Biomedical subjects

C Toroitich-Ruto

Publications and source records attributed to C Toroitich-Ruto.

5 recordsLinked to original sources

PubMed2006

A prospective study assessing the effects of introducing the female condom in a sex worker population in Mombasa, Kenya.

OBJECTIVE: To assess the impact and costs of adding female condoms to a male condom promotion and distribution peer education programme for sex workers in Mombasa, Kenya. DESIGN: A 12 month, prospective study of 210 female sex workers. METHODS: We interviewed participants about their sexual behaviour every 2 months for a total of seven times and introduced female condoms after the third interview. We also collected cost data and calculated the cost and cost effectiveness of adding the female condom component to the existing programme. RESULTS: Introduction of the female condom in an HIV/AIDS prevention project targeting sex workers led to small, but significant, increases in consistent condom use with all sexual partners. However, there was a high degree of substitution of the female condom for male condoms. The cost per additional consistent condom user at a programme level is estimated to be 2160 dollars (1169 pounds sterling, 1711 euros) (95% CI: 1338 to 11 179). CONCLUSIONS: The female condom has some potential for reducing unprotected sex among sex workers. However, given its high cost, and the marginal improvements seen here, governments should limit promotion of the female condom in populations that are already successfully using the male condom. More research is needed to identify effective methods of encouraging sex workers to practise safer sex with their boyfriends.

Single-Use Internal Condom↗

PubMed2004

Fifty ways to leave your rubber: how men in Mombasa rationalise unsafe sex.

OBJECTIVE: To explore the reasons why men who have sex with sex workers in Kenya refuse to use condoms in order to develop potential interventions that might help to overcome these barriers. METHODS: We conducted participant observations over a period of 2 months in the bars, discos, shebeens, and guesthouses of Mombasa, Kenya, where many of the sexual transactions are initiated. RESULTS: Analysis of the participant observations revealed at least 50 reasons for not using a condom, which we grouped into six categories: condoms are not pleasurable, condoms are defective, condoms are harmful, condoms are unnecessary, condoms are too hard to use, and external forces prohibit using condoms. CONCLUSIONS: Some of the reasons men say they do not use condoms would be difficult to affect directly. Others are the result of gaps in knowledge and have not been impacted through better communication strategies. Finally, some of the reasons for not using condoms, such as men's weaknesses, and the loss of pleasure, could possibly be addressed through the introduction of female controlled devices. However, the most important conclusion of this paper is that men who pay for sex do so because it is pleasurable and many men do not find the male condom pleasurable. Therefore, messages targeted at men who have sex with sex workers may not be 100% successful if they only emphasise the benefits of condom use as disease control.

Attitude to Health↗

PubMed2003

Sponge versus diaphragm for contraception: a Cochrane review.

The contraceptive vaginal sponge was developed as an alternative to the contraceptive diaphragm. Unlike the diaphragm, the sponge can be used for more than one coital act within 24 h without the insertion of additional spermicide, and it does not require fitting or a prescription from a physician. We conducted a systematic review of randomized controlled trials that compared the vaginal contraceptive sponge with the diaphragm used with a spermicide in order to evaluate the efficacy and continuation rates of the two devices. The sponge was statistically significantly less effective in preventing overall pregnancy than was the diaphragm in the two trials that met our inclusion criteria. The 12-month cumulative life table termination rates per 100 women for overall pregnancy were 17.4 for the sponge versus 12.8 for the diaphragm in the larger US trial, and 24.5 for the sponge and 10.9 for the diaphragm in the UK trial. Similarly, discontinuation rates at 12 months were higher with the sponge than with the diaphragm [odds ratio 1.3; 95% confidence interval (CI) 1.1-1.6]. Allergic-type reactions were more common with the sponge in both trials, although the frequency of discontinuation for discomfort differed in the two trials. Other randomized controlled trials will be needed to resolve the role of spermicides in preventing sexually transmitted infections or in causing adverse effects.

Contraceptive Devices, Female↗

PubMed2002

Sponge versus diaphragm for contraception.

BACKGROUND: The contraceptive vaginal sponge was developed as an alternative to the contraceptive diaphragm. The sponge, made of polyurethane impregnated with nonoxynol-9 (1g), releases 125 mg of the spermicide over 24 h of use. Unlike the diaphragm, the sponge can be used for more than one coital act within 24 h without the insertion of additional spermicide, and the sponge does not require fitting or a prescription from a physician. How the sponge compares with the diaphragm in terms of efficacy and continuation is not clear. OBJECTIVES: To compare the efficacy and continuation rates of the sponge compared with the diaphragm (used with nonoxynol-9 as a spermicide). Our a priori hypothesis was that the sponge would have a higher failure rate and higher discontinuation rates than the diaphragm. SEARCH STRATEGY: We searched the computerized databases MEDLINE, EMBASE, Popline, LILACS, and the Cochrane Controlled Trials Register. In addition, we searched the reference lists of all potentially relevant articles and book chapters. We also contacted investigators involved with both trials identified to seek other published or unpublished trials. SELECTION CRITERIA: We included randomized controlled trials comparing the vaginal contraceptive sponge (Today; Collatex) with any diaphragm used with nonoxynol-9 to prevent pregnancy. DATA COLLECTION AND ANALYSIS: We examined the studies identified through the literature searches for possible inclusion and evaluated their methodological quality using the Cochrane guidelines. We contacted an author involved with both published trials for supplementary information about randomization and allocation concealment. We entered data into RevMan 4.1 and calculated Peto odds ratios for overall pregnancy and 12-month discontinuation using numbers of women as the denominator. We also abstracted 12-month cumulative life-table ratios for these same outcomes, but were unable to aggregate these data. MAIN RESULTS: The sponge was statistically significantly less effective in both trials in preventing overall pregnancy than was the diaphragm. The 12-month cumulative life-table termination rates per 100 women for overall pregnancy were 17.4 for the sponge versus 12.8 for the diaphragm in the larger U.S. trial and 24.5 for the sponge and 10.9 for the diaphragm in the U.K. trial. Similarly, discontinuation rates at 12 months were higher with the sponge than with the diaphragm (odds ratio 1.3; 95% CI 1.1-1.6). Allergic-type reactions were more common with the sponge in both trials, although the frequency of discontinuation for discomfort differed in the two trials. REVIEWER'S CONCLUSIONS: The sponge was less effective than the diaphragm in preventing pregnancy. Discontinuation rates were higher at 12 months as well. Other randomized controlled trials will be needed to resolve the role of spermicides in preventing sexually transmitted infections or in causing adverse effects.

Contraceptive Devices, Female↗

PubMed2001

The evolution of the family planning programme and its role in influencing fertility change in Kenya.

Kenya was one of the first sub-Saharan countries to enter the fertility transition, and analysts have suggested various explanations for this. This paper examines the growth in contraceptive availability in Kenya by looking at the Kenya family planning programme and its association with the fertility transition. This is of critical programmatic importance because the fertility transition is not yet underway in many sub-Saharan countries. Policymakers will find the information from this study helpful in evaluating the efficacy of current programmes and replicating the Kenyan programme in areas where fertility decline has not yet occurred. For researchers, the study attempts to highlight some of the major factors driving Kenya's fertility decline, apart from the conventional arguments about social and economic development.

Adolescent↗