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Journal Cover African Journal of Reproductive Health
   [6 followers]  Follow    
  This is an Open Access Journal Open Access journal
     ISSN (Print) 1118-4841 - ISSN (Online) 2141-3606
     Published by African Journals Online Homepage  [230 journals]   [SJR: 0.24]   [H-I: 22]
  • Unconsummated Marriage in Sub-Saharan Africa: Case Reports

    • Authors: VM Lema
      Abstract: Unconsummated marriage is a condition where newly married couples are unable to achieve penile-vaginal intercourse for variable periods despite desire and several attempts to do so. Its exact cause(s) is/are unknown, but performance anxiety resulting from or leading to other conditions is reportedly the major etiological factor. It is thought to be more prevalent in traditional and conservative religious communities where premarital sexual exposure is strictly prohibited. Most publications on unconsummated marriage have originated from North America, European and Middle Eastern countries. There have not been any such reports from sub-Saharan Africa, which is home to diverse cultures and traditions regarding premarital sex and marriage. This paper presents a sample of four cases with unconsummated marriage managed by the author in his private clinic based in the city of Nairobi Kenya, over the past five years. Possible etiological factors and management approaches are discussed, with a review of relevant literature. Afr J Reprod Health 2014; 18[3]: 159-165)
      Keywords: Unconsummated marriage, sub-Saharan Africa, Presentation and management
      PubDate: 2014-10-28
      Issue No: Vol. 18, No. 3 (2014)
       
  • Human Papilloma Virus Vaccine: Determinants of Acceptability by Mothers
           for Adolescents in Nigeria

    • Authors: MC Ezeanochie, BN Olagbuji
      Abstract: Vaccination of adolescent females against Human Papilloma Virus (HPV), the causative agent for cervical cancer has recently become available. As minors, parental acceptance of the vaccines for adolescent daughters requires exploration. This was a cross-sectional survey of 201 mothers attending the gynaecology clinic in a University Teaching Hospital in Nigeria on acceptability of the HPV vaccines and its determinants. Although 70% accepted vaccination of their daughters, 30% were unwilling and the commonest reason for unwillingness was that it may encourage sexual promiscuity (62.3%). Mothers with poor knowledge of STI were significantly more unwilling to accept HPV vaccines compared to those with average or good knowledge (p=0.002). Furthermore, perception of susceptibility to HPV infection by daughters was significantly associated with acceptance of the vaccines (p=0.0001). Increased advocacy and public enlightenment on cervical cancer control and the role of HPV vaccines in its prevention is still necessary especially in developing countries. (Afr J Reprod Health 2014; 18[3]: 154-158)
      Keywords: Cervical cancer, Human papilloma virus, vaccine, Nigeria
      PubDate: 2014-10-28
      Issue No: Vol. 18, No. 3 (2014)
       
  • Attitudes of Gatekeepers Towards Adolescent Sexual and Reproductive Health
           in Ghana

    • Authors: A Kumi-Kyereme, K Awusabo-Asare, EKM Darteh
      Abstract: Adults constitute gatekeepers on adolescent sexual and reproductive health (ASRH). This qualitative paper discusses the views of adults on ASRH problems and challenges based on 60 in-depth interviews conducted among adults in Ghana in 2005. Adults were purposively selected based on their roles as parents, teachers, health care providers and community leaders. The major ASRH problems mentioned were teenage pregnancy and HIV/AIDS. The results indicated a number of challenges confronting ASRH promotion including resistance from parents, attitudes of adolescents, communication gap between adults and adolescents and attitudes of health care providers. Among health workers three broad categories were identified: those who were helpful, judgmental and dictators. Some adults supported services for young people while others did not. Some served as mediators and assisted to ‘solve’ ASRH problems, which occurred in their communities. It is argued that exploring the views of adults about their fears and concerns will contribute to the development of strategies and programmes which will help to improve ASRH. (Afr J Reprod Health 2014; 18[3]: 142-153)
      Keywords: Adolescents, Adults, Gatekeepers, Ghana, Adolescent Sexual and Reproductive Health
      PubDate: 2014-10-28
      Issue No: Vol. 18, No. 3 (2014)
       
  • Risk Factors for Transactional Sex among Young Females in Post-Conflict
           Liberia

    • Authors: CC Okigbo, DR McCarraher, M Chen, A Pack
      Abstract: This study aimed to examine the risk factors for engaging in transactional sex among young females in Montserrado County, Liberia. Data from an HIV behavioral survey conducted among young people aged 14 – 25 years were used. The analytical sample included 493 sexually-experienced females. Bivariate and multivariate analyses were conducted. We found that 72% of our sample had ever engaged in transactional sex. Engagement in transactional sex was associated with education (OR: 0.5); reporting no earned income (OR: 1.9); longer duration of sexual activity (OR: 3.5); early sexual debut (OR: 2.5); history of sexual violence (OR: 2.1) and multiple sexual partnerships (OR: 4.0). Respondents' age, residence, and drug/alcohol use were not associated with engagement in transactional sex. HIV interventions should incorporate educational strategies to reduce the prevalence of transactional sex among young people. These strategies should include economic opportunities to offset financial need as well as efforts to eradicate sexual violence. (Afr J Reprod Health 2014; 18[3]: 133-141)
      Keywords: Transactional sex, Young women, HIV risk behaviors, Post-conflict, Liberia.
      PubDate: 2014-10-28
      Issue No: Vol. 18, No. 3 (2014)
       
  • Understanding Maternal Deaths from the Family’s Perspective: Verbal
           Autopsies in Rural Tanzania

    • Authors: GC Webber, B Chirangi
      Abstract: Maternal mortality rates in rural Tanzania are high. In preparation for the introduction of an intervention to reduce maternal deaths by distribution of misoprostol and erythromycin to women living in rural Rorya District, Mara Region, Tanzania, we conducted a limited verbal autopsy by surveying family members of women who died in childbirth in the previous five years. The purpose of this survey was to understand the circumstances surrounding these deaths. Thirty six family members were interviewed. The majority of the deaths occurred on the roadside as the women made their way to a health facility (23/36). Most of the women were delivered by a TBA (16/36) or family member (13/36). The majority of the family members attributed the death of their loved one to bleeding or retained placenta (32/36). Maternal deaths are common in this rural district of Tanzania because of long distances from the health facilities, difficulty finding transportation, costs of transport and hospital, and women’s beliefs about being able to deliver at home and fear of medication. There is a need for increased education of women and their families about the benefits of childbirth in a health care facility attended by skilled providers. There is also a role for the community distribution of misoprostol to be used as an alternative uterotonic medication if a facility birth is not possible, as the rates of maternal death from hemorrhage are unacceptably high. (Afr J Reprod Health 2014; 18[3]: 128-132)
      Keywords: maternal mortality, verbal autopsy, postpartum hemorrhage.
      PubDate: 2014-10-28
      Issue No: Vol. 18, No. 3 (2014)
       
  • Current Evidence Supporting Obstetric Fistula Prevention Strategies in Sub
           Saharan Africa: A Systematic Review of the Literature

    • Authors: AO Banke-Thomas, OE Wilton-Waddell, SF Kouraogo, JE Mueller
      Abstract: Obstetric fistula has been eliminated in developed countries, but remains highly prevalent in sub-Saharan Africa. The End fistula campaign is the first concerted effort to eradicate the disease. The objective of this review is to retrieve and link available evidence to obstetric fistula prevention strategies in sub-Saharan Africa, since the campaign began. We searched databases for original research on obstetric fistula prevention. Fifteen articles meeting inclusion criteria were assessed for quality, and data extraction was performed. Grey literature provided context. Evidences from the articles were linked to prevention strategies retrieved from grey literature. The strategies were classified using an innovative target-focused method. Gaps in the literature show the need for fistula prevention research to aim at systematically measuring incidence and prevalence of the disease, identify the most effective and cost-effective strategies for fistula prevention and utilise innovative tools to measure impact of strategies in order to ensure eradication of fistula. (Afr J Reprod Health 2014; 18[3]: 118-127)
      Keywords: Obstetric fistula; Fistula prevention; Prevention strategies; Sub-Saharan Africa
      PubDate: 2014-10-28
      Issue No: Vol. 18, No. 3 (2014)
       
  • Maternal Health Practices, Beliefs and Traditions in Southeast Madagascar

    • Authors: JL Morris, S Short, L Robson, MS Andriatsihosena
      Abstract: Contextualising maternal health in countries with high maternal mortality is vital for designing and implementing effective health interventions. A research project was therefore conducted to explore practices, beliefs and traditions around pregnancy, delivery and postpartum in southeast Madagascar. Interviews and focus groups were conducted with 256 pregnant women, mothers of young children, community members and  stakeholders; transcripts were analysed to identify and explore  predetermined and emerging themes. A questionnaire was also conducted with 373 women of reproductive age from randomly selected households. Data was analysed using STATA. Results confirmed high local rates of maternal mortality and morbidity and revealed a range of traditional health care practices and beliefs impacting on women’s health seeking  behaviours. The following socio-cultural barriers to health were identified: 1) lack of knowledge, 2) risky practices, 3) delays seeking biomedical care, and 4) family and community expectations. Recommendations include educational outreach and behaviour change communications targeted for women, their partners and family, increased engagement with traditional midwives and healers, and capacity building of formal health service providers. (Afr J Reprod Health 2014; 18[3]: 101-117)
      Keywords: maternal health, pregnancy, birth, postpartum, Madagascar, socio-cultural
      PubDate: 2014-10-28
      Issue No: Vol. 18, No. 3 (2014)
       
  • Rural Origin and Exposure Drives Ghanaian Midwives Reported Future
           Practice

    • Authors: JR Lori, L Livingston, M Eagle, S Rominski, EK Nakua, P Agyei-Baffour
      Abstract: A primary cause of Ghana’s higher than global average maternal mortality rate is limited access to maternal care in rural areas. To date, few studies have examined how rural background/training of midwives impacts their future willingness to work in remote areas. The purpose of this paper is to describe the relationship between Ghanaian student midwife place of origin and rural training on their willingness to choose a future rural practice location. A cross-sectional computer-based survey was completed by 238 final year Ghanaian midwifery students from two public midwifery training schools located in urban Ghana between October and December 2009. The relationship between rural exposure and willingness to work in rural Ghana was analyzed using independent t-test, chi-square, and bivariate logistic regression. Participants who experienced a rural rotation (OR: 1.51, 95% CI: 0.71, 3.22) and those born in a rural area (OR: 2.24, 95% CI: 0.74, 6.75) resulted in greater odds ratio to choose rural practice following graduation. This study indicates an association between midwifery students’ place of origin and training and their willingness to practice in a rural area after graduation. (Afr J Reprod Health 2014; 18[3]: 95-100)
      Keywords: Midwifery, Ghana, human resources for health, maldistribution, rural practice, rural incentives
      PubDate: 2014-10-28
      Issue No: Vol. 18, No. 3 (2014)
       
  • Effects of Improved Access to Transportation on Emergency obstetric Care
           Outcomes in Uganda

    • Authors: S Mucunguzi, H Wamani, P Lochoro, T Tylleskar
      Abstract: Reduction in maternal mortality has not been appreciable in most  low-income countries. Improved access to transport for mothers is one way to improve maternal health. This study evaluated a free-of-charge 24-hour ambulance and communication services intervention in Oyam district using ‘Caesarean section rate’ (CSR) and compared with the neighbouring  non-intervention district. Ecological data were collected retrospectively from maternity/theatre registers in October 2010 for 3 years pre and 3 years  intervention period. The average CSR in the intervention district increased from 0.57% before the intervention to 1.21% (p=0.022) during the  intervention, while there was no change in the neighbouring district (0.51% to 0.58%, p=0.512). Hospital deliveries increased by over 50% per year with a slight reduction in the average hospital stillbirths per 1000 hospital births in the intervention district (46.6 to 37.5, p=0.253). Reliable  communication and transport services increased access to and utilization of maternal health services, particularly caesarean delivery services. (Afr J Reprod Health 2014; 18[3]: 87-94)Keywords: caesarean section, emergency obstetric care, ambulance services, accessibility, referral and communication system
      PubDate: 2014-10-28
      Issue No: Vol. 18, No. 3 (2014)
       
  • Obstetric Danger Signs and Factors Affecting Health Seeking Behaviour
           among the Kassena-Nankani of Northern Ghana: A Qualitative Study

    • Authors: RA Aborigo, CA Moyer, M Gupta, PB Adongo, J Williams, A Hodgson, P Allote, CM Engmann
      Abstract: Improving community members’ knowledge of obstetric danger signs is one strategy for increasing the use of skilled care during pregnancy and the puerperium. This study explored knowledge of obstetric danger signs among a range of community members, examined the sources of their information, and the perceived factors that affect health seeking behaviour in rural northern Ghana. We conducted 72 in-depth interviews and 18 focus groups with community members. All interactions were audio taped, transcribed verbatim and analysed using NVivo 9.0. Community members demonstrated knowledge of a wide range of obstetric danger signs,  including excessive bleeding, stomach aches, waist pains, vomiting and fever. Pregnant women learn about danger signs from a range of providers, and regular contact with formal providers typically coincided with increased knowledge of danger signs. Traditional remedies for problems in obstetrics are plentiful and cultural beliefs often restrict the use of allopathic medicine. Increasing knowledge of obstetric danger signs is necessary but not sufficient to overcome cultural preferences for traditional treatments for pregnancy danger signs. (Afr J Reprod Health 2014; 18[3]: 78-86)Keywords: Obstetric danger signs, knowledge of danger signs, health seeking behaviour, antenatal care, maternal health, Ghana
      PubDate: 2014-10-28
      Issue No: Vol. 18, No. 3 (2014)
       
  • Fertility Desires and Intentions among HIV-Positive Women during the
           Post-natal period in Uganda

    • Authors: SA Gutin, F Namusoke, SB Shade, F Mirembe
      Abstract: This study describes the fertility intentions and discusses the potential  reproductive health needs of post-natal HIV-infected Ugandan women. HIV-infected mothers attending post-natal services in Kampala, Uganda participated in this cross-sectional study using structured interviewer  administered questionnaires. Descriptive statistics and logistic regression models were used to identify predictors of desire for more children. Among 403 participants, 35% desired more children. Of these, 25% wanted another child within 2 years and 75% within 3 years or more. In  multivariable analyses, believing that one’s partners wanted more children (OR=2.44; 95% CI = 1.30, 4.59) was associated with the desire for future children while having more living children was negatively associated with the desire for future children (OR=0.08; 95% CI = 0.02, 0.39). A minority of women desired future pregnancies, and most wanted to delay pregnancy for 3 years. These women are in need of family planning (FP) methods to meet stated desires to delay or end future pregnancies. Perceived partner desire for children also impacts on women’s fertility intentions, highlighting the importance of engaging men during the post-natal period. (Afr J Reprod Health 2014; 18[3]: 67-77)
      Keywords: fertility intentions; desire for children; Post-natal women; HIV; reproductive health; contraception.
      PubDate: 2014-10-28
      Issue No: Vol. 18, No. 3 (2014)
       
  • Defining Motivational Intensity of Need for Family Planning in Africa

    • Authors: B Kuang, J Ross, EL Madsen
      Abstract: Non-users of contraception differ greatly in their likely motivation to adopt a method or resume use. This study presents a new approach to defining high and low motivation groups by stated intention to use, past use, and unmet need, to determine how these groups differ in characteristics and in region of residence. Data come from 23 DHS surveys in sub-Saharan countries, with representation from the eastern/southern region and western/central region. The low motivation non-users, with less past use and less intention to use in the future, are more rural, less educated, and closer to poverty. Motivational intensity is lower in the western/central region, which contains far fewer intenders than the eastern/southern region and where many more report no past use and no unmet need. When used to guide planning, unmet need should be augmented with motivation, since the two classifications do not entirely overlap. Between 10 and 17 percent of current non-users of family planning are likely highly motivated to use, but are not captured in the unmet need classification. Program implications for these non-using groups are discussed.(Afr J Reprod Health 2014; 18[3]: 57-66)
      Keywords: Unmet need, contraceptive use, intention to use family planning
      PubDate: 2014-10-28
      Issue No: Vol. 18, No. 3 (2014)
       
  • Determinants of Preference of Source of Injectable Contraceptives among
           Rural Women in Uganda: A Case Study of Depo-Provera

    • Authors: O Nakayiza, R Wamala, B Kwagala
      Abstract: Understanding preference of source of contraceptive commodities is essential in enhancing the delivery of family planning services. This paper identifies the determinants of preferred source of Depo-Provera among rural women in  Uganda. The analysis is based on data sourced from a Save the Children and Family Health International study involving 642 women who were introduced to the contraceptive three years prior to the evaluation. Data were analyzed at univariate, bivariate and multivariate levels. Private sources were the most preferred of Depo-Provera as compared to public sources. Preference for  private sources was more likely among older women (p < 0.05), those who had never experienced stock-outs of Depo-Provera (p < 0.01), and those who had obtained their last injectable from private sources (p < 0.01). These findings support the strategy of community-based distribution of  contraceptives in enhancing access and utilization of family planning services in Uganda. (Afr J Reprod Health 2014; 18[3]: 48-56)Keywords: Uganda; Source of contraceptives, rural environment
      PubDate: 2014-10-28
      Issue No: Vol. 18, No. 3 (2014)
       
  • A Comparative Analysis of Fertility Differentials in Ghana and Nigeria

    • Authors: O Olatoregun, AF Fagbamigbe, OJ Akinyemi, BY Oyindamola, EA Bamgboye
      Abstract: Nigeria and Ghana are the most densely populated countries in the West African sub-region with fertility levels above world average. Our study compared the two countries’ fertility levels and their determinants as well as the differentials in the effect of these factors across the two countries. We carried out a retrospective analysis of data from the Nigeria and Ghana Demographic Health Surveys, 2008. The sample of 33,385 and 4,916 women aged 15-49 years obtained in Nigeria and Ghana respectively was stratified into low, medium and high fertility using reported children ever born. Data was summarized using appropriate descriptive statistics. Factors influencing fertility were identified using ordinal logistic regression at 5% significance level. While unemployment significantly lowers fertility in Nigeria, it wasn’t significant in Ghana. In both countries, education, age at first marriage, marital status, urban-rural residence, wealth index and use of oral contraception were the main factors influencing high fertility levels. (Afr J Reprod Health 2014; 18[3]: 36-47)
      Keywords: Fertility differential, Educational level, ordinal logistic regression, Nigeria, Ghana
      PubDate: 2014-10-28
      Issue No: Vol. 18, No. 3 (2014)
       
  • Does Access to Antiretroviral Drugs Lead to an Increase in High-Risk
           Sexual Behaviour'

    • Authors: Z De Coninck
      Abstract: No Abstract.

      Keywords: Antiretroviral, ARV, HIV, sexual behaviour, sub-Saharan Africa.
      PubDate: 2014-10-28
      Issue No: Vol. 18, No. 3 (2014)
       
  • Editorial: Defining a New Pathway for Family Planning in Africa After 2014

    • Authors: F Okonofua
      Abstract: No Abstract.
      PubDate: 2014-10-28
      Issue No: Vol. 18, No. 3 (2014)
       
  • Abortion Care in Ghana: A Critical Review of the Literature

    • Authors: SD Rominski, JR Lori
      Abstract: The Government of Ghana has taken important steps to mitigate the impact of unsafe abortion. However, the expected decline in maternal deaths is yet to be realized. This literature review aims to present findings from empirical research directly related to abortion provision in Ghana and identify gaps for future research. A total of four (4) databases were searched with the keywords “Ghana and abortion” and hand review of reference lists was conducted. All abstracts were reviewed. The final include sample was 39 articles. Abortion-related complications represent a large component of admissions to gynecological wards in hospitals in Ghana as well as a large contributor to maternal mortality. Almost half of the included studies were hospital-based, mainly chart reviews. This review has identified gaps in the literature including: interviewing women who have sought unsafe abortions and with healthcare providers who may act as gatekeepers to women wishing to access safe abortion services.
      Keywords: Abortion, Ghana, Review
      PubDate: 2014-10-28
      Issue No: Vol. 18, No. 3 (2014)
       
 
 
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