Impact of experiencing specific side-effects on contraceptive switching and discontinuation in Uganda: Results from a longitudinal PMA Survey

Abstract There is substantial evidence that contraceptive side-effects are a major deterrent to consistent use of contraception but few studies in low- or middle-income countries explore the role that specific side-effects, rather than “side-effects and health concerns”, have on contraceptive dynamics. This study used population-based, longitudinal data to explore the effect that specific side-effects had on contraceptive continuation, discontinuation, and switching in Uganda. Methods Data for this study come from two rounds of PMA2020 data collection in Uganda PMA2020 Uganda’s sixth cross-sectional survey and a follow-up survey conducted one year later. The main outcomes of interest were discontinuation and switching among modern users of hormonal contraceptive methods and the IUD at baseline (n=550). Multivariable multinomial logistic regressions assessed the association of reporting experiencing specific side-effects (more bleeding, less bleeding, irregular bleeding, increased dryness/reduced libido, and physical discomfort) with discontinuation and switching one year later, adjusting for socio-demographic characteristics, type of method, and length of use.ResultsOne-third of hormonal contraceptive users reported experiencing side-effects at baseline. Reporting more bleeding increased the risk of discontinuation by 2.39 times (95% CI: 0.01-4.72). Experiencing irregular bleeding decreased the risk of switching by a factor of 0.40 (95% CI: 0.17-0.93). Vaginal dryness/reduced libido and physical discomfort were both marginally associated with increased relative risk of switching, increasing the risk of switching by a factor of 3.10 (95% CI : 0.97-9.10) and 1.75 (95% CI: 0.95-3.24), respectively. Wealth was significantly negatively associated with discontinuation while education was marginally significantly and positively associated with switching. ConclusionsGreater attention should be paid to understanding the unique contributions of side-effects to contraceptive behavior using population-based data. Not all side-effects are associated with contraceptive discontinuation and switching, despite the experience of side-effects being common. The experience of physical discomfort and vaginal dryness/reduced libido, largely ignored in other research, were shown to affect use. Providing greater individualized care that includes information about common side-effects and how they may impact daily life is necessary.

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Impact of Experiencing Specific Side-Effects on Contraceptive Switching and Discontinuation in Uganda: Results from a Longitudinal PMA Survey

10.21203/rs.3.rs-47447/v1 ◽

2020 ◽

Author(s):

Linnea A Zimmerman ◽

Dana Sarnak ◽

Celia Karp ◽

Shannon Wood ◽

Saifuddin Ahmed ◽

...

Keyword(s):

Relative Risk ◽

Side Effects ◽

Sexual Experience ◽

Hormonal Contraceptive ◽

Population Based ◽

General Category ◽

Physical Discomfort ◽

Individualized Care ◽

Irregular Bleeding ◽

One Year

Abstract There is substantial evidence that contraceptive side effects are a major deterrent to consistent use of contraception but few studies in low- or middle-income countries explore the role that specific side-effects, rather than the general category of “side-effects and health concerns”, have on contraceptive dynamics. This study used population-based, longitudinal data to explore the effect that specific side-effects had on contraceptive continuation, discontinuation, and switching in Uganda. Methods Data for this study come from two rounds of PMA2020 data collection in Uganda PMA2020 Uganda’s sixth cross-sectional survey and a follow-up survey conducted one year later. The main outcomes of interest were discontinuation and switching among modern users of hormonal contraceptive methods at baseline (n=550). Multivariable multinomial logistic regressions assessed the association of reporting experiencing specific side effects (more bleeding, less bleeding, irregular bleeding, changes to sexual experience, and physical discomfort) with discontinuation and switching one year later, adjusting for socio-demographic characteristics, type of method, and length of use.Results One-third of hormonal contraceptive users reported experiencing side-effects at baseline. Reporting more bleeding increased the risk of discontinuation by 2.39 times (95% CI: 0.01-4.72). Experiencing irregular bleeding decreased the risk of switching by a factor of 0.40 (95% CI: 0.17-0.93). Changes to sexual experience or physical discomfort were both associated with increased relative risk of switching; reporting a change to sexual experience increased the relative risk of switching by a factor of 3.10 (95% CI : 0.97-9.10) and physical discomfort increased the relative risk by a factor of 1.75 (95% CI: 0.95-3.24). Wealth was significantly negatively associated with discontinuation while education was marginally significantly and positively associated with switching. Conclusions Greater attention should be paid to understanding the unique contributions of side effects to contraceptive behavior using population-based data. Not all side effects are associated with contraceptive discontinuation and switching, despite the experience of side effects being common. The experience of physical discomfort and changes to sexual experience, largely ignored in other research, were shown to affect use. Providing greater individualized care that includes information about common side effects and how they may impact daily life is necessary.

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Association between experience of specific side-effects and contraceptive switching and discontinuation in Uganda: results from a longitudinal study

Reproductive Health ◽

10.1186/s12978-021-01287-5 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Linnea A. Zimmerman ◽

Dana O. Sarnak ◽

Celia Karp ◽

Shannon N. Wood ◽

Saifuddin Ahmed ◽

...

Keyword(s):

Side Effects ◽

Contraceptive Use ◽

Hormonal Contraceptive ◽

Population Based ◽

Baseline Survey ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Middle Income ◽

Individualized Care ◽

Significant Difference

Abstract Background There is substantial evidence that contraceptive side-effects are a major deterrent to consistent use of contraception but few studies in low- or middle-income countries explore the role of specific side-effects on contraceptive use dynamics. This study used population-based, longitudinal data to explore the effect of specific side-effects on contraceptive continuation, discontinuation, and switching in Uganda. Methods Data for this study come from two rounds of survey data collection in Uganda: PMA2020’s sixth cross-sectional survey and a follow-up survey conducted 1 year later. The main outcomes of interest were discontinuation and switching among users of hormonal contraceptive methods (implants, injectables and oral pill) and the IUD at baseline (n = 560). Multivariable logistic regressions assessed the association of experiencing specific side-effects (more bleeding, less bleeding, irregular bleeding, increased dryness/reduced libido, and physical discomfort) with discontinuation and switching 1 year later, adjusting for socio-demographic characteristics, type of method, and length of use. We also examined the differential effects of side-effects between discontinuation and switching risks. Results About 23% of hormonal and IUD contraceptive users reported experiencing side-effects at baseline survey. Overall, discontinuation and switching were higher among injectables and pill users, compared to IUD and implants users. Reporting more bleeding or less bleeding increased the odds of discontinuation and switching by 2.74 (95% CI 1.00–7.51) and 1.86 (1.04–3.34), respectively. There was no significant difference in discontinuation and switching by side-effects. Conclusions Greater attention should be paid to understanding the unique contributions of side-effects to contraceptive behavior using population-based data. While about a quarter of women reported experiencing side effects, those who experienced bleeding specific side effects were at higher risk of contraceptive discontinuation and switching. Providing greater individualized care that includes information and counseling about common side-effects, how they may impact daily life, and how tolerable these effects may be is necessary.

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Faculty Opinions recommendation of Association of respiratory symptoms and asthma with occupational exposures: findings from a population-based cross-sectional survey in Telemark, Norway.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727449994.793530695 ◽

2017 ◽

Author(s):

Sherwood Burge

Keyword(s):

Respiratory Symptoms ◽

Occupational Exposures ◽

Population Based ◽

Cross Sectional Survey ◽

Cross Sectional

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Population-based cross-sectional prevalence survey of diabetes and diabetic retinopathy in Sohag—Egypt, 2019

BMJ Open ◽

10.1136/bmjopen-2020-047757 ◽

2021 ◽

Vol 11 (6) ◽

pp. e047757

Author(s):

Heba AlSawahli ◽

Caleb D Mpyet ◽

Gamal Ezzelarab ◽

Ibrahim Hassanin ◽

Mohammad Shalaby ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Rapid Assessment ◽

Good Control ◽

Population Based ◽

Secondary Outcome ◽

Public Health Approach ◽

Eye Care ◽

Cross Sectional Survey ◽

Prevalence Survey ◽

Cross Sectional

ObjectivesTo determine the prevalence of diabetes mellitus (DM), prevalence of diabetic retinopathy (DR) and sight-threatening conditions among persons with DM aged 50 years and older in Sohag governorate in Upper Egypt.DesignPopulation-based, cross-sectional survey using the standardised Rapid Assessment of Avoidable Blindness with the addition of the Diabetic Retinopathy module methodology.SettingsSohag governorate in Egypt where 68 clusters were selected using probability proportional to population size. Households were selected using the compact segment technique.Participants4078 people aged 50 years and older in 68 clusters were enrolled, of which 4033 participants had their random blood sugar checked and 843 examined for features of DR.Primary and secondary outcomesThe prevalence of DM and DR; secondary outcome was the coverage with diabetic eye care.ResultsThe prevalence of DM was 20.9% (95% CI 19.3% to 22.5%). The prevalence in females (23.8%; 95% CI 21.4% to 26.3%) was significantly higher than in males (18.9%; 95% CI 17.1% to 20.7%) (p=0.0001). Only 38.8% of persons diagnosed with diabetes had good control of DM. The prevalence of DR in the sample was 17.9% (95% CI 14.7% to 21.1%). The prevalence in females was higher (18.9%; 95% CI 14.0% to 23.8%) than in males (17.1%; 95% CI 13.0% to 21.2%). Up to 85.3% of study participants have never had eye examination. Sight-threatening DR (R4 and/or M2) was detected in 5.2% (95% CI 3.4% to 7.0%) with only 2.3% having had laser treatment.ConclusionThe prevalence of uncontrolled DM in Sohag governorate in Egypt is higher than the national prevalence. There is a high prevalence of sight-threatening retinopathy and/or maculopathy with few people having access to diabetic eye care. A public health approach is needed for health promotion, early detection and management of DR.

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PvMSP8 as a Novel Plasmodium vivax Malaria Sero-Marker for the Peruvian Amazon

Pathogens ◽

10.3390/pathogens10030282 ◽

2021 ◽

Vol 10 (3) ◽

pp. 282

Author(s):

Elizabeth Villasis ◽

Katherine Garro ◽

Angel Rosas-Aguirre ◽

Pamela Rodriguez ◽

Jason Rosado ◽

...

Keyword(s):

Plasmodium Vivax ◽

Area Under The Curve ◽

Surface Protein ◽

Merozoite Surface Protein ◽

Population Based ◽

Peruvian Amazon ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Malaria Exposure ◽

Plasmodium Vivax Malaria

The measurement of recent malaria exposure can support malaria control efforts. This study evaluated serological responses to an in-house Plasmodium vivax Merozoite Surface Protein 8 (PvMSP8) expressed in a Baculovirus system as sero-marker of recent exposure to P. vivax (Pv) in the Peruvian Amazon. In a first evaluation, IgGs against PvMSP8 and PvMSP10 proteins were measured by Luminex in a cohort of 422 Amazonian individuals with known history of Pv exposure (monthly data of infection status by qPCR and/or microscopy over five months). Both serological responses were able to discriminate between exposed and non-exposed individuals in a good manner, with slightly higher performance of anti-PvMSP10 IgGs (area under the curve AUC = 0.78 [95% CI = 0.72–0.83]) than anti-PvMSP8 IgGs (AUC = 0.72 [95% CI = 0.67–0.78]) (p = 0.01). In a second evaluation, the analysis by ELISA of 1251 plasma samples, collected during a population-based cross-sectional survey, confirmed the good performance of anti-PvMSP8 IgGs for discriminating between individuals with Pv infection at the time of survey and/or with antecedent of Pv in the past month (AUC = 0.79 [95% CI = 0.74–0.83]). Anti-PvMSP8 IgG antibodies can be considered as a good biomarker of recent Pv exposure in low-moderate transmission settings of the Peruvian Amazon.

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The relationship between socioeconomic position and health literacy among urban and rural adults in regional China

BMC Public Health ◽

10.1186/s12889-021-10600-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wei Chen ◽

Hongfu Ren ◽

Na Wang ◽

Yaqing Xiong ◽

Fei Xu

Keyword(s):

Health Literacy ◽

Educational Attainment ◽

Socioeconomic Position ◽

Population Based ◽

Outcome Variable ◽

Average Income ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Logistic Regression Models ◽

Rural Adults

Abstract Background To examine associations of socioeconomic position (SEP), separately indicated by education, monthly family average income (FAI) and occupation, with health literacy (HL) among adults in regional China. Methods A cross-sectional survey was conducted among urban and rural adults (aged 25–69 years) who were randomly selected, using the probability proportionate to size sampling approach, from Nanjing municipality of China during October and December of 2016. HL, the outcome variable, was assessed using the Chinese Resident Health Literacy Scale. SEP, our independent variable, was separately measured with educational attainment, monthly family average income and occupation. Logistic regression models were introduced to examine SEP-HL association with odds ratio (OR) and 95% confidence interval (CI). Results Totally, 8698 participants completed the survey. The proportion of participants with unweighted and weighted adequate HL was 18.0% (95%CI = 17.2, 18.8%) and 19.9% (95%CI = 16.6, 23.6%), respectively, in this study. After adjustment for possible confounding factors, each SEP indicator was in significantly positive relation to both unweighted and weight HL level. Participants who obtained 13+ and 10–12 years educational attainment, respectively, had 2.41 (95%CI = 1.60, 3.64) and 1.68 (95%CI = 1.23, 2.29) times odds to record weighted adequate HL compared to their counterparts who were with 0–9 years education. Subjects within upper (OR = 1.92, 95%CI = 1.24, 2.98) and middle FAI tertile (OR = 1.59, 95%CI = 1.19, 2.13), respectively, were more likely to report weighted adequate HL relative to those who were within lower FAI tertile. White collars were more likely to have weighted adequate HL (OR = 1.33, 95%CI = 1.09, 1.61) than blue collars. Conclusions Each of education, FAI and occupation was positively associated with health literacy among urban and rural adults in China. The findings have important implications that different SEP indicators can be used to identify vulnerable residents in population-based health literacy promotion campaigns.

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Maternal adherence to micronutrient supplementation before and during pregnancy in Northwest China: a large-scale population-based cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2018-028843 ◽

2019 ◽

Vol 9 (8) ◽

pp. e028843 ◽

Cited By ~ 6

Author(s):

Danmeng Liu ◽

Yue Cheng ◽

Shaonong Dang ◽

Duolao Wang ◽

Yaling Zhao ◽

...

Keyword(s):

Pregnant Women ◽

Large Scale ◽

Northwest China ◽

Population Based ◽

Shaanxi Province ◽

Micronutrient Supplementation ◽

Cross Sectional Survey ◽

Start Time ◽

Cross Sectional ◽

Scale Population

ObjectivesTo report the situation of maternal micronutrient supplementation before and during pregnancy in Northwest China and to examine the rates of and factors related to the adherence to micronutrient supplementation among pregnant women in this region, where dietary micronutrient intake is commonly insufficient.DesignA large-scale population-based cross-sectional survey.SettingTwenty counties and ten districts of Shaanxi Province.ParticipantsA sample of 30 027 women were selected using a stratified multistage random sampling method. A total of 28 678 women were chosen for the final analysis after excluding those who did not provide clear information about nutritional supplementation before and during pregnancy.Main outcome measuresMaternal adherence to micronutrient supplementation (high and low) were the outcomes. They were determined by the start time and duration of use according to Chinese guidelines (for folic acid (FA) supplements) and WHO recommendations (for iron, calcium and multiple-micronutrient (MMN) supplements).ResultsIn total, 83.9% of women took at least one kind of micronutrient supplement before or during pregnancy. FA (67.6%) and calcium (57.5%) were the primarily used micronutrient supplements; few participants used MMN (14.0%) or iron (5.4%). Adherence to supplementation of all micronutrients was low (7.4% for FA, 0.6% for iron, 11.7% for calcium and 2.7% for MMN). Higher educational levels, higher income levels, urban residence and better antenatal care (including pregnancy consultation and a higher frequency of antenatal visits) were associated with high adherence to micronutrient supplementation.ConclusionMaternal micronutrient supplementation before and during pregnancy in Northwest China was way below standards recommended by the Chinese guidelines or WHO. Targeted health education and future nutritional guidelines are suggested to improve this situation, especially in pregnant women with disadvantaged sociodemographic conditions.

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Exposure of Petrol Station Attendants and Auto Mechanics to Premium Motor Sprit Fumes in Calabar, Nigeria

Journal of Environmental and Public Health ◽

10.1155/2009/281876 ◽

2009 ◽

Vol 2009 ◽

pp. 1-5 ◽

Cited By ~ 15

Author(s):

N. E. Udonwa ◽

E. K. Uko ◽

B. M. Ikpeme ◽

I. A. Ibanga ◽

B. O. Okon

Keyword(s):

General Population ◽

Potential Risk ◽

Venous Blood ◽

Population Based ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Petrol Station ◽

Risk Of Exposure ◽

Structured Questionnaire

A population-based-cross-sectional survey was carried out to investigate the potential risk of exposure to premium motor spirit (PMS) fumes in Calabar, Nigeria, among Automobile Mechanics (AM), Petrol Station Attendants (PSA) and the general population. Structured questionnaire was administered on the randomly chosen subjects to elicit information on their exposure to PMS. Duration of exposure was taken as the length of work in their various occupations. Venous blood was taken for methaemoglobin (MetHb) and packed cells volume (PCV). Mean MetHb value was higher in AM (7.3%) and PSA (5.8%) than in the subjects from the general population (2.7%). PCV was lower in PSA (30.8%), than AM (33.3%) and the subjects from the general population (40.8%). MetHb level was directly proportional, and PCV inversely related, to the duration of exposure. The study suggested increased exposure to petrol fumes among AM, PSA, and MetHb as a useful biomarker in determining the level of exposure to benzene in petrol vapour.

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