Contraceptive Status Research Articles

Societal Influences on the Utilization of Contraception Amongst Women in South Africa

The strong desire to experience motherhood, mediated by prevailing social and cultural norms encourage childbearing in society. Contraceptive use and pregnancy among HIV positive women in South Africa is of growing concern as it may be associated with various adverse factors having socio-economic and health impacts. The timeous initiation and optimal utilisation of antenatal care services is imperative to ensure positive pregnancy outcomes and good maternal health; not always possible due to various challenges in developing countries. Motherhood is a component of a women’s identity in cultural societies and important for female social status. Major challenges are gender-based violence and gender inequality as well as physiological factors that place women at risk like cultural and behavioural practices requiring parental consent for access to reproductive and sexual health services tend to discourage girls and women in their pursuit for decision making in reproductive health. This study examines the societal influences on contraceptive usage amongst women attending an antenatal clinic, their contraceptive use and HIV status in the city of Durban, province KwaZulu-Natal, South Africa. A cross-sectional study was conducted at a Primary Health Care (PHC) facility with a total of 283 pregnant women in trimester one visiting the antenatal clinic for the first time who completed a self-administered questionnaire. Results evidenced that almost 70% of the study population are aware of their HIV status prior to conceiving. Contraceptive usage in HIV positive participants was similar 82 (81%) to 97 (75%) in HIV negative participants. The HIV positive participants were aware of the consequences of non-contraceptive use. HIV positive women were not deterred by the desire to use contraception nor conceive (OR: 1.04, CI: 0.61 - 1.79). The study reports a high number of the women are single (>75%), low level of education (90%), unemployed (>70%). HIV status has no impact on contraceptive use and the prevalence of pregnancy among HIV positive women. The number of miscarriages (11%) and early neonatal deaths (6%) reported appeared higher in HIV positive women. Smoking (>50%) and alcohol consumption (>50%) were equally high amongst the pregnant women. Comprehensive programs for planned pregnancies in HIV positive women is necessary for a paradigm shift in the prevailing social and cultural norms worldwide. Reproductive health education extending to embrace the boys and men in the population will increase the importance and acceptance of contraception usage for both HIV positive and negative women in reproductive health care.

Determinants of Emergency Contraceptive Pill use among the Patients Presenting for Pregnancy Termination at Tertiary Care Hospital in Western Maharashtra

Background: Emergency Contraceptives (EC) are used to prevent unplanned pregnancies thereby preventing the occurrence and consequences of unplanned pregnancy. Emergency contraception is widely available in India. Yet the use of EC is very low and abortion rate in cities is high. Objective: To assess the practice and determinants of use of emergency contraceptive pills among women presenting for pregnancy termination in a tertiary care hospital. Material and Methods: This was a Cross-sectional, hospital-based study, conducted among the women of reproductive age group presenting for termination of pregnancy in a tertiary care hospital in Western Maharashtra. The study was conducted for a period of three months from May to July, 2016. Data was collected with the help of a preformed and prestructured questionnaire. A total of 150 cases were enrolled in the study. The data was tabulated and analyzed using Epi Info and MS Excel. Result: The knowledge of emergency contraception was seen in 34.0% subjects, out of which only 7.3% had good knowledge. Attitude wise assessment of emergency contraception showed that 74.7% subjects had favourable attitude towards its use while only 21% participants used emergency contraceptive pills. The study revealed that there is a low trend of use of modern contraceptives. The major reason for low usage was lack of adequate knowledge on the method, misperceptions of the adverse effects of this method, fear of effect on future fertility. Factors like women belonging to urban area, education, socioeconomic status and knowledge of contraception and emergency contraception and ever used contraceptive were the significant determinants of EC use. Conclusion: It is concluded that knowledge and use of emergency contraceptive is low while all had favourable attitude towards its use. Awareness is to be created among the community through information, education and communication so that the its use will be increased. How to cite this article:Wakankar PS, Parande MA. Determinants of Emergency Contraceptive Pill use among the Patients Presenting for Pregnancy Termination at Tertiary Care Hospital in Western Maharashtra. Int J Preven Curat Comm Med 2019; 5(3): 18-24.

The Prevalence of Nonalcoholic Fatty Pancreas by Endoscopic Ultrasonography.

Pancreatic steatosis or fatty pancreas refers to the fat accumulation in the pancreas, which can lead to inflammation and fibrosis, β-cell dysfunction, fibrosis, and, possibly, pancreatic cancer. This study aimed to study the prevalence of fatty pancreas and its risk factors in patients referred to an endosonography center. During 18 months, 228 patients who were referred to our endosonography center for various reasons were evaluated for fatty pancreas. Fatty pancreas was defined as hyperechoic pancreas echotexture compared with spleen echotexture. Demographic characteristics, past medical history, and laboratory measurements were compared between groups with and without fatty pancreas to determine the risk factors for fatty pancreas. The prevalence of fatty pancreas was 25.9%. Patients with fatty pancreas had a significantly higher mean level of uric acid (P = 0.04), frequency of ischemic heart disease (P = 0.03), hyperlipidemia (P = 0.04), frequency of fatty liver (P < 0.001), and aortic intima thickness (P = 0.01). There was no significant difference in age, sex, body mass index, smoking status, substance abuse, and use of oral contraceptives in the 2 groups. Fatty pancreas is a common disorder. There are meaningful relationships between coronary artery disease, nonalcoholic fatty liver, and atherosclerosis with fatty pancreas.

Twin births in Jordan: incidence, trends, risk factors and implications for under-five mortality: evidence from the 2012 Jordan Population and Family Health Survey.

Research on twinning in developed countries is well documented, but little is known about twinning in less-developed countries due to a lack of data or data limitations. This study examined the level of, trends in and determinants of twin births and their survival under age five in Jordan, using the 2012 Jordan Population and Family Health Survey (JPFHS) data. The birth history of 11,352 women included in the JPFHS provided information on 9859 live births that occurred within five years of the survey date, and these constituted the study subjects. Descriptive statistics, and bivariate and multivariate multilevel logistic regression models were used for data analysis. About 3.5% of the total live births were twins, which is one of the highest rates in developing countries. The twinning rate showed an increasing trend in Jordan, increasing by 45% from 2.4% in 1990 to 3.5% in 2012. Higher maternal age at child birth, higher parity, poor and richer economic status, contraceptive use status, secondary and above level of education of mothers and non-consanguinity were found to be associated with a higher rate of twin births in Jordan. Twins were observed to have a higher risk of low birth weight, being smaller in physical size at birth and at more than four times higher risk of neonatal death compared with singletons. To reduce the risk adverse outcomes of twin pregnancies and further improve maternal and child health, antenatal, delivery and postnatal care should be tailored towards the special needs of twin pregnancies and twin births in Jordan Twin pregnancies should be detected at the early stage of pregnancy so that perinatal outcomes can be improved by frequent prenatal visits, health education, counselling and proper management of peripartum complications.

Predisposing Factors Related to the Contraception Use Plan in Women of Reproductive Age, East Java Indonesia

The planning family acts to help the family to plan the pregnant and natal they want. The target of research: to knowing the factors related to the contraception use plan in women of reproductive age. Method Research: Sample of The Indonesia Demographic and Health Survey (IDHS) 2017 includes 1, 970 census blocks covering urban and rural areas. The implementation of the IDHS uses 3 types of questionnaires. Results: the planned use of contraception in women of reproductive age is mostly in rural areas and in women of reproductive age with elementary-high school education. Most women of reproductive age know more about modern contraception. Plans for use of contraception in women of reproductive age in married women. Conclusions: residence, education, knowledge of the types of contraceptive methods and marital status are related to contraception use plans in women of reproductive age.

Comprehensive abortion care in the Tain District of Ghana: an analysis of DHIMS2 data for 2010-2016

Background: Access to safe abortion services reduces incidence of unsafe abortion. However, other studies have documented negative impacts such as rise in sexually transmitted infections in jurisdictions with liberal abortion laws. Objective: We assessed the impact of Comprehensive Abortion Care (CAC) services on selected reproductive health indicators in the Tain district. Method: Aggregated service data on abortion, contraception (family planning), and delivery antenatal Human Immuno-deficiency Virus (HIV) infection status of women age 10-49 years were extracted from the District Health Information Management System version 2 (DHIMS-2) database for the period 2010 to 2016. Data were converted to rates using projected population figures from the Ghana Statistical Service and presented as tables and graph for trend analysis. Results: The proportion of unsafe abortion increased from 2010 to 2012 and declined from 2013 onwards with increasing proportions of women opting for safe induced abortions; while spontaneous abortions followed an incremental trend from 2010 to 2013; leveling out from 2014. The family planning acceptor rates stayed above 38% over the period. The total fertility rate (women age 10-14 inclusive) increased sequentially from 4.6/1000 women in 2010 to 89.4/1000 in 2016. The HIV infection prevalence were 2.2%, 3.7%, 3.4%, 3.8%, 2.5%, 2.3% and 2.7% for 2010 to 2016 respectively. Conclusion: Access to Comprehensive Abortion Care (CAC) services reduces the incidence of unsafe abortions. Improved access to contraception may not necessarily lead to a decline in abortion or fertility rates. Liberalizing abortion does lead to a rise in the prevalence of sexually transmitted infections (HIV). Funding: No external funding received Keywords: unsafe abortion, comprehensive abortion care, Tain District, DHIMS 2.

Human Leukocyte Antigen similarity decreases partners' and strangers' body odor attractiveness for women not using hormonal contraception

The Human Leukocyte Antigen (HLA) is a gene complex that encodes important elements of the human immune system. HLA profile is communicated via olfaction and interindividual diversity is assumed to be advantageous for mate choice. Additionally, HLA diversity appears to enhance satisfaction and sexual attraction in existing romantic partnerships. However, whether this effect is transmitted via body odors and whether it results in an attraction towards HLA-dissimilar individuals and/or an avoidance of HLA-similar ones remains unclear. In the present study, we genotyped couples and asked each participant to rate a body odor sample from their partner and from three strangers of the opposite sex who expressed a similar or dissimilar HLA-B and HLA-C genotype. We found no statistically significant preference for HLA similarity or dissimilarity in men. Among women, the observed effects differed depending on hormonal contraception status. Like men, women on hormonal contraception did not exhibit significant HLA-related preferences. However, for women not using hormonal contraceptives, odors from HLA-B and HLA-C similar donors were significantly less attractive than those from HLA-dissimilar donors, regardless of whether the samples were from a partner or a stranger. Our findings support the hypothesis that HLA similarity is perceived via body odors and that such similarity affects human attraction. This mechanism may serve an evolutionarily adaptive function in preventing prospective offspring from having decreased immunocompetence, or decreasing the chance of kin mating.

What people prefer and what they think they prefer in short- and long-term partners. The effects of the phase of the menstrual cycle, hormonal contraception, pregnancy, and the marital and the parenthood status on partner preferences

Abstract The issue with most studies concerned with mate selection preferences in humans is that they rely on declarations and rational actions of experimental subjects, which are affected by their pre-conceived opinions and prejudices. Moreover, current research suggests that subcortical structures and processes, rather than the neocortex, play the principal role in actual partner choice behaviour. Consequently, we have only limited information on how relevant our current knowledge is in relation to real-life human ethology. To address these issues, we surveyed 2718 women and 4073 men between the ages of 16–50 and compared their declared and observed preferences for various properties in short-term and long-term partners. We found differences between what the subjects declared to prefer and what they preferred in reality: for example, men declared that wealth was the second least desirable property out of eleven in short-term partners, but we observed that in reality, they considered wealth the third most important factor after charisma and sense of humour. Similarly, while women declared that dominance and masculinity were desirable properties in short-term partners, in the observational part of the study, they showed little preference for these traits. Furthermore, we investigated the effects of the phase of the menstrual cycle, hormonal contraception, pregnancy, and partnership and parenthood status on these preferences. We found some support for the good parents hypothesis and no support for the good genes and the immunocompetence handicap hypotheses when observed, rather than declared preferences were considered. We also detected that hormonal contraception, and parenthood and partnership status influenced declared preferences in considerable ways, but had only a small, if any, impact on observed preferences. We suggest interpreting the results of studies reliant on declarations and rational actions of experimental subjects with great caution.

Association of Combined Tobacco Smoking, Hormonal Contraceptive use and Status Matrimonial with Cervical Cancer Evolution in Tunisian Women.

Status matrimonial, cigarette smoking and hormonal contraceptive (HC) use have been associated with cervical cancer (CC) establishment by influencing the CC carcinogenesis process. In the present study, we aim to confirm this correlation between these factors and the risk of CC occurrence among Tunisian population. To evaluate the role of matrimonial status, smoking and HC as cofactors of CC installation, we performed a random selection of 600 women from Salah Azeiz institute in Tunisia and a questionnaire was conducted by doctors for each patient. Logistic regression after adjustment for potential confounding factors, relative excess risk due to interaction (RERI) and synergy index (S) were used to evaluate the additive interaction. Subgroup analysis was conducted to examine whether the relative risks changed with CC stages. There were an excess risk among smoker patients and patient with HC use (p < 0.001) for CC installation. Women who are smokers have a 14 times greater risk of suffering from cervical cancer and approximately 24 times greater to develop an advanced form of CC malignancy. Having a history of using birth control pills increase CC occurrence and aggravation (OR~2). The matrimonial status seems an important factor for CC appearance (OR = 3.58 and 2.46) among CC Tunisian patient. However, no significant biological interaction from this three joint exposure was observed in the early FIGO stages but the risk increase in advanced FIGO stages. In our Tunisian cohort, oral contraception, smoking habit and matrimonial status are associated with an overall increased risk of CC development. Indeed, it may damage the local immunity system and may affect the disease severity in patient carriers of some genetic risk biomarkers. The balance of cancer risks may vary among Tunisian CC patient, depending on some environmental co-factors.

Association of neutering with health and welfare of urban free-roaming cat population in Israel, during 2012-2014

'Trap-Neutering by gonadectomy-Return' (TNR) is currently becoming an accepted method for managing free-roaming cat (FRC) populations, especially in human habitation. However, data regarding its impact on cat welfare are limited. In order to determine the demographic risk factors for FRC morbidity, we followed FRC populations in the city of Rishon LeZion during 2012–2014. Their age status (kitten/adult), contraceptive status (neutered/intact), sex, body-condition-scoring (BCS 1-5/5; 1= emaciation, 5= obesity), skin lesions, and external signs of disabilities and injuries were recorded and analyzed. We fitted a mixed effects generalized linear model to each cat-condition. Overall, 4615 cat-observations were recorded, of which 692 were kittens, 2365 neutered adults and 1445 intact adults. In comparison to intact adults, kittens had a significantly higher prevalence of emaciation (BCS 1; OR of 4.61, CI95% 2.67–7.6, p < 0.001) and severe disability or injury (OR of 3.65, CI95% 1.44–9.25, p = 0.006). Among adult cats, neutered cats had higher prevalence of obesity (BCS 5; OR 30.6, CI95% 10.06–93.09, p < 0.001), lower prevalence of skin lesions (OR of 0.51, CI95% 0.3-0.86, p = 0.011), and close to significant lower prevalence of severe disability or injury (OR of 0.4, CI95% 0.15–1.07, p = 0.068). However, these neutered adults also had a higher prevalence of permanent disability (e.g. anophthalmia, tail or limb absence) (OR of 1.67, CI95% 1.12–2.49, p = 0.012). A higher ratio of neutered FRCs in the geographical surroundings was correlated with a reduced prevalence of emaciated (BCS 1; OR of 0.85 for the increase of 10% in proportion of neutered cats, CI95% 0.74-0.97, p = 0.020) and thin adult cats (BCS 2; OR of 0.94 for the increase of 10% in proportion of neutered cats, CI95% 0.90-0.98, p = 0.010), among both neutered and intact cats. The results suggest that neutering has a favorable effect on FRC health. Such effect can be due to both a direct influence on the neutered cats themselves, as well as to an indirect effect on the general cat population (intact and neutered cats) by reducing competitive behavior of the neutered cats, which may enable other cats to gain additional access to vital resources. A higher prevalence of permanent disability found among the neutered FRCs does not necessarily represent a higher risk of injury but can rather be attributed to their potentially prolonged lifespan.

Colorado in the Crossroads: Opinions on Over-The-Counter Status of Progesterone-Only Contraceptives [16G

INTRODUCTION: Long-Acting Reversible Contraception availability has reduced unintended pregnancy in Colorado, but 300,000 women are still in need of family planning services. In 2012, ACOG announced support for over-the-counter (OTC) oral contraceptives. Since that time, multiple legislative solutions have been proposed, but have been met with opposition for unclear reasons. The purpose of this study was to clarify stakeholder opinions on making progesterone-only pills (POPs) available OTC. METHODS: Individual qualitative interviews were conducted with 60 professionals recruited from five stakeholder groups: insurance industry (IC), religious leaders (RL), healthcare professionals (HP), health organization leadership (HO), and health policy (HL). These interviews solicited participants’ perspectives about making POPs available OTC in Colorado. Descriptive content analysis organized data into categories and themes. RESULTS: Most participants felt that Colorado is ready to endorse OTC POPs, and would support its implementation. HP and HO showed the largest support, encouraging women’s autonomy in their reproductive health decisions, and noting pharmacist support for this idea. HO showed the most opposition, citing patient cost concerns. RL and IC were conflicted, citing safety, education, and legislative wording concerns. Among all groups, political opposition and cost were perceived as the largest barriers against deregulation. CONCLUSION: The consensus among Colorado’s stakeholders is that the state is ready for OTC POPs. However, there was disagreement among groups as to the barriers to achieving that goal. Our research will help groups better understand each other’s interests so that we can come to a consensus on helping women in need in the state of Colorado.

DNA methylation of imprinted gene control regions in the regression of low-grade cervical lesions.

The role of host epigenetic mechanisms in the natural history of low-grade cervical intraepithelial neoplasia (CIN1) is not well characterized. We explored differential methylation of imprinted gene regulatory regions as predictors of the risk of CIN1 regression. A total of 164 patients with CIN1 were recruited from 10 Duke University clinics for the CIN Cohort Study. Participants had colposcopies at enrollment and up to five follow-up visits over 3 years. DNA was extracted from exfoliated cervical cells for methylation quantitation at CpG (cytosine-phosphate-guanine) sites and human papillomavirus (HPV) genotyping. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox regression to quantify the effect of methylation on CIN1 regression over two consecutive visits, compared to non-regression (persistent CIN1; progression to CIN2+; or CIN1 regression at a single time-point), adjusting for age, race, high-risk HPV (hrHPV), parity, oral contraceptive and smoking status. Median participant age was 26.6 years (range: 21.0-64.4 years), 39% were African-American, and 11% were current smokers. Most participants were hrHPV-positive at enrollment (80.5%). Over one-third of cases regressed (n = 53, 35.1%). Median time-to-regression was 12.6 months (range: 4.5-24.0 months). Probability of CIN1 regression was negatively correlated with methylation at IGF2AS CpG 5 (HR = 0.41; 95% CI = 0.23-0.77) and PEG10 DMR (HR = 0.80; 95% CI = 0.65-0.98). Altered methylation of imprinted IGF2AS and PEG10 DMRs may play a role in the natural history of CIN1. If confirmed in larger studies, further research on imprinted gene DMR methylation is warranted to determine its efficacy as a biomarker for cervical cancer screening.

HIV Status and Use of Contraceptives Among Women of Reproductive Age Group Attending the State Specialist Hospital Akure, 2017: A Comparative Study

Background: Globally, in 2015 there were about 17.8 million women living with HIV (WLHA) and about 80% were in their reproductive age and lived in sub-Saharan Africa. WLHA are advised to limit family size and have access to the use of safe and effective contraceptive methods.

Contraceptive use by disability status: new national estimates from the National Survey of Family Growth

ObjectiveThe objective was to determine population-based estimates of use of contraception among women 15–44 years of age in the United States by disability status. Study designWe examined the relationship between disability status and use of contraception among 7505 women at risk of unintended pregnancy using data from the 2011–2015 National Survey of Family Growth. ResultsAfter examining the full distribution of contraceptive method use by disability status, we found that disability status was significantly associated with differences in three categories of use: female sterilization, the oral contraceptive pill and nonuse of contraception. Multivariate analysis shows that use of female sterilization was higher among women with cognitive disabilities (aOR=1.54, 95% CI=1.12–2.12) and physical disabilities (aOR=1.59, CI=1.08–2.35) than for those without disabilities after controlling for age, parity, race, insurance coverage and experience of unintended births. Use of the pill was less common among women with physical disabilities than for those without disabilities (aOR=0.57, CI=0.40–0.82). Finally, not using a method was more common among women with cognitive disabilities (aOR=1.90, CI=1.36–2.66). ConclusionsSelf-reported cognitive disabilities (“serious difficulty concentrating, remembering or making decisions”), as well as physical disabilities, are significant predictors of contraceptive choices after controlling for several known predictors of use. ImplicationsThe patterns found here suggest that screening for self-reported cognitive and physical disabilities may allow health care providers to tailor counseling and sex education to help women with disabilities prevent unintended pregnancy and reach their family size goals.

Cross-sectional study of contraceptive use among Chinese women of reproductive age: results based on a mobile application (APP)-derived data.

To evaluate the contraceptive status among Chinese women of reproductive age and factors associated with contraceptive methods. A cross-sectional study from November 2015 to January 2016 was conducted. We used APP to collect demographics and contraceptive use information of women aged 14-44years in China. A total of 23,669 women completed the study. After data cleaning, 19,768 (83.5%) women were included in the final analysis. The prevalence of contraceptive use was 78.9%; while 21.05% of women did not use any method, condoms (40.10%), rhythm, or withdrawal (31.03%) were the most commonly used methods. When contraceptive methods were divided into four categories-long-acting contraceptives (LAC), short-acting contraceptive (SAC), Others, and "No use"-the prevalence was 6.1% (601/19,678), 40.8% (8022/19,678), 35.1% (6912/19,678), and 21.1% (4143/19,678), respectively. Women with a high level of education, being unmarried, and sexually active women tended to choose SAC; married women were associated with LAC usage. Women with irregular menstrual cycle used a high proportion of emergency contraception. The prevalence of contraceptive use was 78.9%, with condom use being most prominent. Young women of reproductive age have low awareness of contraception. Relevant departments should take necessary measures to improve this situation.

Domestic violence: a hidden barrier to contraceptive use among women in Nigeria.

BackgroundThe nonuse of family planning methods remains a major public health concern in the low-and-middle-income countries, especially due to its impact on unwanted pregnancy, high rate of abortion, and transmission of sexually transmitted diseases. Various demographic and socioeconomic factors have been reported to be associated with the nonuse of family planning methods. In the present study, we aimed at assessing the influence of domestic violence (DV) on contraceptive use among ever married women in Nigeria.MethodsData on 22,275 women aged between 15 and 49 years were collected from the most recent Nigeria Demographic and Health Survey conducted in 2013. The outcome variable was contraceptive utilization status, and the main exposure variable was DV, which was assessed by the self-reported experience of physical and psychological abuse. Complex survey method was employed to account for the multistage design of the survey. Data analyses were performed by using bivariate and multivariable techniques.ResultsThe mean age of the participants was 31.33±8.26. More than four fifths (84%) of the participants reported that they were not using any contraceptive methods at all. Lifetime prevalence of psychological and physical abuse was, respectively, 19.0% (95% CI =18.0–20.1) and 14.1% (95% CI =13.3–14.9). Women who reported physical abuse were 28% (adjusted odds ratio [AOR] =1.275; 95% CI =1.030–1.578), and those reported both physical and psychological abuse had 52% (AOR =1.520; 95% CI =1.132–2.042) higher odds of not using any contraception.ConclusionThe rate of contraception nonuse was considerably high and was found to be significantly associated with DV. Thus, the high prevalence of DV may compromise the effectiveness of the family planning programs in the long run. Evidence-based intervention strategies should be developed to protect the health and reproductive rights of the vulnerable women and to reduce DV by giving the issue a wider recognition in public policy making.

Factors affecting menopause in Nepalese women

Introductions: Menopause is a physiological event that indicates the end of reproductive period in woman’s life. It has many health issues and morbidity. There are multiple factors that influence age of onset of menopause and we aim to find these associated factors.&#x0D; Methods: The 2011 ‘Nepal demographic and health survey’ data was used in this study. Logistic regression was used to find the association between the dependent and independent variables using bi-variate and multi-variate analysis.&#x0D; Results: The bivariate analysis showed the association of age, wealth index, education, marital status, employment, use of oral contraceptives and smoking with menopause. The multivariate analysis showed the independent association of age, education, employment and oral contraceptives.&#x0D; Conclusions: The employment, marital status and use of oral contraceptives were found to be independently associated with the age of onset of menopause on multivariate analysis.

The role of mHealth intervention on maternal and child health service delivery: findings from a randomized controlled field trial in rural Ethiopia.

The provision of consistent and quality maternal and child health (MCH) services is a challenge for Ethiopia where most of the population lives in the rural setup. Health service delivery is constrained mainly by shortage of health professionals, meager resources, limited awareness among the society and bureaucratic procedures. Low health service utilization of antenatal care (ANC), delivery services, and postnatal care (PNC) are believed to contribute for high maternal and child mortality rates. Innovative approach like mHealth based technological intervention believed to alleviate such challenges in countries like ours. However, currently, there are few evidences that demonstrate the impact of mHealth technology applications on the level of service utilization. Therefore, the objective our study is to assess the role of mobile phone equipped with short message service (SMS) based data-exchange software linking community health workers to Health Centers in rural Ethiopia affect selected MCH outcomes. A community-based randomized control trial (RCT) was conducted in three woredas of Guraghe zone (Ezha, partial &Abeshge full intervention, Sodo Control). Mobile phones equipped with FrontlineSMS based, locally developed application was distributed to all health extension workers (HEWs) to both intervention woredas who filled maternal, child and stock related forms and submitted to the central server which in turn sends reminder about the scheduled date of ANC visit, expected date of delivery, PNC, immunization schedule and vaccine and contraceptive stock status. Moreover, in Abeshge, the voluntary health workers (vCHW) and HEW supervisors in both intervention woreda were given a phone to facilitate communication with the HEW. No mobile was offered to the control woreda.Pre [2012] and post [2013] intervention community based survey on mothers who have under 5 and under 1 year old child was done to assess the effect of the mobile intervention on selected MCH process indicators. Structured and pretested questionnaire was used to collect data and SPSS v16 statistical software was used for analysis. Three thousand two hundred and forty mothers, 1,080 from each, were surveyed in the three woredas. The study revealed that the proportion of mothers receiving more than four ANC visits increased significantly in both intervention woredas. Besides, the rate of ANC delivered by HEWs improved in Ezha woreda (T1) (19.01% to 28.27%), proportions of deliveries attended by skilled health workers increased and home delivery decreased in all woredas; most pronounced increases in referrals from health post to health center by HEWs, reported in Ezha and Abeshge. The intervention also led to a significant reduction in stock-outs of preferred contraceptive products in Ezha (T1) from 16.96% to 8.24% but no change was observed in both contraceptive prevalence and immunization rates in the control and the other intervention woreda. The study confirmed the positive contribution of SMS based mobile phone intervention in most of the selected MCH service indicators, like improvement in the percent of recommended number of ANC visit, percentage of delivery attended by health workers and facilitating the work processes of the health workers in rural Ethiopia.

Fertility Differential Among Lower Caste in Lamachaur VDC, Kaski

Fertility measures the rate of which a population adds to itself by births and is normally assessed by relating the number of births to the size of some section of population. It has been observed that the levels and patterns of fertility vary considerably in various sub groups of the same population in terms of educational attainment, occupation, age at marriage, contraception user etc. This study, therefore, attempts to study of fertility differential among lower caste people. This study is based on descriptive cum analytical research design. Every household of Dalit community in ward no 6, 7 and 8 of Lamachaur VDC are included in the study with a sample population of 85eligible women aged 15-49 years from 85 households. Fertility differential among lower caste people shows that most of the respondents were in the age group of 36-49 and then followed by age group 26-35 and 15-25. Higher fertility is concentrated in the age at marriage from 16 to 19 as compare to other groups of age at marriage. Literate respondents have low fertility as compared to illiterate respondents. Working respondents have high fertility as compared to non-working respondents. The users of contraception have high fertility as compared to non-users of contraception.But, there is no significant relationship between fertility and age of women, age at marriage, literacy status, occupation and users of contraception as measured by chi-square test. It is better to make women literate and to marry at the age after 19 to reduce fertility.Janapriya Journal of Interdisciplinary Studies, Vol. III (December 2014), page: 47-53

Postpartum LARC Use in Low-Risk Women in Centering Pregnancy® Versus Traditional Nurse Midwifery Prenatal Care [5F

INTRODUCTION: Despite the low failure rates of long-acting reversible contraceptive devices (LARC) of 0.05-0.8%, women typically choose less effective forms of contraception. This is of particular interest in the postpartum patient population with regards to prevention of short interval pregnancies, which have increased morbidity. This study investigates rates of LARC use in women who attend Centering Pregnancy® (CP), a standardized group care, versus traditional prenatal (TP) care with Certified Nurse Midwifes (CNM). METHODS: IRB approved, retrospective chart analysis was conducted for all women who participated in (1) GP care between March 2012 and May 2016 and (2) TP care during the same time period. Contraception status was recorded at discharge and at a scheduled 6-8 week postpartum visit. RESULTS: 126 women participated in GP care and 847 women attended TP care. GP patients were more likely to be admitted to the antepartum service (33.6% vs 13.4%, P &lt; .0001), deliver before 37 weeks (9.5% vs 3.8%, P=.004) and have a higher average of prenatal visits (14 vs 11, P &lt; .0001). LARC use rates at discharge were similar between the two groups (27.8% vs 34.4%, P=.144). More women attended their postpartum visit in the GP group (94.4% vs 83.2%, P=0.001) and LARC use rates at the postpartum visit were not statistically different (31.9% vs 33.3%, P=0.764). CONCLUSION: Despite a greater number of prenatal visits among women who attended group prenatal care at our institution, there was no significant difference in LARC use rates at discharge after delivery or at the postpartum visit.