Uptake of long acting reversible contraception following integrated couples HIV and fertility goal-based family planning counselling in Catholic and non-Catholic, urban and rural government health centers in Kigali, Rwanda

Abstract Background. There is unmet need for family planning in Rwanda. We previously developed an evidence-based couples’ family planning counseling (C)FPC program in the capital city that combines: 1) fertility goal-based family planning counseling with a focus on long-acting reversible contraceptive (LARC) for couples wishing to delay pregnancy; 2) health center capacity building for provision of LARC methods, and 3) LARC promotion by community health workers (CHW) trained in community-based provision (CBP) of oral and injectable contraception. From 2015-2016, this service was integrated into eight government health centers in Kigali, reaching 6,072 clients and resulting in 5,743 LARC insertions. Methods. From May-July 2016, we conducted health center needs assessments in 30 rural health centers using surveys, key informant interviews, logbook extraction, and structured observations. The assessment focused on the infrastructure, materials, and human resources needed for LARC demand creation and provision.Results. Few nurses had received training in LARC insertion (41% implant, 27% intrauterine device (IUD)). All health centers reported working with CHW, but none trained in LARC promotion. Health centers had limited numbers of IUDs (average 16.4), implants (average 56.1), functional gynecological exam tables (average 2.3), and lamps for viewing the cervix (average <1). Many did not have backup power supplies (40%). Most health centers reported no funding partners for family planning assistance (60%). Per national guidelines, couples’ voluntary HIV counseling and testing (CVCT) was provided at the first antenatal visit at all clinics, reaching over 80% of pregnant women and their partners. However, only 10% of health centers had integrated family planning and HIV services. Conclusions. To successfully implement (C)FPC and LARC services in rural health centers across Rwanda, material and human resource capacity for LARC provision will need to be greatly strengthened through equipment (gynecological exam tables, sterilization capacity, lamps, and backup power supplies), provider trainings and follow-up supervision, and new funding partnerships. Simultaneously, awareness of LARC methods will need to be increased among couples through education and promotion to ensure that demand and supply scale up together. The potential for integrating (C)FPC with ongoing CVCT in antenatal clinics is unique in Africa and should be pursued.

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Cross-sectional assessment of government health center needs to implement long-acting reversible contraception services in rural Rwanda

BMC Women s Health ◽

10.1186/s12905-021-01555-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Amelia Mazzei ◽

Rosine Ingabire ◽

Etienne Karita ◽

Jeannine Mukamuyango ◽

Julien Nyombayire ◽

...

Keyword(s):

Family Planning ◽

Health Center ◽

Rural Health ◽

Health Centers ◽

Power Supplies ◽

Cross Sectional ◽

Government Health ◽

Family Planning Counseling ◽

Rural Health Centers ◽

Long Acting

Abstract Background There is unmet need for family planning in Rwanda. We previously developed an evidence-based couples’ family planning counseling (C)FPC program in the capital city that combines: (1) fertility goal-based family planning counseling with a focus on long-acting reversible contraceptive (LARC) for couples wishing to delay pregnancy; (2) health center capacity building for provision of LARC methods, and (3) LARC promotion by community health workers (CHW) trained in community-based provision of oral and injectable contraception. From 2015 to 2016, this service was integrated into eight government health centers in Kigali, reaching 6072 clients and resulting in 5743 LARC insertions. Methods From May to July 2016, we conducted cross-sectional health center needs assessments in 30 rural health centers using surveys, key informant interviews, logbook extraction, and structured observations. The assessment focused on the infrastructure, materials, and human resources needed for LARC demand creation and provision. Results Few nurses had received training in LARC insertion [41% implant, 27% intrauterine device (IUD)]. All health centers reported working with CHW, but none trained in LARC promotion. Health centers had limited numbers of IUDs (median 10), implants (median 39), functional gynecological exam tables (median 2), and lamps for viewing the cervix (median 0). Many did not have backup power supplies (40%). Most health centers reported no funding partners for family planning assistance (60%). Per national guidelines, couples’ voluntary HIV counseling and testing (CVCT) was provided at the first antenatal visit at all clinics, reaching over 80% of pregnant women and their partners. However, only 10% of health centers had integrated family planning and HIV services. Conclusions To successfully implement (C)FPC and LARC services in rural health centers across Rwanda, material and human resource capacity for LARC provision will need to be greatly strengthened through equipment (gynecological exam tables, sterilization capacity, lamps, and backup power supplies), provider trainings and follow-up supervision, and new funding partnerships. Simultaneously, awareness of LARC methods will need to be increased among couples through education and promotion to ensure that demand and supply scale up together. The potential for integrating (C)FPC with ongoing CVCT in antenatal clinics is unique in Africa and should be pursued.

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Acceptance and Positive Attitude Increased Utilization of Long Acting and Permanent Family Planning Methods Among Reproductive Age Group Women from Debre Berhan District, Ethiopia: Quantitative and Qualitative Analysis

Journal of Community Medicine & Health Education ◽

10.4172/2161-0711.1000541 ◽

2017 ◽

Vol 07 (04) ◽

Author(s):

Asegidew W ◽

Tariku B ◽

Kaba M ◽

Getachew S ◽

Ketsela K

Keyword(s):

Family Planning ◽

Qualitative Analysis ◽

Positive Attitude ◽

Reproductive Age ◽

Age Group ◽

Debre Berhan ◽

Planning Methods ◽

Long Acting ◽

Family Planning Methods ◽

Reproductive Age Group

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1535. Impact of Defunding Family Planning Health Centers on Gonorrhea and Chlamydia Cases in Iowa: A Spatiotemporal Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1715 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S768-S768

Author(s):

Megan L Srinivas ◽

Eileen Yang ◽

Weiming Tang ◽

Joseph Tucker

Keyword(s):

Family Planning ◽

Low Income ◽

Rural Areas ◽

Spatiotemporal Analysis ◽

Incidence Rates ◽

Health Centers ◽

Transmitted Infection ◽

Missed Opportunities ◽

Linear Regression Modeling ◽

The Impact

Abstract Background Fifteen states have defunded family planning health centers (FPHCs), causing thousands to be left without health services. This has accelerated in the COVID-19 era. FPHCs provide low-income individuals in rural areas with essential primary care services, including sexually transmitted infection prevention, testing, and treatment. The purpose of this analysis is to use spatiotemporal methods to examine the impact of FPHC closures in Iowa on the reported number of gonorrhea and chlamydia cases at the county level. Methods This analysis investigates the association between FPHC closures and changes in the number of gonorrhea and chlamydia cases between 2016 and 2018. Iowa implemented defunding policies for family planning clinics, resulting in four FPHC closures in June 2017. 2016 pre-closure STI incidence rates were compared to 2018 post-closure rates. Gonorrhea and chlamydia rates in the four Iowa counties with clinic closures were compared to the 95 Iowa counties without closures. T tests were used to compare changes in reported gonorrhea and chlamydia rates in the two settings. Linear regression modeling was used to determine the relationship between clinic closures and changes in gonorrhea and chlamydia cases. Results The gonorrhea burden in Iowa increased from 83 cases per 100,000 people in 2016 to 153.8 cases per 100,000 people in 2018. The four counties with clinic closures experienced a significantly larger increase (absolute 217 cases per 100,000 population) in their gonorrhea rate compared to counties without FPHC closures (absolute 121 cases per 100,000 population). There was also a significant relationship between clinic closures and increasing gonorrhea rates (p = 0.0015). Over the three-year period, there was no change in chlamydia rates (p = 0.1182). However, there was a trend towards counties with more FPHC closures having a higher number of chlamydia cases (p = 0.057). Conclusion Despite the fact that many STI diagnoses are made and reported by FPHCs, our data suggest that clinic closures may have contributed to an increase in gonorrhea and chlamydia cases. This is consistent with delayed diagnoses and missed opportunities for providing essential STI services to vulnerable and under-served rural residents. Legislative action is urgently needed to curtail this trend. Disclosures All Authors: No reported disclosures

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Exploring country-wide equitable government health care facility access in Uganda

International Journal for Equity in Health ◽

10.1186/s12939-020-01371-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Nicholas Dowhaniuk

Keyword(s):

Health Care ◽

Random Forest ◽

Health Center ◽

Travel Time ◽

Health Centers ◽

Sub Saharan Africa ◽

Walking Distance ◽

Laboratory System ◽

Government Health ◽

Sub Saharan

Abstract Background Rural access to health care remains a challenge in Sub-Saharan Africa due to urban bias, social determinants of health, and transportation-related barriers. Health systems in Sub-Saharan Africa often lack equity, leaving disproportionately less health center access for the poorest residents with the highest health care needs. Lack of health care equity in Sub-Saharan Africa has become of increasing concern as countries enter a period of simultaneous high infectious and non-communicable disease burdens, the second of which requires a robust primary care network due to a long continuum of care. Bicycle ownership has been proposed and promoted as one tool to reduce travel-related barriers to health-services among the poor. Methods An accessibility analysis was conducted to identify the proportion of Ugandans within one-hour travel time to government health centers using walking, bicycling, and driving scenarios. Statistically significant clusters of high and low travel time to health centers were calculated using spatial statistics. Random Forest analysis was used to explore the relationship between poverty, population density, health center access in minutes, and time saved in travel to health centers using a bicycle instead of walking. Linear Mixed-Effects Models were then used to validate the performance of the random forest models. Results The percentage of Ugandans within a one-hour walking distance of the nearest health center II is 71.73%, increasing to 90.57% through bicycles. Bicycles increased one-hour access to the nearest health center III from 53.05 to 80.57%, increasing access to the tiered integrated national laboratory system by 27.52 percentage points. Significant clusters of low health center access were associated with areas of high poverty and urbanicity. A strong direct relationship between travel time to health center and poverty exists at all health center levels. Strong disparities between urban and rural populations exist, with rural poor residents facing disproportionately long travel time to health center compared to wealthier urban residents. Conclusions The results of this study highlight how the most vulnerable Ugandans, who are the least likely to afford transportation, experience the highest prohibitive travel distances to health centers. Bicycles appear to be a “pro-poor” tool to increase health access equity.

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Integration of Family Planning Counselling to Mass Screening Campaign for Cervical Cancer: Experience from Guinea

Obstetrics and Gynecology International ◽

10.1155/2018/3712948 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6

Author(s):

D. W. A. Leno ◽

F. D. Diallo ◽

A. Delamou ◽

F. D. Komano ◽

M. Magassouba ◽

...

Keyword(s):

Cervical Cancer ◽

Family Planning ◽

Mass Screening ◽

Local Treatment ◽

Cost Effective ◽

Cross Sectional Study ◽

Cross Sectional ◽

Capital Cities ◽

Long Acting ◽

Cancer Experience

Aim. To assess feasibility of integrating family planning counselling into mass screening for cervical cancer in Guinea. Methodology. This was a descriptive cross-sectional study conducted over a month in Guinea regional capital cities. The targeted population comprised women aged 15 to 49 years. Nearly 4000 women were expected for the screening campaigns that utilized VIA and VIL methods with confirmation of positive tests through biopsy. A local treatment was immediately performed when the patient was eligible. Results. Overall 5673 women aged 15 to 60 years were received, a surplus of 42% of the expected population. 92.3% of women were aged 15–49 years and 90.1% were 25–49 years. Long-acting methods were the most utilized (89.2% of family planning users). 154 precancerous and cancerous lesions were screened, a global positivity rate of 2.7%. Conclusion. Integration of counselling and family planning services provision during cervical cancer mass screening is a feasible strategy. A cost-effective analysis of this approach would help a better planning of future campaigns and its replication in other contexts.

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