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PubMed1999

Using practical quality improvement approaches and tools in reproductive health services in east Africa.

BACKGROUND: A nonprofit, nongovernment organization, AVSC International provides technical assistance worldwide, including a range of reproductive health services and quality improvement (QI) approaches and tools. Current activities in East Africa involve several hundred sites, including referral hospitals, district-level hospitals, and individual family planning clinics. THE QI PACKAGE: AVSC and its local partners developed Client-Oriented, Provider-Efficient Services (COPE), a problem-solving process and set of tools to involve all levels of site staff members in assessing and improving the services. The COPE tools--self-assessment guides, client interview guides, client flow analyses, and action plans--promote involvement, ownership, and commitment to the QI process. Facilitative supervision and whole-site training complemented AVSC's traditional approaches of medical monitoring and informed choice. Facilitative supervision encourages supervisors and managers to consider staff members as internal customers, whose needs they must meet for staff to be able to meet the needs of external customers (clients). Whole-site training was developed to meet the needs of staff members and providers, who needed to function as a team responsible for providing high-quality services. CASE STUDY: A government hospital that has adopted the entire package of QI approaches, has used the Quality Improvement Quotient self-assessment surveys to track its progress in several elements of high-quality care, including management and supervision, safety, and information and client--provider interactions. For example, maternity ward staff learned how to pass on to their clients information about clients' rights and family planning methods through posters, pamphlets, sample contraceptives, and health talks. LESSONS LEARNED: AVSC's work with local organizations suggests a number of lessons learned, including the following: easy-to-use tools that promote staff involvement and ownership are essential in the QI process, QI requires considerable staff development and capacity building at all levels, and although the QI approaches were initially introduced for a relatively narrow field of services, they are applicable to and have increasingly been used in other departments and wards. (It is difficult, may be impossible, and certainly undesirable, to limit QI activities to one ward or service.) CONCLUSION: Activities in East Africa have shown that QI is possible even in very resource-poor settings. The same principles have guided the process in all the different programs, with some adaptation of the tools used. AVSC program activities are to continue to disseminate the experiences of sites implementing the package of tools and approaches, to advocate for investment in supervision and management capacity building as a means to support continuous quality improvement, and to further study the impact of the QI approaches on service quality.

Adult↗
PubMed2004

The sexual and reproductive health of young people in Adjumani district, Uganda: qualitative study of the role of formal, informal and traditional health providers.

This qualitative study of young people and health care workers in Adjumani, northern Uganda, found that young people are generally very knowledgeable about STD spread and prevention as well as methods for prevention of pregnancy. Health workers are the most important category of people providing information on sexual and reproductive health (SRH) for young people. However, many health workers are conservative with regard to adolescent sexuality. There is a lack of training in and guidelines for working with adolescents. This, along with inadequate access to SRH services for young people, accounts for the failure to adequately deal with young people's problems. Physical, social, psychological and economic factors create barriers to service accessibility. Socio-economic, religious and cultural factors affect sexual behaviour and outcomes in Adjumani district, making some young people vulnerable, particularly young women. In an effort to find alternative services that meet their needs better, young people visit informal and traditional health care providers despite having to pay for these services. The confidentiality and privacy that they offer could be a lesson for formal health care providers. Further training and integration of traditional health care providers is essential as they already play a major part in SRH service delivery to young people.

Adolescent↗
PubMed1999

Reproductive health in Bulgaria--development and problems.

Dr. Rankova documents the current demographic crisis in Bulgaria, relates it to issues of reproductive health in that country, and describes briefly and comments on the current efforts to improve the health care system there.

Adolescent↗
PubMed1996

Sexual behaviour, contraceptive practice and reproductive health among school adolescents in rural Transkei.

OBJECTIVES: To determine the patterns of sexual maturation, sexual behaviour, contraceptive practice and reproductive health among Transkeian adolescents. DESIGN: Cross-sectional descriptive study, using self administered questionnaires. SETTING: Twenty-six schools in 22 rural districts of the Transkei region of the Eastern Cape. SUBJECTS: Standard 5, 6 and 7 pupils of both sexes. OUTCOME MEASURES: Demographic and social characteristics, maturational and sexual behavioural milestones, and the prevalence of contraceptive use, pregnancies and sexually transmitted diseases (STDs). RESULTS: Data from 1,072 girls and 903 boys were analysed. The mean ages (+/-SD) of the girls and boys were 15.29 +/- 1.89 and 16.25 +/- 2.05 years, respectively. Menarche and semenarche occurred at 13.90 +/- 1.23 and 15.12 +/- 1.58 years in girls and boys, respectively. Overall, 76% of the girls and 90.1% of the boys in this survey were already sexually experienced. The age of initiation of sexual activity was positively correlated with the age of first dating and the age of menarche and semenarche. The boys initiated sexual activity at an earlier age (13.43 v. 14.86 years, P = 0.0000), had sexual intercourse more regularly (61.6% v. 42.3%, P = 0.0000) and more frequently, and had more lifetime sexual partners (mean of 3.27 v. 1.35, P = 0.0000) than the girls did. Nearly twice as many sexually experienced boys as girls had a history of STD (48% v. 25%, P = 0.0000) and, of these, 19.1% of the boys and 6.5% of the girls had a history of genital ulcer disease. The prevalence of whether contraceptives had ever been used was only 23% among sexually experienced girls and, of these, only 19.4% used condoms. Surprisingly, 62.1% of the sexually experienced boys had used condoms, and of these nearly one-third enjoyed using them. The prevalence of adolescent schoolgirl pregnancy was 31.3%. CONCLUSIONS: Sexual maturation occurs at an earlier age than previously among rural Transkeian adolescents. This is associated with early initiation and a high level of sexual activity, low contraceptive usage, and a high rate of adolescent pregnancy and STDs, which therefore expose adolescents to a high risk of HIV infection.

Adolescent↗
PubMedDate not supplied

Reproductive health and blurred professional boundaries.

We recognize that many of the issues raised are not simple. Our proposal calls for the same thoughtful deliberation applied in other settings to be brought to bear on reproductive health care. Some have already tried alternative approaches. In Albuquerque, New Mexico, a university hospital neonatologist and the district attorney have collaborated to create an alternative to sentencing program for women who are arrested for drug-related crimes and found to be both pregnant and drug addicted. Rather than proceed with criminal sanctions, these women are offered entry into a drug treatment program that is geared to families with young children and run by the pediatrics department. Here, the physician and the district attorney collaboratively responded in ways congruent with the professional integrity of each. In another example in Portland, Oregon, physicians, drug treatment providers, and child protective social service representatives cooperatively defeated a legislative proposal to mandatorily test and report pregnant women for illicit drug use and, instead, formed a task force to jointly develop state policy regarding the issue. Drug use, HIV infection, child abuse, and poverty are all cause for alarm. Yet it is critical that our frustration about these difficult problems not be translated into blaming individuals for "deviance," or into short-term inadequate responses. In developing policy we should consider the impact on the legal and ethical rights and obligations of both patient and physician. For every course, we should evaluate both immediate and long-term efficacy, the consequences for the doctor-patient relationship, and the consequences for medical integrity. In the midst of the present regulatory and fiscal turmoil affecting health care, we urge physicians to be careful and deliberate in the policies they embrace and the actions they take.

Confidentiality↗
PubMed2006

Validating neonatal mortality and use of NGO reproductive health outreach services in rural Bangladesh.

Although the neonatal mortality rate (NMR) in Bangladesh remained steady between 1995-99 and 1999-2003 (41-42 deaths per 1,000 live births), evidence from the management information system (MIS) of a large nongovernmental organization (NGO) program indicates that the NMR declined by about 50 percent between 1996 and 2002 in the area served. This study aims to validate the recording of neonatal deaths among the cohort of children registered as born in 2003 and to assess the evidence of a decline in the NMR. It also measures the coverage of reproductive health outreach services, focusing on 12 of the 27 NGOs that have provided services in the same areas since 1996. Field-workers' registers, verbal autopsy reports, and immunization records were checked to confirm infants' survival. Interviews were conducted with 142 mothers of children who died within 28 days postpartum and with a random sample of 109 women with registered stillbirths. Out of 11,253 registered live births in 2003, 210 neonatal deaths were found, compared with 194 deaths that were reported in the MIS for 2003. The corrected NMR was 19 deaths per 1,000 live births, and it was in the range of 15-29 deaths per 1,000 live births in 11 of the NGO areas. Because underreporting of neonatal deaths was probably higher in 1996 when the MIS-reported NMR was 39 deaths per 1,000 live births, the decline in the NMR is likely to have been genuine.

Bangladesh↗
PubMed2003

A meta-analysis review of the effects of recombinant bovine somatotropin. 2. Effects on animal health, reproductive performance, and culling.

This manuscript presents the results of a review of the effects of recombinant bovine somatotropin (rBST) on dairy cattle health, reproductive performance, and culling, that was carried out by an expert panel established by the Canadian Veterinary Medical Association (CVMA). The panel was established by the CVMA in response to a request from Health Canada in 1998 and their report was made public in 1999. A series of meta-analyses was used to combine data on health-related parameters that were extracted from all randomized clinical trials that had been published in peer-reviewed journals or which were provided by Health Canada from the submission by Monsanto for registration of rBST in Canada. A companion paper (1) presents the estimates of the effect of the drug on production parameters. Recombinant bovine somatotropin was found to increase the risk of clinical mastitis by approximately 25% during the treatment period but there was insufficient data to draw firm conclusions about the effects of the drug on the prevalence of subclinical intra-mammary infections. Use of rBST increased the risk of a cow failing to conceive by approximately 40%. For cows which did conceive, there was no effect on services per conception and only a small increase in average days open (5 days). Use of the drug had no effect on gestation length, but the information about a possible effect on the risk of twinning was equivocal. Cows treated with rBST had an estimated 55% increase in the risk of developing clinical signs of lameness. Few studies reported data on culling, but based on those that did, there appeared to be an increase risk of culling evident in multiparous cows. Use of the drug in 1 lactation period appeared to reduce the risk of metabolic diseases (particularly ketosis) in the early period of the subsequent lactation.

Animals↗
PubMed1999

Reproductive health and legal duties of medical confidentiality.

This article discusses the reasons for, and the dimensions of, the obligations the law imposes on health care practitioners to keep confidential the information they obtain about their patients in the course of the therapeutic relationship, with particular reference to issues of reproductive health.

Confidentiality↗
PubMed2006

Fertility treatment and reproductive health of male offspring: a study of 1,925 young men from the general population.

Little is known the about the reproductive health of offspring after fertility treatment. In 2001-2005, the authors approached young Danish men attending a compulsory physical examination to determine their fitness for military service. A total of 1,925 men volunteered, delivered a semen sample, had a physical examination performed and a blood sample drawn, and responded to a questionnaire. Their mothers were questioned about whether they had received fertility treatment in order to conceive their sons. Forty-seven mothers reported having received fertility treatment to conceive the index subject. After control for confounders, men whose mothers had received fertility treatment to conceive them had a 46% lower sperm concentration (95% confidence interval (CI): -63, -20) and a 45% lower total sperm count (95% CI: -64, -16). They had a smaller testis size (-0.9 ml, 95% CI: -2.2, 0.4), fewer motile sperm (-4.0%, 95% CI: -8.0, -0.1), and fewer morphologically normal spermatozoa (-2.0%, 95% CI: -4.1, 0.0). They also had a lower serum testosterone level and free androgen index (results not statistically significant). These findings should be viewed in light of the increasing use of fertility treatments. Although the cause of these findings is unknown, they raise concern about possible late effects of fertility treatment. Larger-scale studies of children born after fertility treatment should be performed.

Adult↗
PubMed2000

[Trends in the reproductive health of women in the Czech Republic 1993-1997. V. International comparisons].

OBJECTIVE: 1) Overall objective is to detect changes in reproductive health of women due to changes in the system of social and health care. 2) The particular objective of this part of the study (part V) is to compare the incidence of induced abortions and contraceptive use in the Czech Republic and selected developed countries during last 20 years. DESIGN: Retrospective comparative epidemiological study. SETTING: Institute for the Care of Mother and Child, Praha 4-Podolí. METHODS: Input data for the Czech Republic use came from the results of the four previous parts of the study. The data from similar studies in selected countries were divided into two groups. Seven countries of Central Europe formed the first group, the second group consisted of 14 countries of Western and Northern Europe and 4 developed countries over-the-ocean. The both groups were ordered according to the reliability of reported data. RESULTS: The cause of higher number of induced abortions and lower number of women using effective contraception in the Czech Republic compared to other developed countries falls into sixties when different social approach towards induced abortion legislation and concurrent development of planned parenthood began. This is being documented by comparisons of data on use of induced abortions and contraceptive use among women of different age groups, while using internationally accepted indicators. Although the number of induced abortions did not change substantially in western countries during last 20 years (there has been even slight increase in some of them since 1993), the number of induced abortions in the Czech Republic decreased markedly, and this fact, together with increased use of contraception since 1993 led to decrease of difference in between these two variables, compared to western countries. CONCLUSIONS: The 2-3 fold higher number of induced abortions in the Czech Republic than in countries of the second group before 1993 decreased substantially; there were only 19.3 induced abortions per 1000 women in the Czech Republic in 1997 compared to average of 14.1 induced abortions in developed countries. Use of effective contraceptive methods is lower in the Czech Republic due to low use of sterilization.

Abortion, Induced↗
PubMed2001

Effects of different suckling systems on milk production, udder health, reproduction, calf growth and some behavioural aspects in high producing dairy cows - a review.

This article discusses the consequences of different suckling systems in the industrial countries for the milk production, udder health, reproduction and behaviour of high producing dairy cows and the effects on the gain, health and behaviour of the calves. The suckling systems are divided into three different categories depending on the purpose and duration of the suckling period. Long-term suckling with or without additional milking covering the period where the calf has a nutritional need for milk, and short-term suckling, where cow and calf are kept together in the colostrum period only.Long-term suckling without additional milking in early lactation can in some situations stimulate the subsequent milk production to a greater extent than milking alone. No clear or significant differences can be found between restricted and free suckling systems. Most experiments show that suckling decreases the risk of mastitis in the suckling period and in some cases even for some time after the suckling has been terminated. Suckling and milking during the same period is not advantageous in production turns because of a very poor ejection of milk. Long-term suckling can increase the post-partum interval until first heat, in some cases until the end of the suckling period. However, as the cows appear to be more fertile, the net effect on reproduction is small. The suckled calves are usually healthy with a high daily gain. Short-term suckling have more advantages than disadvantages on production, health and behaviour of both the cow and the calf compared to an immediate separation after birth.

Journal Article↗
PubMed2002

Challenging the stereotypes: men, withdrawal, and reproductive health in Lebanon.

In Lebanon, coitus interruptus or withdrawal remains a widely practiced method of family planning. Our research sought to understand the role of men in reproductive health in Lebanon by focusing on this common practice. Our main questions were: Why is it that the practice persists when more effective modern methods of family planning are available? How is the decision taken to practice withdrawal? When is withdrawal practiced and with whom? And, finally, does the practice of withdrawal affect sexual pleasure and the sexual relationship more generally?To answer these questions, we embarked on a small exploratory study using in-depth interviews with 16 open-ended questions. We found that the most important reason for the continuing practice of withdrawal is fear of side effects from other methods. Men and women expect pleasure and fulfillment in sexual relations, but they are willing to limit their pleasure to limit their fertility by means they consider safe. No one prototypical practice of withdrawal seems to exist, and this may explain whether or not the method fails to prevent pregnancy.

Adult↗
PubMed1998

IAMANEH and the new concept of reproductive health. International Association for Maternal and Neonatal Health.

Prof. Hubbert De Watteville, first Secretary General and founder of the International Federation of Gynecologists and Obstetricians (FIGO), created the International Association for Maternal and Neonatal Health (IAMANEH) in 1977, after realizing that the improvements in maternal and neonatal health observed in developed countries were not benefiting the so-called Third World. The purpose of IAMANEH was to stimulate local associations to take initiatives to improve the health of the women and their children. Lack of attention to women's own health has been characteristic of the emphasis on antenatal care to protect the newborn or family planning to reduce demographic growth, with little attention to the needs of women themselves. The evolution to the more comprehensive concepts of reproductive health has been slow and moved by a few visionaries in the Obstetrics and Gynecology establishment and by the women's rights movement. Currently, the concept has been accepted at world conferences, such as those of Cairo (1994) and Beijing (1995). Brazil officially incorporated an even wider concept of Comprehensive Women's Health Care, originated at the State University of Campinas and formally adopted by the Federal Government in 1984. It was placed in practice in the state of São Paulo between 1987 and 1990, showing important improvements in the quantity and quality of services provided to women.

Adolescent↗
PubMed1995

From birth control to reproductive health.

During the 1960s birth control was seen as the only means of curbing the very rapid population growth that resulted from decreased mortality without a parallel decrease in fertility. Birth control was considered such a priority that the means used to achieve it were not always respectful of human rights, and, for the same reason, it did not work as expected. During the 1970s and 1980s, birth control policy was re-evaluated. Concepts such as the need to balance birth control with socioeconomic development, to avoid target-oriented programs that imposed particular contraceptive methods on people, to integrate contraceptive services within a comprehensive women's health care program, and to emphasize the importance of quality of care became accepted. This led to the understanding that a reproductive health care approach was a more efficient way to achieve people's wellbeing and, at the same time, to reduce fertility. The need for greater dialog between women/clients and men/providers is emphasized.

Brazil↗