scholarly journals Postpartum long-acting contraception uptake and service delivery outcomes after a multilevel intervention in Kigali, Rwanda

2020 ◽  
pp. bmjsrh-2020-200741
Author(s):  
Julie Espey ◽  
Rosine Ingabire ◽  
Julien Nyombayire ◽  
Alexandra Hoagland ◽  
Vanessa Da Costa ◽  
...  
Keyword(s):  
Supply And Demand ◽  
Intrauterine Device ◽  
Unmet Need ◽  
Secondary Analysis ◽  
Stakeholder Involvement ◽  
Primary Objective ◽  
Published Data ◽  
National Priority ◽  
Long Acting ◽  
Multilevel Intervention

IntroductionPostpartum family planning (PPFP) is critical to reduce maternal–child mortality, abortion and unintended pregnancy. As in most countries, the majority of PP women in Rwanda have an unmet need for PPFP. In particular, increasing use of the highly effective PP long-acting reversible contraceptive (LARC) methods (the intrauterine device (IUD) and implant) is a national priority. We developed a multilevel intervention to increase supply and demand for PPFP services in Kigali, Rwanda.MethodsWe implemented our intervention (which included PPFP promotional counselling for clients, training for providers, and Ministry of Health stakeholder involvement) in six government health facilities from August 2017 to October 2018. While increasing knowledge and uptake of the IUD was a primary objective, all contraceptive method options were discussed and made available. Here, we report a secondary analysis of PP implant uptake and present already published data on PPIUD uptake for reference.ResultsOver a 15-month implementation period, 12 068 women received PPFP educational counselling and delivered at a study facility. Of these women, 1252 chose a PP implant (10.4% uptake) and 3372 chose a PPIUD (27.9% uptake). On average providers at our intervention facilities inserted 83.5 PP implants/month and 224.8 PPIUDs/month. Prior to our intervention, 30 PP implants/month and 8 PPIUDs/month were inserted at our selected facilities. Providers reported high ease of LARC insertion, and clients reported minimal insertion anxiety and pain.ConclusionsPP implant and PPIUD uptake significantly increased after implementation of our multilevel intervention. PPFP methods were well received by clients and providers.

scholarly journals Introducing the hormonal Intrauterine Device in Madagascar, Nigeria, and Zambia: results from a pilot study

2022 ◽  
Vol 19 (1) ◽  
Author(s):  
Kendal Danna ◽  
Grace Jaworski ◽  
Bakoly Rahaivondrafahitra ◽  
Francia Rasoanirina ◽  
Anthony Nwala ◽  
...  
Keyword(s):  
Intrauterine Device ◽  
Descriptive Analysis ◽  
Unmet Need ◽  
Cumulative Probability ◽  
User Characteristics ◽  
Middle Income ◽  
Prospective Longitudinal Study ◽  
Highly Effective ◽  
Long Acting ◽  
Prospective Longitudinal

Abstract Background The hormonal Intrauterine Device (IUD) is a highly effective contraceptive option growing in popularity and availability in many countries. The hormonal IUD has been shown to have high rates of satisfaction and continuation among users in high-income countries. The study aims to understand the profiles of clients who choose the hormonal IUD in low- and middle-income countries (LMICs) and describe their continuation and satisfaction with the method after 12 months of use. Methods A prospective longitudinal study of hormonal IUD acceptors was conducted across three countries—Madagascar, Nigeria, and Zambia—where the hormonal IUD had been introduced in a pilot setting within the of a broad mix of available methods. Women were interviewed at baseline immediately following their voluntary hormonal IUD insertion, and again 3 and 12 months following provision of the method. A descriptive analysis of user characteristics and satisfaction with the method was conducted on an analytic sample of women who completed baseline, 3-month, and 12-month follow-up questionnaires. Kaplan–Meier time-to-event models were used to estimate the cumulative probability of method continuation rates up to 12 months post-insertion. Results Each country had a unique demographic profile of hormonal IUD users with different method-use histories. Across all three countries, women reported high rates of satisfaction with the hormonal IUD (67–100%) and high rates of continuation at the 12-month mark (82–90%). Conclusions Rates of satisfaction and continuation among hormonal IUD users in the study suggest that expanding method choice with the hormonal IUD would provide a highly effective, long-acting method desirable to many different population segments, including those with high unmet need.

Quality of life in RCT of pasireotide to reduce pancreatic complications following resection.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 393-393
Author(s):  
Anne Eaton ◽  
Mithat Gonen ◽  
Paul Jack Karanicolas ◽  
Michael Ian D'Angelica ◽  
Ronald P. DeMatteo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Controlled Trial ◽  
Unmet Need ◽  
Secondary Analysis ◽  
Primary Objective ◽  
Recent Trial ◽  
Double Blind ◽  
Significant Difference ◽  
Eortc Qlq

393 Background: A recent trial demonstrated that prophylactic pasireotide reduces pancreatic complication (PC) rates (primary objective). In this secondary analysis, we describe quality of life (QoL) in this population before and after resection using a standard instrument (the EORTC QLQ-C30) and the EORTC pancreatic cancer module (PAN26), which was recently developed to address the unmet need for QoL assessment in this subpopulation. Also of interest is assessing the association between PC and QoL and testing the hypothesis that pasireotide improves QoL. Methods: We conducted a randomized, double-blind, placebo-controlled trial of preoperative subcutaneous pasireotide in 300 patients undergoing pancreaticoduodenectomy or distal pancreatectomy. Participants completed the C30 and PAN26 preoperatively and on postoperative days 14 and 60. Scores were compared using paired t-tests. Results: All patients completed at least one questionnaire and 87% of patients completed all three. No major differences in QoL were seen between treatment groups so pooled results were reported. A significant worsening of function at 14 days was detected on all PAN26 and C30 function scales except hepatic and emotional functioning (EF), and all C30 symptom scales (all p<.01). These effects lessened by 60 days, but scores remained significantly worse than baseline with the exception of the sexuality, cognitive functioning, nausea and vomiting, insomnia and constipation scales, which returned to near baseline, and EF, which was significantly better than baseline (p=0.03). PC occurred in 45 patients and was associated with worse body image, dyspnea, financial difficulties and physical, role, emotional and social functioning at 14 and 60 days (all p<.05). Conclusions: During the first 14 days following resection, patients can be expected to have a significant decline in QoL. Many symptoms abate by 60 days, and EF improves. Although pasireotide effectively reduced PC, its effect did not appear to translate to improved QoL based on this sample of 300 patients. While PC was associated with worse QoL, most patients in both pasireotide and placebo groups did not experience PC, which may explain why no significant difference in QoL was observed. Clinical trial information: NCT00994110.

scholarly journals Introducing the Hormonal Intrauterine Device in Madagascar, Nigeria, and Zambia: Results From a Pilot Study

2021 ◽  
Author(s):  
Kendal Danna ◽  
Grace Jaworski ◽  
Bakoly Rahaivondrafahitra ◽  
Francia Rasoanirina ◽  
Anthony Nwala ◽  
...  
Keyword(s):  
Intrauterine Device ◽  
Descriptive Analysis ◽  
Unmet Need ◽  
User Characteristics ◽  
Middle Income ◽  
Prospective Longitudinal Study ◽  
Highly Effective ◽  
Estimate Method ◽  
Long Acting ◽  
Prospective Longitudinal

Abstract Background: The hormonal Intrauterine Device (IUD) is a highly effective contraceptive option growing in popularity and availability in many countries. The hormonal IUD has been shown to have high rates of satisfaction and continuation among users in high-income countries. The study aims to understand the profiles of clients who choose the hormonal IUD in low-and middle-income countries (LMICs) and describe their continuation and satisfaction with the method after 12 months of use. Methods: A prospective longitudinal study of hormonal IUD acceptors was conducted across three countries—Madagascar, Nigeria, and Zambia—where the hormonal IUD had been introduced in a pilot setting within the context of a broad mix of available methods. Women were interviewed at baseline immediately following their voluntary hormonal IUD insertion, and again three and 12 months following provision of the method. A descriptive analysis of user characteristics and satisfaction with the method was conducted on an analytic sample of women who completed baseline, three-month, and 12-month follow-up questionnaires. Kaplan-Meier cumulative hazard models were used to estimate method continuation rates up to 12 months post-insertion.Results: Each country had a unique demographic profile of hormonal IUD users with different method use histories. Across all three countries, women reported high rates of satisfaction with the hormonal IUD (67-100%) and high rates of continuation at the 12-month mark (91-93%).Conclusions: Rates of satisfaction and continuation among hormonal IUD users in the study suggest that expanding method choice with the hormonal IUD would provide a highly effective, long-acting method desirable to many different population segments, including those with high unmet need.

scholarly journals Medical management of deeply infiltrating endometriosis - 7 year experience in a tertiary endometriosis centre in London

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Marianne Wild ◽  
Tariq Miskry ◽  
Asmaa Al-Kufaishi ◽  
Gillian Rose ◽  
Mary Crofton
Keyword(s):  
Medical Management ◽  
Obstructive Uropathy ◽  
Intrauterine Device ◽  
Secondary Analysis ◽  
Surgical Excision ◽  
Hormonal Contraceptive ◽  
Reproductive Age ◽  
Deeply Infiltrating Endometriosis ◽  
Hormonal Therapies ◽  
Infiltrating Endometriosis

Abstract Background Deeply infiltrating endometriosis has an estimated prevalence of 1% in women of reproductive age. Ninety percent have rectovaginal lesions but disease may also include the bowel, bladder and ureters. Current practice often favours minimally invasive surgical excision; however, there is increasing evidence that medical management can be as effective as long as obstructive uropathy and bowel stenosis are excluded. Our objective was to establish the proportion of women with deeply infiltrating endometriosis successfully managed with hormonal therapies within our tertiary endometriosis centre in West London. Secondary analysis was performed on anonymised data from the Trust’s endometriosis database. Results One hundred fifty-two women with deeply infiltrating endometriosis were discussed at our endometriosis multidisciplinary meeting between January 2010 and December 2016. Seventy-five percent of women underwent a trial of medical management. Of these, 44.7% did not require any surgical intervention during the study period, and 7.9% were symptomatically content but required interventions to optimise their fertility prospects. Another 7.0% were successfully medically managed for at least 12 months, but ultimately required surgery as their symptoms deteriorated. 26.5% took combined oral contraceptives, 14.7% oral progestogens, 1.5% progestogen implant, 13.2% levonorgestrel intrauterine device, 22.1% gonadotrophin-releasing hormone analogues, and 22.1% had analogues for 3–6 months then stepped down to another hormonal contraceptive. All women who underwent serial imaging demonstrated improvement or stable disease on MRI or ultrasound. Conclusions Medical treatments are generally safe, well tolerated and inexpensive. More than half (52.6%) of women were successfully managed with medical therapy to control their symptoms. This study supports the growing evidence supporting hormonal therapies in the management of deeply infiltrating endometriosis. The findings may be used to counsel women on the likely success rate of medical management.

A secondary analysis of the library profession’s self-reported competence and comfort in working with patrons with disabilities

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
JJ Pionke
Keyword(s):  
Graduate School ◽  
Information Science ◽  
Secondary Analysis ◽  
Assistive Technologies ◽  
Library And Information Science ◽  
Published Data ◽  
Content Type ◽  
Current State ◽  
Practical Implications ◽  
The Continuum

PurposeThis article presents a secondary analysis of previously published data in order to drive discussion of the library profession’s current state of preparedness in working with patrons with disabilities.Design/methodology/approachThis article used a secondary analysis of survey data that have been previously published to determine what the continuum of data said about the current state of preparedness in the profession when working with people with disabilities.FindingsA comparison of the data from both surveys reveals that there are not only gaps in library graduate school education related to disability and accessibility but also that those gaps are not being addressed through professional development and staff training after students enter the workforce.Research limitations/implicationsThis was a secondary analysis of data, so no new data could be added. There was also no representation from library graduate school administration.Practical implicationsAn awareness is built that there needs to be more instruction for library graduate students and library employees on topics related to disability, accessibility and assistive technologies.Originality/valueThe topic has never been studied before in this kind of continuum of data, and the use of the secondary analysis of data with the library and information science profession is exceedingly rare.

scholarly journals Stigma as a barrier to family planning use among married youth in Ethiopia

2018 ◽  
Vol 51 (4) ◽  
pp. 505-519
Author(s):  
Aparna Jain ◽  
Hussein Ismail ◽  
Elizabeth Tobey ◽  
Annabel Erulkar
Keyword(s):  
Family Planning ◽  
Supply And Demand ◽  
Unmet Need ◽  
Principal Component ◽  
Principal Component Factor Analysis ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Adolescent Groups ◽  
Anticipated Stigma ◽  
Youth Friendly Service

AbstractNearly 33 million female youths have an unmet need for voluntary family planning (FP), meaning they are sexually active and do not want to become pregnant. In Ethiopia, age at marriage remains low: 40% and 14% of young women aged 20–24 were married by the ages of 18 and 15, respectively. Despite increases in FP use by married 15- to 24-year-olds from 5% in 2000 to 37% in 2016, unmet need remains high at 19%. Supply-and-demand factors have been shown to limit FP use, yet little is known about how stigma influences FP use among youth. This study validates an anticipated stigma (expectation of discrimination from others) index and explores its effect on unmet need. A cross-sectional survey was implemented with 15- to 24-year-old female youth in Ethiopia in 2016. The analytic sample included married respondents with a demand (met and unmet need) for FP (n=371). A five-item anticipated stigma index (Cronbach’sα=0.66) was developed using principal component factor analysis. These items related to fear, worry and embarrassment when accessing FP. The findings showed that 30% agreed with at least one anticipated stigma question; 44% had an unmet need; 58% were married before age 18; and 100% could name an FP method and knew where to obtain FP. In multivariate regression models, youth who experienced anticipated stigma were significantly more likely to have an unmet need, and those who lived close to a youth-friendly service (YFS) site were significantly less likely to have an unmet need. Interventions should address anticipated stigma while focusing on social norms that restrict married youth from accessing FP; unmet need may be mitigated in the presence of a YFS; and the anticipated stigma index appears valid and reliable but should be tested in other countries and among different adolescent groups.

Adolescents and the Copper Intrauterine Device: Emergency & Long-Acting Contraception

2018 ◽  
Vol 31 (2) ◽  
pp. 168
Author(s):  
Melissa Dundas ◽  
April Lee ◽  
Edward McCabe ◽  
Seleshi Demissie ◽  
Anthony Gonzalez
Keyword(s):  
Intrauterine Device ◽  
Long Acting ◽  
Copper Intrauterine Device

scholarly journals Tail-phase safety, tolerability, and pharmacokinetics of long-acting injectable cabotegravir in HIV-uninfected adults: a secondary analysis of the HPTN 077 trial

2020 ◽  
Vol 7 (7) ◽  
pp. e472-e481 ◽  
Author(s):  
Raphael J Landovitz ◽  
Sue Li ◽  
Joseph J Eron ◽  
Beatriz Grinsztejn ◽  
Halima Dawood ◽  
...  
Keyword(s):  
Secondary Analysis ◽  
Long Acting

scholarly journals UNMET NEED: KONSEP YANG MASIH PERLU DIPERDEBATKAN

Populasi ◽  
2016 ◽  
Vol 24 (1) ◽  
pp. 72-90
Author(s):  
Umi Listyaningsih ◽  
Sumini Sumini ◽  
Sonyaruri Satiti
Keyword(s):  
Family Planning ◽  
Performance Indicator ◽  
Supply And Demand ◽  
Unmet Need ◽  
Economic Background

Unmet need or the unful lled need for contraception is often associated with two things, namely supply and demand. This research attempted to overview the concept of unmet need by giving the attention to the socio-economic background of the couples. Through analizing the result of family survey in Daerah Istimewa Yogyakarta (DIY) and interviewing the eld surveyor of family planning (Petugas Lapangan Keluarga Berencana-PLKB) and women that categorized as unmet need, this research found that the numet need concept still needed to be explored further, especially when unmet need was used as the performance indicator in DIY. It related to the evidance that unmet need did not always end up with pregnancy. 

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