Browsing by Subject "Reproductive health"

Contraceptive prevalence in Haiti remains low despite extensive foreign aid targeted at improving family planning. [1] Earlier studies have found that peer-informed learning have been successful in promoting sexual and reproductive health. [2-5] This pilot project was implemented as a three-month, community-based, educational intervention to assess the impact of peer education in increasing contraceptive knowledge among women in Fondwa, Haiti. Research investigators conducted contraceptive information trainings to pre-identified female leaders of existing women’s groups in Fondwa, who were recruited as peer educators (n=4). Later, these female leaders shared the knowledge from the training with the test participants in the women’s group (n=23) through an information session. Structured surveys measuring knowledge of contraceptives were conducted with all participants before the intervention began, at the end of the intervention, and four weeks after the intervention. The surveys measured general contraceptive knowledge, knowledge about eight selected types of modern contraceptives and contraceptive preferences and attitudes. Only test participants showed significant improvement in their general contraceptive knowledge score (p<0.001), but both test participants and peer educators showed significant improvement in overall knowledge scores for identifying the types and uses of modern contraceptive methods. Assessment for knowledge retention remained significantly higher four weeks after the intervention than prior to the intervention. Therefore, a one-time, three-hour peer-based educational intervention using existing social structures is effective, and might be valuable in a population with minimal access to education and little to no knowledge about contraceptives.

Abstract

Background: While highly preventable cervical cancer remains a leading cause of

cancer in women globally. Sub-Saharan Africa is disproportionately affected, and in

Kenya specifically, over 4,800 new cervical cancer cases are diagnosed and over 2,000

deaths occur each year. While screening for human papillomavirus (HPV) is a more

cost-effective screening strategy with the potential to increase screening uptake, there is

substantial lost to follow-up (LTFU) for treatment following a positive HPV screen. This

study aimed to identify the predictors of successful treatment acquisition and explore

the barriers and facilitators to seeking treatment among HPV positive women.

Methods: This mixed-methods study was integrated into an ongoing clusterrandomized

trial of implementation strategies in rural western Kenya. This study

randomly selected 100 HPV positive women from the original study database and

conducted a treatment acquisition behavior survey. The study sought a 50/50 ratio of

women who were treated and LTFU, but obtained data from 61 treated women and 39

LTFU women. A subset of 10 women in each group were then selected for in-depth

interviews. Analysis included descriptive statistics to compare treated and LTFU

women’s responses to the survey questionnaire. Interview transcripts were coded and

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analyzed through code-by-code comparisons of women who were treated and women

who were LTFU.

Results: Cost of transportation and distance to the health facility were the most

common challenges in seeking treatment among both treated and LTFU women. Among

women who sought treatment, 67% (n=41) reported that their peers knew their HPV test

result, whereas among LTFU women only 38% (n=15) reported that their peers knew

their HPV test result (p=0.007). There was a significant difference in knowing their peers’

HPV result between treated and LTFU women (p=0.03). Partner support was described

by treated and LTFU women similarly, in that most women reported that they relied on

their partners for transportation money, and that men not understanding the disease

may prevent them from supporting their wives in seeking treatment. Additional barriers

included fear of the treatment process, stigma within their community, logistical

barriers, and lack of information on the disease and treatment. Facilitators to treatment

seeking included peer encouragement, support and encouragement of their children,

involving men in educational sessions, bringing facilities closer and providing

transportation to the health facility.

Conclusions: Cost of transportation, distance to the treatment facility, support of

partners and children, feelings of fear and stress, stigma within the community and

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logistical barriers were reported similarly across treated and LTFU groups. The greatest

disparity between the two groups was a lack of social support among LTFU women.

Given the potential impact of involving men and women in the community in

educational sessions, and promoting treatment seeking in groups, interventions that use

these treatment facilitators are needed.

Adolescent girls in sub-Saharan Africa must transition through puberty in the context of heightened risk for reproductive tract infections and mental illness. At the same time, girls experience menstrual stigma and a lack of resources to manage menstruation. Although menstruation and other puberty-specific stressors may negatively impact girls’ well-being, little is known about the relationships between puberty-specific stressors, coping, mental health, and reproductive health among girls in sub-Saharan Africa. The present dissertation seeks to fill this gap by investigating the types of puberty-specific stressors experienced by adolescent girls and young women in Tanzania, how girls cope with stressors, and the associations between stress and coping and mental health and reproductive health. A qualitative interview study and cross-sectional survey study were conducted to explore stress, coping, and health among adolescent girls in Tanzania. Both studies showed that girls experienced significant and disruptive puberty-specific stressors, with sexual pressure and menstrual pain constituting two of the most common stressors. Stressors were associated with depression, anxiety, and reproductive tract infections. Active coping and avoidant coping showed inconsistent relationships with stressors and mental health. Overall, psychosocial interventions are needed to reduce the negative impact of puberty-specific stressors on mental health and reproductive health among adolescent girls in Tanzania.

Adolescent girls' sexual and reproductive health (SRH) is a significant public health issue, but little is known about the SRH outcomes of orphaned and separated adolescent girls, who face a higher risk of abuse and neglect in the absence of parental guidance, underscoring the critical need for research. This study examines the SRH outcomes (early pregnancy and condom use) and their predictors among adolescent girls aged 15 to 21 in five low- and middle-income countries, including orphaned and separated children. We conducted a cross-sectional analysis of 933 participants during the latest round of data collection from a longitudinal cohort study to assess predictors of early pregnancy and condom use. We first used bivariable logistic regression to identify potential predictors of each outcome. Potential predictors included education level, abuse, working status, relationship status, and age. Predictors that were significant (p<=0.10) in crude analyses were added to a multivariable model to assess associations in the presence of other predictors. In bivariable analysis, we found that education, marital status, history of abuse, work status, and age are associated with early pregnancy. However, we did not find a significant association for condom use with any predictors. It should be noted that the findings may be imprecise due to the small sample sizes and exclusion of children under 16 years old. Further research is needed to explore targeted interventions aimed at reducing early pregnancy and promoting condom use. Addressing education, work, and relationship status may enhance the effectiveness of such interventions.