | - Esther van Kleef
- Public Health, Prince Leopold Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Sophie Meakin
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine Faculty of Epidemiology and Public Health, London, UK
| | | | | | - Mathias Mossoko
- Ministry of Health, Kinshasa, The Democratic Republic of the Congo
| | | | - Marjam Esmail
- Public Health Emergencies, UNICEF, New York, New York, USA
| | - Giulia Earle-Richardson
- National Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marie-Amelie Degail
- Health Emergencies Programme, World Health Organization, Geneve, Switzerland
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7
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Schwandt H, Boulware A, Corey J, Herrera A, Hudler E, Imbabazi C, King I, Linus J, Manzi I, Merritt M, Mezier L, Miller A, Morris H, Musemakweli D, Musekura U, Mutuyimana D, Ntakarutimana C, Patel N, Scanteianu A, Shemeza BE, Stapleton M, Sterling-Donaldson G, Umutoni C, Uwera L, Zeiler M, Feinberg S. An examination of the barriers to and benefits from collaborative couple contraceptive use in Rwanda. Reprod Health 2021; 18:82. [PMID: 33874969 PMCID: PMC8054403 DOI: 10.1186/s12978-021-01135-6] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 04/02/2021] [Indexed: 11/20/2022] Open
Abstract
Background Supportive male involvement is strongly correlated with contraceptive use. In Rwanda, where the contraceptive prevalence rate among married women increased from 17 to 52% from 2005 to 2010, and stagnated at 53% in 2015, understanding the role of male partners in collaborative couple contraceptive use can help inform programs designed to further increase the use of contraception in Rwanda. Methods This study utilized qualitative methods in 2018, specifically 32 in-depth interviewers with mostly current users of modern contraceptive methods and eight focus group discussions with family planning providers—both family planning nurses and community health workers (CHWs). Respondents were from Musanze and Nyamasheke Districts, the districts with the highest and lowest modern contraceptive use, respectively, to explore the role of couple collaboration in family planning use in Rwanda. Data were analyzed using the thematic content approach in Atlas.ti (8). Results Findings demonstrate that some men are opposed to use of male methods of contraception, and some are opposed to any contraceptive use, which can lead to covert use. Women and providers prefer collaborative couple contraceptive use—as a result, providers advocate for and encourage male partner participation in contraceptive use. Women are most often burdened with seeking out information, initiating discussions, and sharing information discovered about contraceptive use with partners. Decision-making about contraceptive use, once discussed, can be collaborative and motivated by financial considerations. When couple contraceptive use is collaborative, benefits range from marital harmony to husband’s support of sustained use through reminders about appointments, joint counseling, and support in managing side effects. Conclusion Family planning providers at the community and clinic levels encourage collaborative contraceptive use among couples and some Rwandan couples communicate well about family planning use. Despite the positives, women are expected to source family planning information, share that information with their male partners, seek out family planning services, and use family planning. If more Rwandan male partners accepted use, used male methods of contraception, and participated even more in the work it takes to use family planning, the potential for sustained, and even enhanced, contraceptive use in Rwanda could be realized.
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Affiliation(s)
- Hilary Schwandt
- Western Washington University, 516 High Street, MS9118, Bellingham, WA, 98225, USA.
| | - Angel Boulware
- Spelman College, 350 Spelman Ln SW, Atlanta, GA, 30314, USA
| | - Julia Corey
- Wheaton College, 26 E Main St, Norton, MA, 02766, USA
| | - Ana Herrera
- Northwest Vista Community College, 3535 N Ellison Dr., San Antonio, TX, 78251, USA
| | - Ethan Hudler
- Whatcom Community College, 237 W Kellogg Rd, Bellingham, WA, 98226, USA
| | | | - Ilia King
- Xavier University, 1 Drexel Dr., New Orleans, LA, 70125, USA
| | | | | | - Madelyn Merritt
- Western Washington University, 516 High Street, MS9118, Bellingham, WA, 98225, USA
| | - Lyn Mezier
- SUNY Oswego, 7060 NY-104, Oswego, NY, 13126, USA
| | - Abigail Miller
- Western Washington University, 516 High Street, MS9118, Bellingham, WA, 98225, USA
| | - Haley Morris
- Western Oregon University, 345 Monmouth Ave N, Monmouth, OR, 97361, USA
| | | | - Uwase Musekura
- Eastern Oregon University, One University Blvd, La Grande, OR, 97850, USA
| | | | | | - Nirali Patel
- Arcadia University, 450 S Easton Rd, Glenside, PA, 19038, USA
| | | | | | - Madi Stapleton
- Western Washington University, 516 High Street, MS9118, Bellingham, WA, 98225, USA
| | | | | | | | - Madeleine Zeiler
- Western Washington University, 516 High Street, MS9118, Bellingham, WA, 98225, USA
| | - Seth Feinberg
- Western Washington University, 516 High Street, MS9118, Bellingham, WA, 98225, USA
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8
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Schwandt HM, Boulware A, Corey J, Herrera A, Hudler E, Imbabazi C, King I, Linus J, Manzi I, Merritt M, Mezier L, Miller A, Morris H, Musemakweli D, Musekura U, Mutuyimana D, Ntakarutimana C, Patel N, Scanteianu A, Shemeza BE, Sterling-Donaldson G, Umutoni C, Uwera L, Zeiler M, Feinberg S. "… the way we welcome them is how we will lead them to love family planning.": family planning providers in Rwanda foster compassionate relationships with clients despite workplace challenges. BMC Health Serv Res 2021; 21:293. [PMID: 33794871 PMCID: PMC8017655 DOI: 10.1186/s12913-021-06282-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rwanda has markedly increased the nation's contraceptive use in a short period of time, tripling contraceptive prevalence in just 5 years between 2005 and 2010. An integral aspect of family planning programs is the interactions between family planning providers and clients. This study aims to understand the client-provider relationship in the Rwandan family planning program and to also examine barriers to those relationships. METHODS This qualitative study in Rwanda utilized convenience sampling to include eight focus group discussions with family planning providers, both family planning nurses and community health workers, as well as in-depth interviews with 32 experienced modern contraceptive users. Study participants were drawn from the two districts in Rwanda with the highest and lowest modern contraceptive rates, Musanze and Nyamasheke, respectively Data analysis was guided by the thematic content approach, Atlas.ti 8 was utilized for coding the transcripts and collating the coding results, and Microsoft Excel for analyzing the data within code. RESULTS Data analysis revealed that, despite workplace related challenges - including inadequate staffing, training, and resources, relationships between providers and clients are strong. Family planning providers work hard to understand, learn from, and support clients in their initiation and sustained use of contraceptives. CONCLUSION Given the existing context of purposeful efforts on the part of family planning providers to build relationships with their clients, if the current level of government support for family planning service provision is enhanced, Rwanda will likely sustain many current users of contraception and engage even more Rwandans in contraceptive services in the future.
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Affiliation(s)
- Hilary M Schwandt
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA.
| | - Angel Boulware
- Spelman College, 350 Spelman Ln SW, Atlanta, GA, 30314, USA
| | - Julia Corey
- Wheaton College, 26 E Main St, Norton, MA, 02766, USA
| | - Ana Herrera
- Northwest Vista Community College, 3535 N Ellison Dr., San Antonio, TX, 78251, USA
| | - Ethan Hudler
- Whatcom Community College, 237 W Kellogg Rd, Bellingham, WA, 98226, USA
| | | | - Ilia King
- Xavier University, 1 Drexel Dr, New Orleans, LA, 70125, USA
| | | | | | - Madelyn Merritt
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | - Lyn Mezier
- SUNY Oswego, 7060 NY-104, Oswego, NY, 13126, USA
| | - Abigail Miller
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | - Haley Morris
- Western Oregon University, 345 Monmouth Ave N, Monmouth, OR, 97361, USA
| | | | - Uwase Musekura
- Eastern Oregon University, One University Blvd, La Grande, OR, 97850, USA
| | | | | | - Nirali Patel
- Arcadia University, 450 S Easton Rd, Glenside, PA, 19038, USA
| | | | | | | | | | | | - Madeleine Zeiler
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
| | - Seth Feinberg
- Western Washington University, 516 High Street MS9118, Bellingham, WA, 98225, USA
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Ahmed Z, Ataullahjan A, Gaffey MF, Osman M, Umutoni C, Bhutta ZA, Dalmar AA. Understanding the factors affecting the humanitarian health and nutrition response for women and children in Somalia since 2000: a case study. Confl Health 2020; 14:35. [PMID: 32514300 PMCID: PMC7254682 DOI: 10.1186/s13031-019-0241-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Somalia has been ravaged by more than two decades of armed conflict causing immense damage to the country's infrastructure and mass displacement and suffering among its people. An influx of humanitarian actors has sought to provide basic services, including health services for women and children, throughout the conflict. This study aimed to better understand the humanitarian health response for women and children in Somalia since 2000. METHODS The study utilized a mixed-methods design. We collated intervention coverage data from publically available large-scale household surveys and we conducted 32 interviews with representatives from government, UN agencies, NGOs, and health facility staff. Qualitative data were analyzed using latent content analysis. RESULTS The available quantitative data on intervention coverage in Somalia are extremely limited, making it difficult to discern patterns or trends over time or by region. Underlying sociocultural and other contextual factors most strongly affecting the humanitarian health response for women and children included clan dynamics and female disempowerment. The most salient operational influences included the assessment of population needs, donors' priorities, and insufficient and inflexible funding. Key barriers to service delivery included chronic commodity and human resource shortages, poor infrastructure, and limited access to highly vulnerable populations, all against the backdrop of ongoing insecurity. Various strategies to mitigate these barriers were discussed. In-country coordination of humanitarian health actors and their activities has improved over time, with federal and state-level ministries of health playing increasingly active roles. CONCLUSIONS Emerging recommendations include further exploration of government partnerships with private-sector service providers to make services available throughout Somalia free of charge, with further research on innovative uses of technology to help reaches remote and inaccessible areas. To mitigate chronic skilled health worker shortages, more operational research is needed on the expanded use of community health workers. Persistent gaps in service provision across the continuum must be addressed, including for adolescents, for example. The is also a clear need for longer term development focus to enable the provision of health and nutrition services for women and children beyond those included in recurrent emergency response.
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Affiliation(s)
- Zahra Ahmed
- Somali Disaster Resilience Institute, Mogadishu, Somalia
| | - Anushka Ataullahjan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Michelle F. Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Mohamed Osman
- Somali Disaster Resilience Institute, Mogadishu, Somalia
| | | | - Zulfiqar A. Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi City, Pakistan
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Mobula LM, Samaha H, Yao M, Gueye AS, Diallo B, Umutoni C, Anoko J, Lokonga JP, Minikulu L, Mossoko M, Bruni E, Carter S, Jombart T, Fall IS, Ahuka-Mundeke S. Recommendations for the COVID-19 Response at the National Level Based on Lessons Learned from the Ebola Virus Disease Outbreak in the Democratic Republic of the Congo. Am J Trop Med Hyg 2020; 103:12-17. [PMID: 32431285 PMCID: PMC7356463 DOI: 10.4269/ajtmh.20-0256] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The tenth outbreak of Ebola virus disease (EVD) in North Kivu, the Democratic Republic of the Congo (DRC), was declared 8 days after the end of the ninth EVD outbreak, in the Equateur Province on August 1, 2018. With a total of 3,461 confirmed and probable cases, the North Kivu outbreak was the second largest outbreak after that in West Africa in 2014–2016, and the largest observed in the DRC. This outbreak was difficult to control because of multiple challenges, including armed conflict, population displacement, movement of contacts, community mistrust, and high population density. It took more than 21 months to control the outbreak, with critical innovations and systems put into place. We describe systems that were put into place during the EVD response in the DRC that can be leveraged for the response to the current COVID-19 global pandemic.
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Affiliation(s)
- Linda Meta Mobula
- Division of General. Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.,Ebola Response Team, Health, Nutrition and Population, Global Practice, World Bank Group, Washington, District of Columbia.,Center for Humanitarian Health, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Hadia Samaha
- Ebola Response Team, Health, Nutrition and Population, Global Practice, World Bank Group, Washington, District of Columbia
| | - Michel Yao
- World Health Organization, AFRO, Health Emergencies Programme, Brazzaville, Democratic Republic of the Congo
| | - Abdou Salam Gueye
- World Health Organization, Country Office, Nouakchott, Mauritania.,World Health Organization, AFRO, Health Emergencies Programme, Brazzaville, Democratic Republic of the Congo
| | - Boubacar Diallo
- World Health Organization, AFRO, Health Emergencies Programme, Brazzaville, Democratic Republic of the Congo
| | - Chantal Umutoni
- Ebola Response Team, UNICEF, Goma, Democratic Republic of the Congo
| | - Julienne Anoko
- World Health Organization, AFRO, Health Emergencies Programme, Brazzaville, Democratic Republic of the Congo
| | - Jean-Pierre Lokonga
- Programme de Développement du Système de Santé, Ministry of Health, Goma, Democratic Republic of the Congo
| | - Luigi Minikulu
- Ebola Technical Secretariat, Goma, Democratic Republic of the Congo
| | - Mathias Mossoko
- Ebola Technical Secretariat, Goma, Democratic Republic of the Congo
| | - Emanuele Bruni
- World Health Organization, Health Emergencies Programme, Geneva Switzerland
| | - Simone Carter
- Ebola Response Team, UNICEF, Goma, Democratic Republic of the Congo
| | - Thibaut Jombart
- London School of Tropical Medicine and Hygiene, London, United Kingdom
| | - Ibrahima Soce Fall
- World Health Organization, Health Emergencies Programme, Geneva Switzerland
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Ayoya MA, Higgins-Steele A, Massai D, Umutoni C, Saegusa A, Mubalama JC, Kleschnitzki S, Lattouf S, Ramaroson S, Gruloos-Ackermans F. Health authorities' leadership reduces cholera deaths in Haiti. Lancet 2012; 380:473-4. [PMID: 22863052 DOI: 10.1016/s0140-6736(12)61291-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ahoua L, Umutoni C, Huerga H, Minetti A, Szumilin E, Balkan S, Olson DM, Nicholas S, Pujades-Rodríguez M. Nutrition outcomes of HIV-infected malnourished adults treated with ready-to-use therapeutic food in sub-Saharan Africa: a longitudinal study. J Int AIDS Soc 2011; 14:2. [PMID: 21219607 PMCID: PMC3027085 DOI: 10.1186/1758-2652-14-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [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: 05/18/2010] [Accepted: 01/10/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Among people living with HIV/AIDS, nutritional support is increasingly recognized as a critical part of the essential package of care, especially for patients in sub-Saharan Africa. The objectives of the study were to evaluate the outcomes of HIV-positive malnourished adults treated with ready-to-use therapeutic food and to identify factors associated with nutrition programme failure. METHODS We present results from a retrospective cohort analysis of patients aged 15 years or older with a body mass index of less than 17 kg/m² enrolled in three HIV/AIDS care programmes in Africa between March 2006 and August 2008. Factors associated with nutrition programme failure (patients discharged uncured after six or more months of nutritional care, defaulting from nutritional care, remaining in nutritional care for six or more months, or dead) were investigated using multiple logistic regression. RESULTS Overall, 1340 of 8685 (15.4%) HIV-positive adults were enrolled in the nutrition programme. At admission, median body mass index was 15.8 kg/m² (IQR 14.9-16.4) and 12% received combination antiretroviral therapy (ART). After a median of four months of follow up (IQR 2.2-6.1), 524 of 1106 (47.4%) patients were considered cured. An overall total of 531 of 1106 (48.0%) patients failed nutrition therapy, 132 (11.9%) of whom died and 250 (22.6%) defaulted from care. Men (OR = 1.5, 95% CI 1.2-2.0), patients with severe malnutrition at nutrition programme enrolment (OR = 2.2, 95% CI 1.7-2.8), and those never started on ART (OR = 4.5, 95% CI 2.7-7.7 for those eligible; OR = 1.6, 95% CI 1.0-2.5 for those ineligible for ART at enrolment) were at increased risk of nutrition programme failure. Diagnosed tuberculosis at nutrition programme admission or during follow up, and presence of diarrhoeal disease or extensive candidiasis at admission, were unrelated to nutrition programme failure. CONCLUSIONS Concomitant administration of ART and ready-to-use therapeutic food increases the chances of nutritional recovery in these high-risk patients. While adequate nutrition is necessary to treat malnourished HIV patients, development of improved strategies for the management of severely malnourished patients with HIV/AIDS are urgently needed.
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