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Journal Cover African Journal of Reproductive Health
  [SJR: 0.561]   [H-I: 29]   [5 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  [265 journals]
  • Unpacking the barriers to reproductive health services in Ghana: HIV/STI
           testing, abortion and contraception

    • Authors: Nandita Thatte, Jeffrey B. Bingenheimer, Khadidiatou Ndiaye, Rajiv N. Rimal
      Abstract: Youth report embarrassment, cost, and poor access as barriers to sexual and reproductive health (SRH) services. Interventions to address barriers like youth friendly services have yet to conclusively demonstrate impact on protective behaviours like condom or contraceptive use. SRH encompasses a range of services so we aimed to assess how perceived barriers differed depending on the service being sought between common services accessed by young people: HIV/STI testing, abortion, and contraception. 1203 Ghanaian youth were interviewed. Data was analysed to identify barriers by service type, demographics, and between high and low HIV prevalence communities. Being embarrassed or shy was the most commonly reported barrier across services. Overall being embarrassed or shy, fear of safety, fear of family finding out and cost were the most reported barriers across all services. Further analysis by service indicated that being embarrassed was a significantly greater barrier for HIV/STI testing and contraception when compared with abortion (p<0.001) and safety concerns and cost were significantly greater barriers for abortion and contraception compared with HIV/STI testing (p<0.001). Efforts to develop interventions that consider the service being sought may help address the range of barriers faced by youth with diverse SRH needs. (Afr J Reprod Health 2016; 20[2]: 53-61).Keywords: Barriers, HIV/AIDS/STIs, Abortion, Contraception, Ghana, Youth
      PubDate: 2016-09-28
      Issue No: Vol. 20, No. 2 (2016)
  • Sexual dysfunction in premenopausal women treated for breast cancer –
           implications for their clinical care

    • Authors: Valentino Manase Lema
      Abstract: Breast cancer is the commonest cancer in women globally. Early stage diagnosis in young sexually active women, coupled with advances in adjuvant therapy has contributed to an increase in the number of young survivors. A diagnosis of breast cancer may affect the woman’s self-esteem, sexuality and intimate relationships. Surgical alteration or loss of the breast, a symbol of femininity and sexuality, may negatively impact her body-image. Chemotherapy may cause ovarian damage leading to premature menopause. The psychological effects thereof may impair the man’s ability to offer emotional support to the woman as well as affect their relationship. These may affect a survivor’s sexual functioning and quality of life. This paper reports on four pre-menopausal women treated for breast cancer and the sexual sequels thereof. It is aimed at raising awareness amongst health providers managing women with breast cancer in sub-Saharan Africa on the impact thereof of their quality of life as well as sexual functioning. Treatment of breast cancer has focused mainly on improved survival with no due consideration of its impact on quality of life. There is need for multi-disciplinary approach in managing these patients to address all concerns in a wholesome manner. (Afr J Reprod Health 2016; 20[2]: 122-128).Keywords: Breast cancer, young women, sexual dysfunction, sub-Saharan Africa
      PubDate: 2016-09-28
      Issue No: Vol. 20, No. 2 (2016)
  • Disparities in abortion experience and access to safe abortion services in
           Ghana: evidence from a retrospective survey

    • Authors: John K. Ganle, Bernard Obeng, Joseph Y. Yeboah, Eva Tagoe-Darko, Charlotte M. Mensah
      Abstract: In Ghana, abortion mortality constitutes 11% of maternal mortality. Empirical studies on possible disparities in abortion experience and access to safe abortion services are however lacking. Based on a retrospective survey of 1,370 women aged 15-49 years in two districts in Ghana, this paper examines disparities in women’s experiences of abortion and access to safe abortion care. Disparities in rates of abortion experience and access to safe abortion care were assessed using absolute (the difference in rates between groups), relative (the ratio of rates between selected and reference groups), and mean measures. Results suggest that 24% of women had at least one abortion in the five years preceding the survey. However, large gradients of socio-spatial disparities in abortion experience exist. The majority of abortions were also potentially unsafe: 53% of abortions occurred outside of any healthcare facility. Women themselves and medical doctors, respectively, performed 57% and 4% of all abortions. The majority of women also felt they could not get safe abortion even if they wanted one. Together, these results highlight the need for concerted multi-sectorial strategies, including legislative reform and provision of family planning services, to help transition from unsafe to safe abortions. (Afr J Reprod Health 2016; 20[2]: 43-52).Keywords: Disparities, Unsafe abortion, Contraceptive use, Family planning, Abortion law, Ghana
      PubDate: 2016-09-28
      Issue No: Vol. 20, No. 2 (2016)
  • Determinants of elongation of the Labia Minora in Tete Province, central
           Mozambique: findings of a household survey

    • Authors: Guillermo Martínez Pérez, Brigitte Bagnol, Matthew Chersich, Esperanza Mariano, Francisco Mbofana, Terence Hull, Adriane Martin Hilber
      Abstract: A WHO-supported provincial-level population-based survey was conducted in 2007 to understand the determinants and implications for health of vaginal practices. A total of 919 women aged 18-60 were selected randomly for enrolment. This is the first population-based study of females in Tete Province, Mozambique. At some time over their lives, 98.8% of women had practiced elongation of their labia minora and a quarter (24.0%) had done so in the past month. Currently practicing women were more likely to have engaged in sex recently, and used contraceptives and condoms at last sex than women who had stopped labial elongation. Younger age, residence in rural areas and having two or more male partners were also determinants of current practice. Women commonly reported they practiced for no specific reason (62.8%). Discomforting itchiness and lower abdominal pain were more frequent in women who had stopped labial elongation than in women who were currently practicing. Although women may not report current vaginal ill health, it is possible that prospective cohort studies could uncover alterations in genital vaginal flora or other indicators of impact on women’s health. The findings of this study do not suggest that labial elongation is linked with high-risk behaviors for HIV transmission. (Afr J Reprod Health 2016; 20[2]: 111-121).Keywords: Labia minora elongation; vaginal practices; Mozambique; survey; cross-sectional studies
      PubDate: 2016-09-28
      Issue No: Vol. 20, No. 2 (2016)
  • Gender differentials and disease-specific cause of infant mortality: a
           case study in an urban hospital in Accra, Ghana

    • Authors: Awolu Adam
      Abstract: Infant mortality is a major public health problem especially in developing countries. It is an indicator of quality of and accessibility to primary healthcare as well as the overall health status of a country. Understanding the risk factors for infant mortality is the first important step to reducing its incidence/prevalence. This study examined the prevalence and disease-specific causes of infant mortality in an urban hospital in Ghana and gender differences in the burden of infant mortality. Births and deaths data at the hospital were reviewed and analyzed. Results indicated infant mortality of 32/1000 live births and highlighted malaria, severe anemia, and neonatal sepsis as the leading causes of infant deaths. Gender differences in infant mortality was not statistically significant (X2; P-value=0.73). It is critical to strengthen existing malaria control programs for infants and develop targeted interventions to improve infant nutrition for high risk infants. (Afr J Reprod Health 2016; 20[2]: 104-110).Keywords: Infant, mortality, Ghana, malaria, gender
      PubDate: 2016-09-28
      Issue No: Vol. 20, No. 2 (2016)
  • Self-Efficacy mediates the association between partner trust and condom
           usage among females but not males in a Kenyan cohort of orphan and
           vulnerable youth

    • Authors: Michael L. Goodman, Melissa B. Harrell, Stanley Gitari, Philip H. Keiser, Lauren A. Raimer-Goodman
      Abstract: Continuing gains against incidence of HIV and other unwanted consequences of unprotected sex requires deeper understanding of characteristics of condom usage among sexually active youth. The present study assesses whether partner trust predicts condom usage, and whether potential associations were mediated by general self-efficacy, among a cohort of sexually active adolescents in Meru County, Kenya. We also sought to discover associations between socio-economic status, psychological resilience and partner trust to increase understanding of trust towards one’s intercourse partner. Mediation analyses, stratified by gender, reveal that condom usage is predicted by self-efficacy and partner trust among females but not males. Higher psychological resilience predicts lower partner trust among both genders. Partner trust was lower among female respondents who were not literate, but did not significantly vary by literacy among males. Reported previous monthly earnings were not significantly associated with partner trust among males or females. The present findings support further study on partner trust, and its association with protective sex behaviors. Further, interventions targeting condom usage among females may benefit from actions to increase awareness of partner sexual behavior and increasing self-efficacy. (Afr J Reprod Health 2016; 20[2]: 94-103).Keywords: condom use; self-efficacy; orphans and vulnerable children; Kenya
      PubDate: 2016-09-28
      Issue No: Vol. 20, No. 2 (2016)
  • Integrating intimate partner violence screening and counseling in a family
           planning clinic: evaluation of a pilot project in Conakry, Guinea

    • Authors: Ghazaleh Samandari, Alexandre Delamou, Pernamou Traore, Fatoumata Guilinty Diallo, Sita Millimono, Bienvenu Salim Camara, Kira Laffe, Fabio Verani, Maimouna Tolliver
      Abstract: Few programs exist to address Intimate Partner Violence (IPV) in Guinea. In 2014, Engender Health, in partnership with the local health authorities in Conakry, Guinea, piloted an integrated approach to IPV screening and counseling, within an existing family planning clinic. This article describes both the process of formulating and implementing this approach, as well as the results of an evaluation of the program. From January to June of 2014, Engender Health staff trained midwives at the Conakry International Planned Parenthood Federation family planning clinic staff in screening and counseling client for IPV. Program evaluators used project records, interview with program staff (n=3), midwives (n=3) and client exit interviews (n=53) to measure the outcomes of this pilot project. Regardless of their IPV status, clients appreciated having a venue in which to discuss IPV. Program staff also felt empowered by the additional training and support for IPV screening. The evaluation yielded valuable suggestions for improvement, including more time for staff training and mock client interview practice, additional skills in counseling, and stronger referral links for women who screen positive for IPV. Integrating IPV screening into family planning services is an important and feasible method for reaching vulnerable women with IPV services. (Afr J Reprod Health 2016; 20[2]: 86-93).Keywords: Sexual intercourse, sexual debut, risk factor, HIV/AIDS, IPV
      PubDate: 2016-09-28
      Issue No: Vol. 20, No. 2 (2016)
  • Determinants of maternal utilization of health services and nutritional
           status in a rural community in South-West Nigeria

    • Authors: Adebowale Ayo Stephen, Akinyemi Odunayo Joshua
      Abstract: Poor Maternal Health (MH) remains an issue of public health concern in Nigeria. This study identified the determinants of maternal utilization of health services and nutritional status in a rural community in south-west Nigeria. It was a cross-sectional house-hold survey of women aged 15-49 years. Data were analysed using Chi-square, logistic regression and generalized linear models (α=.05). Respondents’ mean age was 29.9±7.8 years and about 9.0% were underweight, 76.7% attended ≥4 ANC visits and 65.7% were provided with ANC by skilled health workers. Sixty-two percent delivered in modern health facility, 67.5% were assisted by skilled health worker and 29.1% sought post-natal care within the first 3 days after delivery. The likelihood of delivery in health facility was 1.48(C.I=1.10-1.99, p<0.05) higher among women in monogamous than those in polygamy family. The estimated maternal mortality ratio was 448 deaths/100,000 live-births. The findings emphasize the need to scale-up MH improvement strategies in the study area. (Afr J Reprod Health 2016; 20[2]: 72-85).Keywords: Maternal health care; Rural community, Maternal nutritional status
      PubDate: 2016-09-28
      Issue No: Vol. 20, No. 2 (2016)
  • Family planning providers’ experiences and perceptions of long-acting
           reversible contraception in Lilongwe, Malawi

    • Authors: Tapika Mwafulirwa, Michele S. O’Shea, Gloria Hamela, Emilia Samuel, Christine Chingondole, Virginia Chipangula, Mina C. Hosseinipour, Jennifer H. Tang
      Abstract: Less than 2% of Malawian women use long-acting reversible contraception (LARC). We describe experiences of Malawian family planning providers, focusing on LARC. We conducted a mixed-methods study using questionnaires and focus group discussions with providers in Lilongwe. Data were analyzed separately and triangulated. Most (58%) participants saw over 30 patients daily. Only 19% had ever inserted IUC. Qualitative data were complementary; participants noted that LARC provision was important, though hindered by lack of experienced providers, work burden, and low demand. Future efforts to improve LARC access in Lilongwe must address both supply and demand-side barriers. (Afr J Reprod Health 2016; 20[2]: 62-71).Keywords: Family planning, long-acting reversible contraception, Malawi
      PubDate: 2016-09-28
      Issue No: Vol. 20, No. 2 (2016)
  • The effects of early first sexual intercourse amongst Lesotho women:
           evidence from the 2009 Lesotho Demographic and Health Survey

    • Authors: Tshaudi Motsima, Jean-Claude Malela-Majika
      Abstract: Age at first sexual intercourse may be a predictor of future sexual behaviour and an important indicator for exposure to HIV transmission. The purpose of the study is to establish risk factors associated with age at first intercourse among Lesotho women aged 15 to 49 years. The data used came from the 2009 Lesotho Demographic and Health Survey and probit models were applied for analysis. It was found that women who have had their first sexual intercourse at age 16 or below were at risk of being married at age 18 or below (p < 0.001), are likely not to make it to secondary school (p < 0.001) and having the highest chance of not have known about the AIDS disease as compared to women who have had their sexual intercourse after the age of 16 years (p < 0.05). Delaying entry into sexuality could be safer and more secure to protect the sexual and reproductive health in young women. The more time women spend at school the less likely that they can engage in sexual intercourse at a young age (Afr. J Reprod Health 2016; 20[2]: 34-42).Keywords: Sexual intercourse, sexual debut, risk factor, HIV, AIDS
      PubDate: 2016-09-28
      Issue No: Vol. 20, No. 2 (2016)
  • The relationship between facility-based delivery and infant immunization
           in sub-Saharan Africa

    • Authors: Cheryl A. Moyer, Dana Benyas, Sarah Rominski
      Abstract: This study explored the relationship between facility-based delivery and infant immunizations in sub-Saharan Africa, controlling for economic development indicators. Publically available data were collected and imported into Stata 11.0 for descriptive, correlation, and regression analyses. Facility delivery was significantly associated with full vaccination and BCG immunization in children aged 12-23 months. Facility delivery was associated with full vaccination (p<.019), even after controlling for antenatal care usage, Gross National Income per capita, percent of the country’s population residing in an urban setting, and percent of the population with at least a secondary education (β: 0.45 (95% CI: 0.08 – 0.81)). The relationship between facility delivery and immunization is significant, and robust enough to remain after controlling for economic and social indicators linked to both. These results suggest the benefits of facility delivery transcend the immediate survival benefit for mothers and their babies, and may serve as a gateway to further interactions with the healthcare system. (Afr. J Reprod Health 2016; 20[2]: 27-33).Keywords: institutional delivery; skilled birth attendance; infant immunizations; Africa; developing countries
      PubDate: 2016-09-28
      Issue No: Vol. 20, No. 2 (2016)
  • Determinants of condom use among selected migrant commercial farm workers
           in South Africa

    • Authors: Linda Musariri, Clifford O. Odimegwu
      Abstract: Previous studies have shown that HIV prevalence rates are relatively high while condom use is low in migrant communities in South Africa. Using data from the Integrated Biological and Behavioural Surveillance Survey implemented by the International Organisation for Migration in 2010 among farm workers, this study seeks to investigate factors associated with condom use among migrant men and women in selected commercial farms in two provinces of South Africa. The study analysed 943 sexually active non-South Africans working in selected farms. Data analysis was undertaken at univariate, bivariate and multivariate levels using logistic regression producing odds ratios to examine the associations at 5% level of significance. The results showed that access to free condoms, financial stability and staying away from spouse increased the odds of condom use among migrant farm workers in Limpopo and Mpumalanga. Amongst men being financially stable and having access to free condoms significantly increased the odds of using condoms. Amongst women being married reduced the odds of using condoms while access to free condoms and living away from spouse significantly increased condom use. Determinants of condom use vary between male and female migrants. HIV prevention policies and programmes targeting migrant farm workers should be gender sensitive. (Afr J Reprod Health 2016; 20[2]: 13-26).Keywords: HIV prevention, migrant labour, risky behaviour, vulnerabilities
      PubDate: 2016-09-28
      Issue No: Vol. 20, No. 2 (2016)
  • The Botswana medical eligibility criteria wheel: adapting a tool to meet
           the needs of Botswana’s Family Planning program

    • Authors: Caron R. Kim, Nancy Kidula, Molly K. Rammipi, Lesego Mokganya, Mary Lyn Gaffield
      Abstract: In efforts to strive for family planning repositioning in Botswana, the Ministry of Health convened a meeting to undertake an adaptation of the Medical eligibility criteria for contraceptive use (MEC) wheel. The main objectives of this process were to present technical updates of the various contraceptive methods, to update the current medical conditions prevalent to Botswana and to adapt the MEC wheel to meet the needs of the Botswanian people. This commentary focuses on the adaptation process that occurred during the week-long stakeholder workshop. It concludes with the key elements learned from this process that can potentially inform countries who are interested in undergoing a similar exercise to strengthen their family planning needs. (Afr. J Reprod Health 2016; 20[2]: 9-12)Keywords: Family planning, Contraception, Medical Eligibility Criteria (MEC), Adaptation
      PubDate: 2016-09-28
      Issue No: Vol. 20, No. 2 (2016)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
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