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PubMed1995

Cambodia. Programmatic approach to IEC on reproductive health.

Various UNFPA-funded population programs are now in place in six provinces and the capital and some more are in the pipeline. The ones currently being implemented include projects on maternal and child health and birth spacing, national population census, improvement of family health of displaced persons, and socio-economic research. Those in the pipeline are population education in the school system, gender and population issues, and population and environment. All the programs mentioned have implications for information, education and communication (IEC). To implement these programs effectively, UNFPA and the government realized the need for IEC support. To provide a coherent, integrated and holistic approach to the provision of IEC support to all the UNFPA-funded population activities, a programmatic approach to IEC was developed with the assistance of CST adviser on population communication, Mr. Francisco Roque. The IEC program will basically support the government policy of providing voluntary birth spacing services as a means to promote better maternal and child health through IECM activities; and to provide adequate information to selected target groups required to bring about desired behavioral changes in responsible reproductive decision-making and lifestyle. The target groups to be reached include: service providers and health workers, policymakers and administrators, women of reproductive age, men, and the adolescents aged 15-19 as well as teachers and trainers. The IEC interventions hope to create awareness of the benefits of birth spacing, introduce population concepts in curricula and appropriate health/teaching materials in selected medical schools and secondary schools, reduce misconceptions, provide proper counseling, and sustain government's interest and commitment to the population program.

Asia↗
PubMed1993

Reproductive health, population growth, economic development and environmental change.

World population will increase by 1000 million, or by 20%, within 10 years. Ninety-five per cent of this increase will occur in the South, in areas that are already economically, environmentally and politically fragile. Morbidity and mortality associated with reproduction will be greater in the current decade than in any period in human history. Annually, 40-60 million pregnancies will be terminated and 5-10 million children will die within one year of birth. AIDS-related infections, e.g. tuberculosis, will undermine health care in Africa (and elsewhere) and in places AIDS-related deaths will decimate the work-force. The growth in population and associated morbidity will inhibit global economic development and spawn new problems. The key issues are migration, the spread of disease, the supply of water and the degradation of land, and fiscal policies with respect to family planning, pharmaceuticals and Third-World debt. Full education, particularly of women, and more effective family planning in the South have the power to unlock the problem. Failure will see the developed countries, with their 800 million population, swamped by the health, economic and environmental problems of the South, with its projected population of 5400 million people for the year 2000.

Demography↗
PubMed2004

Thyroid dysfunction and women's reproductive health.

Thyroid dysfunction is extremely common in women and has unique consequences related to menstrual cyclicity and reproduction. Even minimal hypothyroidism can increase rates of miscarriage and fetal death and may also have adverse effects on later cognitive development of the offspring. Hyperthyroidism during pregnancy may also have adverse consequences. Accordingly, thyrotropin (TSH) determination is warranted for all women planning pregnancy or those already pregnant. Replacement doses should be carefully monitored throughout pregnancy because the increased renal iodine loss and estrogen-induced rise in thyroxine-binding globulin (TBG) often result in a higher dose requirement. Although thyroid abnormalities are part of the standard differential diagnosis of menstrual disorders, recent studies indicate that these are relatively infrequent causes. Nonetheless, TSH is still required as part of the laboratory evaluation of women with abnormal cycles. The incidence of postpartum thyroiditis is high--6%-8% in various studies. A TSH should be performed in all postpartum patients who are depressed, who complain of unusual fatigue or anxiety or have any of the classical symptoms of hyperthyroidism or hypothyroidism. Practitioners providing health care for women should be alert to thyroid disorders as possible etiological factors in nonspecific symptoms such as fatigue and depression. However, most women with these symptoms are euthyroid; replacement therapy for them is not indicated. The long-standing dogma of thyroidology that replacement with levothyroxine alone is satisfactory for all hypothyroid patients has recently been questioned but results of trials are inconclusive. Nonetheless, satisfactory regimens can be found for the vast majority of patients.

Female↗
PubMed2003

Reproductive health in rural Malawi: a population-based survey.

OBJECTIVES: To assess pregnancy outcome, maternal mortality and health-seeking behaviour in a rural African population and to assess the effects on these of women's education, distance from a health centre and household type. DESIGN: Descriptive population-based study. SETTING: A rural community in southern Malawi. POPULATION: All women living in the catchment area of a rural health centre. METHODS: Interviews with women in 20,649 households using structured questionnaires. MAIN OUTCOME MEASURES: Pregnancy outcome, the effect of women's education, distance from a health centre and household type on pregnancy outcome, maternal morbidity and estimates of maternal and perinatal mortality. RESULTS: Educational level was lower for women than for men. A significant association was found between educational level and fertility. Women aged 45-49 reported an average of six pregnancies with four resulting in currently living children. Successful pregnancy outcome was more likely with increased education and if the woman lived closer to the health centre. Despite living an average of 5 km from the health centre, over 90% of women attended antenatal clinic with a mean of five visits. Assistance at delivery by a trained health care worker was more likely as education increased and was less likely as distance from the health centre increased. Maternal mortality was reported at 413 per 100,000 deliveries (95% CI 144-682). The perinatal mortality rate in this population was estimated at 30 per 1000. An increased perinatal mortality was noted for women who were delivered by a female relative. Perinatal mortality rates were similar for delivery by a traditional birth attendant or a trained nurse-midwife. Education and proximity to the health centre were both associated with improved outcome. CONCLUSIONS: Many women in this rural community suffer the consequences of high pregnancy loss. Maternal and perinatal mortality are high. Improved education and skilled assistance at delivery can result in improved pregnancy outcome. Proximity of any household to a health centre has an effect on outcomes.

Adolescent↗
PubMed1998

Adolescent pregnancy and reproductive health in Transkei (rural South Africa).

A study of adolescent unmarried pregnancy was conducted in 1994 in the Transkei, Eastern Cape (South Africa). Data included a survey of 2,290 married and unmarried women, ages 15 to 49 years, and qualitative data collected from adolescents, parents and family planning officials. While only 11 percent of women were ever-married by age 19 years, 43 percent have had children. Marriage is late, with 64 percent of women 20-24 years never-married, a marked departure from universal and early marriage regarded as characteristics of most african societies. The recent South African political economy has contributed to the predominance of unmarried child-bearing in South Africa. For more than a century black men were recruited to work in cities, while by law, women and children had to remain in rural areas. This policy promoted a norm of unmarried women (possibly the largest in Africa) and a general acceptance of child-bearing outside marital unions.

Adolescent↗
PubMed2001

Reproductive health and STDs among clients of a women's health mobile clinic in rural Bali, Indonesia.

Recent studies in Indonesia have reported significant levels of STDs in low-risk urban groups. To gather data on rural women, a prevalence study was undertaken in Bali utilizing a women's health mobile clinic. Rural (n=312) women were tested for vaginal reproductive tract infections (RTIs) by on-site wet mount, for Neisseria gonorrhoeae and Chlamydia trachomatis by unamplified DNA (Gen-Probe) test, and for syphilis by rapid plasma reagin (RPR). Results were: candidiasis 5.8%; bacterial vaginosis (BV) 37.2%; trichomoniasis 15.1%; gonorrhoea 0.7%; chlamydial infection 5.6%; syphilis 0%. Overall 55.1% had at least one RTI and 19.2% had at least one STD. Reported non-monogamy, pain with urination and genital lesions, observed cervical friability and cervical motion tenderness were associated with cervical STD infection (P<0.05). We conclude that there is a need for improved services for STD prevention and RTI/STD management in rural Bali, and for condom promotion.

Candidiasis↗
PubMed2006

WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity.

BACKGROUND: Health care planning for chronic pelvic pain (CPP), an important cause of morbidity amongst women is hampered due to lack of clear collated summaries of its basic epidemiological data. We systematically reviewed worldwide literature on the prevalence of different types of CPP to assess the geographical distribution of data, and to explore sources of variation in its estimates. METHODS: We identified data available from Medline (1966 to 2004), Embase (1980 to 2004), PsycINFO (1887 to 2003), LILACS (1982 to 2004), Science Citation index, CINAHL (January 1980 to 2004) and hand searching of reference lists. Two reviewers extracted data independently, using a piloted form, on participants' characteristics, study quality and rates of CPP. We considered a study to be of high quality (valid) if had at least three of the following features: prospective design, validated measurement tool, adequate sampling method, sample size estimation and response rate >80%. We performed both univariate and multivariate meta-regression analysis to explore heterogeneity of results across studies. RESULTS: There were 178 studies (459975 participants) in 148 articles. Of these, 106 studies were (124259 participants) on dysmenorrhoea, 54 (35973 participants) on dyspareunia and 18 (301756 participants) on noncyclical pain. There were only 19/95 (20%) less developed and 1/45 (2.2%) least developed countries with relevant data in contrast to 22/43 (51.2%) developed countries. Meta-regression analysis showed that rates of pain varied according to study quality features. There were 40 (22.5%) high quality studies with representative samples. Amongst them, the rate of dysmenorrhoea was 16.8 to 81%, that of dyspareunia was 8 to 21.8%, and that for noncyclical pain was 2.1 to 24%. CONCLUSION: There were few valid population based estimates of disease burden due to CPP from less developed countries. The variation in rates of CPP worldwide was due to variable study quality. Where valid data were available, a high disease burden of all types of pelvic pain was found.

Chronic Disease↗
PubMed2004

Assessment of obesity, lifestyle, and reproductive health needs of female citizens of Al Ain, United Arab Emirates.

This study was conducted to determine the reproductive and lifestyle characteristics in a representative sample (n = 535) of women in Al Ain, United Arab Emirates, to guide the development of health programmes for this population with rising affluence. A cross-sectional survey was carried out using the stratified two-stage sampling technique. Although most women were young, were pre-menopausal, did not smoke, reported good health status, and 84% (95% confidence interval [CI] 81-87%) reported being sufficiently active to meet expert recommendations, the prevalence of obesity (defined by body mass index > or = 30) was very high (35%; 95% CI 31-39%) and many (28%; 95% CI 24-32%) reported having a chronic disease. The prevalence of obesity was associated positively with age and negatively with education (p < 0.001 for both). Postmenopausal women had significantly more chronic diseases, reported poor health more often, were less physically active (p < 0.001 for all), and had a higher percentage of body fat (p = 0.002) compared to premenopausal women. Health services should emphasize the prevention and treatment of obesity and improving the general health status of postmenopausal women.

Adult↗
PubMed1998

Combined oral contraceptives, migraine and ischaemic stroke. Clinical and Scientific Committee of the Faculty of Family Planning and Reproductive Health Care and the Family Planning Association.

The incidence of ischaemic stroke is low in women of reproductive age but increased in women with migraine, particularly if they also take combined oral contraceptives (COCs). Since there is limited evidence that this risk may be further focused on some groups of women with migraine, this paper presents current recommendations for COC use by a confirmed migraineur, pending further data.

Adult↗