Family Planning Counseling Research Articles

Pelaksanaan Program Pengendalian Penduduk Di Dinas Pengendalian Penduduk Dan Keluarga Berencana Kota Bitung

This research aims to explain and analyze the implementation of the family planning program at the Population Control and Family Planning Office of Bitung City based on the scientific research process on the science of development resource management. The research was conducted from March to April 2023. This research took place at the Population Control and Family Planning Office of Bitung City. The results showed that the human resources of program implementers were divided into three groups of work units, namely employees at the Bitung City Population Control and Family Planning Office, employees at the District UPTD. Cadres and PPKBD at the kelurahan level. Employees at the Population Control and Family Planning Office of Bitung City have responsibilities in implementing the program in accordance with their main tasks and functions in the field of population control, counseling and mobilization. Employees at the sub-district UPTD in implementing the program conduct counseling, family planning services and family data collection. Cadres and PPKBD at the village level in implementing the program function to increase family planning participation, reduce alocon dropout, reduce stunting rates, help facilitate family planning services, counseling and family assistance and report regularly every month.

FAMILY PLANNING ATTITUDE IN TURKISH CULTURE: RELATIONSHIP BETWEEN EXPERIENCING UNINTENDED PREGNANCY, RECEIVING COUNSELING, AND ACCESSING METHODS

Objective: In this study, it was aimed to determine the frequency of married women using methods related to family planning and the factors associated with method use.
 Method: 400 women between the ages of 15 and 49 were a part of the research, which was carried out as a descriptive and relationship-seeking study. The family planning attitude scale and a personal information form were utilized in the data collection phase of the study, and data were analyzed using the IBM SPSS 25 program. Ethics committee permission and written consent from the participants were obtained for the habituation to take place. T-test, one-way variance, and multiple regression analyzes were used in the analysis of the data.
 Results: It was determined that the total mean score of the family planning attitude scale of the women was 133.49 ± 18.78, 67% of them used a modern family planning method, and 32.5% of them received counseling for family planning. It has been found that women's family planning attitudes are affected by age, income level, availability of family planning products and method selection reasons. It has been determined that the family planning attitude scale sub-dimensions of women who have experienced abortion/abortion have lower attitudes towards family planning and family planning method attitudes than women who have not experienced abortion/abortion.
 Conclusion: According to the research, women have positive attitudes regarding family planning, but not at the level that is ideal. More effectively delivering training and consulting services is crucial to fostering a good attitude toward family planning.

Identifikasi faktor yang berhubungan dengan pemilihan alat kontrasepsi pada pasangan usia subur di Desa Sei Kamah I

A country with a large population will have a high population density. Indonesia is now handling this problem. Based on information collected from the Sei Dadap District Family Planning Counseling Office from 583 couples of reproductive age in Desa Sei Kamah I in 2021, as many as 253 (43.30%) were actively registered as family planning participants. This study aimed to identify, analyze and explain the factors related to the selection of contraceptives for reproductive age couples (RAC) in Desa Sei Kamah I, Sei Dadap District, Asahan Regency. This research is an analytical survey research with a cross-sectional research design. The fixation of sample size in this study was calculated using the sample calculation formula, it calls the cross-sectional formula and obtained a sample of 82 respondents. This study has six independent variables, specifically: variables of age, number of children, level of education, level of knowledge, partner support, and pregnancy plans with the dependent variable being the choice of contraception at RAC. Data were collected by interview using a questionnaire and then analyzed using the chi-square test with a value of α = 0.05. The results showed that the variable related to the choice of contraceptives in RAC was the couple's support (p=0.001). The cadres are expected to grow the husband's support for their wife to use long-term contraceptives and bring awareness for the husband to participate in using long-term contraceptives, Man Operation Method (MOM) with involvement from public figures, because the husband's support significantly affects the contraception that the respondent will choose.

Effects of Postpartum Family Planning Counselling on Contraceptives Knowledge, Attitude and Intention Among Women Attending a General Hospital in The Gambia: A Randomized Controlled Trial.

This study aimed to evaluate the effectiveness of PPFP counselling on contraceptives knowledge, attitudes and intention among women attending a general hospital in The Gambia. A quasi-experimental design with an intervention and comparison group was used. The intervention was PPFP counselling using the GATHER approach. A sample size of 674 participants was determined by a formula for comparison between the two groups. The questionnaire was developed based on a literature review and was pre-tested on 10% of the total study sample size (68). A reliability of 0.731 was obtained. A systematic random sampling method was employed to select study participants who met the inclusion criteria. Data were collected during face-to-face interviews in local languages with a 100% response rate at baseline and 96% at post-test. Data were analysed using the SPSS version 21.00 and the statistical analysis included both descriptive and inferential methods. An ethical approval was obtained from the Research and Ethics Committee, School of Basic Medical Sciences, College of Medicine, University of Benin (CMS/REC/2017/017) and the Gambia Government/Medical Research Council Laboratories Joint Ethics Committee (R017016Av1.1). Baseline respondents' socio-demographic characteristics revealed that the two groups had similar characteristics. A statistically significant difference existed on knowledge, attitude, and intention to use contraceptive methods between the intervention and comparison groups at post-intervention (p<0.05) while no significant difference was observed at baseline. Significant gains were achieved in the intervention group in terms of knowledge, attitude, and intention post-intervention. PPFP counselling during the postpartum period and before the discharge of women from the hospital may improve knowledge, attitude and intention to use contraceptives and, therefore, increase the likelihood of contraceptive uptake and thus prevent unwanted and closely spaced pregnancies.

Lipidomics—Paving the Road towards Better Insight and Precision Medicine in Rare Metabolic Diseases

Even though the application of Next-Generation Sequencing (NGS) has significantly facilitated the identification of disease-associated mutations, the diagnostic rate of rare diseases is still below 50%. This causes a diagnostic odyssey and prevents specific treatment, as well as genetic counseling for further family planning. Increasing the diagnostic rate and reducing the time to diagnosis in children with unclear disease are crucial for a better patient outcome and improvement of quality of life. In many cases, NGS reveals variants of unknown significance (VUS) that need further investigations. The delineation of novel (lipid) biomarkers is not only crucial to prove the pathogenicity of VUS, but provides surrogate parameters for the monitoring of disease progression and therapeutic interventions. Lipids are essential organic compounds in living organisms, serving as building blocks for cellular membranes, energy storage and signaling molecules. Among other disorders, an imbalance in lipid homeostasis can lead to chronic inflammation, vascular dysfunction and neurodegenerative diseases. Therefore, analyzing lipids in biological samples provides great insight into the underlying functional role of lipids in healthy and disease statuses. The method of choice for lipid analysis and/or huge assemblies of lipids (=lipidome) is mass spectrometry due to its high sensitivity and specificity. Due to the inherent chemical complexity of the lipidome and the consequent challenges associated with analyzing it, progress in the field of lipidomics has lagged behind other omics disciplines. However, compared to the previous decade, the output of publications on lipidomics has increased more than 17-fold within the last decade and has, therefore, become one of the fastest-growing research fields. Combining multiple omics approaches will provide a unique and efficient tool for determining pathogenicity of VUS at the functional level, and thereby identifying rare, as well as novel, genetic disorders by molecular techniques and biochemical analyses.

Magnitude of Modern Contraceptive Utilization and its Associated Factors Among Postpartum Women in Bench Sheko Zone, Southwest Ethiopia, 2021: Community-Based Cross-Sectional Study

Despite the significant benefit of postpartum modern contraceptives to avert the problems related to short interpregnancy intervals and unintended pregnancy, still the uptake remains low in Ethiopia. The aim of the study was to assess the magnitude of family planning use during the puerperium period and the factors associated with it in the Benchi Sheko zone of Southwest Ethiopia. From 10th March to 10th May/2021, 385 mothers were enrolled in a community-based cross-sectional study. Participants were nominated using simple random sampling. To collect the data, an interviewer-administered questionnaire was used. To identify the factors associated with the utilization of postpartum contraceptives, bivariate and multivariable logistic regression analyses were used. The statistical significance level was determined at p-value &lt; .05. The overall utilization of postpartum modern family planning utilization was 50.4% (95% CI: 45.3, 55.3). Maternal education (AOR = 2.26, 95% CI; 1.03–4.95), informed on family planning (AOR = 0.34, 95% CI; 0.13–0.91), counseled on contraceptives during Antenatal Care (ANC) (AOR = 1.82, 95% CI: 1.05–3.17), previous family planning utilization (AOR = 0.45, 95% CI: 0.28–0.73), counseled on contraceptives at the time of PNC (AOR = 1.70, 95% CI: 1.07–2.71), and resumption of sexual intercourse after delivery (AOR = 4.17, 95% CI: 1.57–11.08) were the major factors hindering the utilization of modern contraceptives. the overall magnitude of modern contraceptive utilization during the puerperium period was low. Having counseling, information, and previous experience in family planning, and time to sexual intercourse resumption were clinical predictors of family planning utilization. A concerted effort to incorporate contraceptive services into maternal, neonatal, and child health (MNCH) service units should strengthen much, and counseling gives due emphasis.

Pengaruh Penyuluhan KB dalam Pandangan Islam terhadap Keikutsertaan Pemilihan Kontrasepsi bagi Calon Akseptor di Dusun Jabung Yogyakarta Indonesia

Based on the Population Growth Rate (LPP) data in 2018, the number of births in Indonesia was 5 million (1.28%) per year. One of the reasons is the lack of knowledge and participation of childbearing-age couples in contraceptive selection. They were given Islamic family planning (FP) counseling because most of Indonesia's population is Muslim. This study aims to determine the effect of FP counseling in the Islamic view on participation in contraceptive selection for prospective FP acceptors in Jabung, Pandowoharjo, and Sleman Yogyakarta. Pre-experimental research methods with on group pretest-posttest design. The Instrument was a questionnaire. The population was 49 childbearing women who did not use any kind of contraception and used total sampling. Bivariate analysis techniques used the Wilcoxon test. The average score of participation of prospective FP acceptors in choosing contraceptives before and after FP counseling in the Islamic view was increased from 57.76% to 82.29%, which showed a difference of 30.53. Wilcoxon test obtained z significance value which showed that FP counseling in the Islamic view was an effect on the participation in contraceptive selection for prospective FP acceptors at 0,000 with p value 0,000 &lt;0.005.

Assessment of community pharmacy professionals’ willingness, involvement, beliefs, and barriers to offer health promotion services: a cross-sectional study

IntroductionThe role of community pharmacy professionals has been expanded to patient care and health promotion service globally. However, in Ethiopia, there is a scanty of data on the issue, although the country is dealing with a double burden of non-communicable and communicable diseases.ObjectivesThis study aimed to assess community pharmacy professionals’ willingness, involvement, beliefs, and barriers to offer extended services for health promotion in Injibara town, Amhara, Ethiopia.MethodsA cross-sectional study was conducted among licensed and registered community pharmacy professionals working in Injibara town from June 25 to July 10, 2022. A structured self-administered questionnaire was used to collect data. The data were presented using descriptive statistics. The data were analyzed using STATA version 16 software.ResultsA total of 24 community pharmacy professionals were involved in the study, with a response rate of 92.3%. Approximately 91.7% of them were involved in health promotional services. Of them, 54.1% were willing and strongly believed that their involvement in health promotion services would have a positive impact on promoting health. A total of 60.9% of the community pharmacy professionals reported that they were very involved in family planning and alcohol consumption counseling. Different barriers to not providing health promotion services were also cited.ConclusionsMajority of community pharmacy professionals in this study is involved in health promotional services but there are also barriers on their involvement. Therefore, governmental strategies to overcome the barriers that hamper their involvement should be designed.

Knowledge and practices of modern contraceptives among religious minority (Muslim) women: A cross-sectional study from Southern Nepal.

Uptake of family planning (FP) services could prevent many unwanted pregnancies, and unsafe abortions and avert maternal deaths. However, women, especially from ethnic and religious minorities, have a low practice of contraceptives in Nepal. This study examined the knowledge and practices of modern contraceptive methods among Muslim women in Nepal. A cross-sectional study was conducted among 400 Muslim women in the Khajura Rural Municipality of Banke district. Data were collected using face to face structured interviews. Two outcome variables included i) knowledge of and ii) practices of contraceptives. Knowledge and practice scores were estimated using the list of questions. Using median as a cut-off point, scores were categorised into two categories for each outcome variable (e.g., good knowledge and poor knowledge). Independent variables were several sociodemographic factors. The study employed logistic regression analysis, and odds ratios (OR) were reported with 95% confidence intervals (CIs) at a significance level of p<0.05 (two-tailed). Almost two-thirds (69.2%) of respondents had good knowledge of modern contraceptive methods, but only 47.3% practised these methods. Women of nuclear family (adjusted odds ratio (aOR) = 0.60; 95% CI: 0.38,0.95), and who work in agricultural sector (aOR = 0.38; 95% CI: 0.22, 0.64) were less likely to have good knowledge on modern contraceptives. Women with primary (aOR = 2.59; 95% CI: 1.43, 4.72), secondary and above education (aOR = 4.41; 95% CI:2.02,9.63), women with good knowledge of modern contraceptives (aOR = 2.73; 95% CI: 1.66, 4.51), who ever visited a health facility for FP counselling (aOR = 4.40; 95% CI: 2.58, 7.50) had higher odds of modern contraceptives practices. Muslim women had low use of modern contraceptive methods despite having satisfactory knowledge about them. There is a need for more equitable and focused high-quality FP practices. Targeted interventions are needed to increase the knowledge and practices of contraceptives in the Muslim community. The study highlights the need to target FP interventions among socially disadvantaged women, those living in a nuclear family, and those with poor knowledge of modern contraceptives.

Clustering Couples of Childbearing Age to Get Family Planning Counseling Using K-Means Method

&#x0D; &#x0D; &#x0D; &#x0D; Couples of Childbearing Age (CCA) in the Madiun Regency have increased in the last three years. It caused the population in Madiun to overgrow with the newborn, which implies the economic, social, and environmental aspects. This study aims to cluster villages in Madiun with CCA case studies instead of birth control participants who will give birth and want children to determine the priority of getting Family Planning (in Indonesia, namely Keluarga Berencana/KB) counseling. K-Means clustering is used in this study because it has a linear space of complexity that can be executed quickly and easily. The result of this study is four (4) CCA clusters. CCA cluster 1 is a very high level of giving birth and wanting children, consisting of 7 villages. CCA cluster 2 is a high level of giving birth and wanting children with 119 villages. CCA cluster 3 is a medium level of giving birth and wanting children in 50 villages, and CCA cluster 4 is a low level of giving birth and wanting children, including 34 villages. So, cluster 1, which includes seven villages, is the most prioritized to get Family Planning counseling because it is the CCA cluster with the most birthing rate and wants children. This research obtained a silhouette coefficient of 0.42, which belongs to the medium level.&#x0D; &#x0D; &#x0D; &#x0D;

Changes in clients' perceptions of family planning quality of care in Kaduna and Lagos States, Nigeria: A mixed methods study.

Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) are crucial to improving access to family planning (FP) services in Nigeria. Although the private sector is preferred for convenience, availability of commodity, privacy, and timeliness, less well known is the quality of care received by clients who obtain FP services from CPs and PPMVs. This paper seeks to explore the use of validated quality of care measures for programming in Kaduna and Lagos States and to assess how these measures worked in capturing changes in quality of care using client exit interviews implemented at two time points. Using validated measures of quality of care, 598 and 236 exit interviews in rounds 1 and 2 were conducted with FP clients aged 18-49 years old. The quality of care domains were assessed using 22 questions. A weighted additive quality score was created, and scores were grouped into three: low, medium, and high quality. Changes in quality of care received were examined using χ 2 test. A subset of 53 clients were selected for in-depth interviews. Deductive and inductive approaches were used for coding, and data analysis was thematic. In Lagos, we observed increases in 16 out of 22 items while in Kaduna increases were only observed in 8 items. For instance, increases were observed in the proportion of women who experienced visual privacy between rounds 1 and 2 in Lagos (74%-89%) and Kaduna (66%-82%). The quality of care received by clients changed over time. Women who reported high quality care in Lagos increased from 42% to 63%, whereas women who reported high quality care in Kaduna decreased from 35% to 21%. In both states, in-depth interviews revealed that women felt they were treated respectfully, that their sessions with providers were visually private, that they could ask questions, and that they were asked about their preferred method. This study demonstrates that clients received high quality of care services from providers (CPs and PPMVs) especially in Lagos, and such services can be improved over time. Continuous support may be required to maintain and prevent reduction in quality of FP counseling and services, particularly in Kaduna.

A mixed-methods study of factors influencing postpartum intrauterine device uptake after family planning counseling among women in Kigali, Rwanda.

Rwanda has high unmet need for family planning (FP), especially in the postpartum period when women are advised to space pregnancies at least two years for improved maternal-child health. Despite interest in the copper intrauterine device (IUD), a highly cost-effective method, access and uptake remain low. This study aimed to determine factors associated with postpartum IUD (PPIUD) uptake after postpartum family planning (PPFP) counseling as well as provider perceptions of facilitators and barriers to clients' PPIUD uptake. Postpartum women who received PPFP counseling and were less than 6 weeks postpartum were recruited for a case-control study in Kigali, Rwanda in 2018. We recruited n = 74 women who had accepted and n = 91 women who had declined the PPIUD. Multivariate logistic regression analyses evaluated associations between women's socio-demographics, FP knowledge and decision-making, and the outcome of PPIUD uptake. Six focus groups (FGs) were conducted with FP providers (n = 24) and community health workers (n = 17) trained to deliver PPFP counseling to assess perceptions of PPFP counseling and facilitators and barriers to PPIUD uptake. FG discussions were recorded, translated, and analyzed for themes. Factors associated (P<0.1) with PPIUD uptake included citing its non-hormonal nature, effectiveness, and duration of protection against pregnancy as advantages. Exclusive male partner control over FP decisions (relative to women's control or joint decision-making) was associated with non-use. Overall, limited knowledge about some aspects of the PPIUD persisted among clients even after counseling. Provider FGs highlighted client concerns, inconsistent FP messaging, and lack of male partner involvement as factors influencing non-use. Knowledge of the IUD and its benefits was associated with PPIUD uptake. There is need to refine PPFP counseling messages to address remaining knowledge gaps and concerns. Additionally, male partner involvement in FP counseling and decisions with their partners could be a key strategy to increase both PPIUD and FP uptake in Rwanda.

POSTPARTUM MODERN CONTRACEPTIVE UTILIZATION IN ADDIS ABABA: ANTEPARTUM DECIDEDNESS FOR POSTPARTUM UPTAKE

Introduction: Family planning (FP) slows population growth and helps achieve national and international development goals. FP counselling is the first intervention in family planning programs and can be done during late pregnancy. Antepartum FP counseling is not practiced adequately during the antenatal care (ANC) service delivery at which time women can decide to use Post-Partum Modern Contraceptive (PPMC). Women’s antenatal decidedness rate to use PPMC is not known. Objective: To assess the prevalence of antenatal decidedness to use PPMC among pregnant women in Addis Ababa city. Methods: A cross-sectional study was conducted from Tir 01, 2012 to Tir 30, 2012 EC on a population of women who had their 4th ANC visits in 98 health centers in Addis Ababa. The calculated sample size was 422; and the sampling procedure was made in 2 stages: Cluster Sampling and Simple Random Sampling. Study subjects were enrolled in a continuous all-inclusive manner starting from the first woman who came on her scheduled 4th ANC visit on day one of the study period until the total number of study subjects was obtained. A semi-structured, anonymous, self-prepared &amp; pre-tested questionnaire was used to collect data; and data collection was as an exit interview. Data was entered &amp; analyzed using SPSS version 25 software. Results: During the routine ANC follow up only 153 (36.9%) have had FP counseling, and the study team delivered the service for 262 (63.1%). Three hundred eighteen (76.6%) have antenatally decided to use PPMC. The rate of antenatal decidedness to use PPMC was higher for those who had FP counseling by the study team compared to those counseled during the routine ANC follow up (77.9% Vs 74.5%). Religion, the round of ANC visit the FP counseling was given, and the number of topics covered during the FP counseling were found to be determining factors for women’s antenatal decidedness to use PPMC. Conclusion: The FP counseling service delivery rate during the routine ANC service is low. Women will decide to use PPMC antenatally if they get a FP planning counseling conducted during the ANC follow up. The FP counseling should include 4 major topics (available types, efficacy, advantages &amp; disadvantages, and side effects of each method), and an adequate duration should be allocated for it. Further study to find out why ANC care providers at health centers are not providing FP counseling service to all of their clients is recommended.

Family Planning and Fertility Counseling Perspectives of Gender Diverse Adults and Youth Pursuing or Receiving Gender Affirming Hormone Therapy

To describe family planning and fertility counseling perspectives of reproductive-age gender diverse adults and youth pursuing gender affirming hormone therapy. This was a cross sectional survey study of gender diverse adults and youth pursuing or receiving gender affirming hormone therapy. The primary outcomes of interest were parental desire and priorities for fertility preservation. Fifty-seven individuals (46 adults and 11 youths) completed the survey; 51% were transgender women, 35% were transgender men, and 14% identified as non-binary. 32 participants expressed interest in (n = 15, 26%) or uncertainty about (n = 18, 32%) future parenthood. 48% of participants had considered gamete cryopreservation, but only 7% each previously completed or planned to pursue this fertility option; 67% cited cost as a barrier. Participants with interest in or uncertainty about future parenthood were more likely to consider cryopreservation (P <.001) or stopping hormones for fertility preservation (P <.001). 58% of respondents reported discussing fertility preservation with a health care provider with lower rates among youth participants (P = .017). From a family planning perspective, 58% of respondents described counseling as adequate; 23% described it as inadequate and 19% reported not receiving any counseling. Participants who endorsed strong or uncertain parental desire were more likely to report inadequate counseling (P = .016). Gender diverse individuals interested in or undecided about future parenthood were more likely to consider cryopreservation and report inadequate family planning counseling. Therefore, current counseling practices may be insufficient and referral to a fertility specialist should be considered.

Quality of family planning counseling: An evaluation in the context of premarital counseling services carried out within a provincial health directorate in Turkey.

Good quality family planning (FP) counseling meets the reproductive health needs of individuals and couples by supporting autonomous decision making. Survey-based assessments cannot catch nuances of FP counseling. This study aimed to evaluate the quality of FP counseling offered to couples in Turkiye (Kocaeli)- which is a primary example of a developing country. This study was conducted with health workers providing at least six months pre-marriage counseling services in five institutions. Data were obtained by information form, individual face-to-face interviews, and observation. Most of the 17 participants kindly welcomed, made simple explanations without making medical terms by making face-to-face and eye contact during the counseling. While some participants were able to provide information about contraception methods, other participants were not able to explain by showing an example of each method. This study's findings demonstrated that the quality of FP counseling in Turkiye is still sub-optimal. The time allocated to FP counseling was short and there was no given information about all methods of contraception. To increase the quality of FP counseling services offered by health providers, the existing FP guidelines and training packages must be reviewed.

CLINICAL AND HEMORRHAGIC PROFILES OF HEMOPHILIA A FEMALE CARRIERS OF INTRON 22 INVERSION

According to the Ministry of Health, Brazil had 10,821 patients diagnosed with hemophilia A (HA) in 2019 and with Minas Gerais had the third largest population of HA patients. Fundação Hemominas is a reference treatment center in this state for the clinical and laboratory care of these patients. HA is an X-linked coagulopathy caused by a deficiency of coagulation factor VIII (FVIII). Almost all patients are male, and females are considered carriers if they have an X chromosome with a mutation in the FVIII gene. In addition, it is estimated that there are 1.6 female carriers for every male HA patient. HA Carriers are classified into five categories based on residual plasma FVIII level (FVIII:C) and phenotype: (i) FVIII:C > 40% with bleeding phenotypes are classified as symptomatic; (ii) FVIII:C > 40% without bleeding phenotypes are classified as asymptomatic; (iii) FVIII:C > 5% to 40% are classified as mild HA; (iv) FVIII:C 1% to 5% are classified as moderate HA; and (v) FVIII:C < 1% are classified as severe HA. The aim of this study was to analyze the clinical and hemorrhagic profiles of female relatives of patients with severe HA with intron-22 inversion treated at Fundação Hemominas and older than 12 years. To date, sixteen participants have been enrolled in the study after signing an informed consent form. Participants answered two questionnaires: 1) evaluation of bleeding - ISTH (BAT-ISTH); and 2) evaluation of arthralgia. Peripheral blood samples were collected in a citrate tube and processed for DNA extraction. Genotyping to identify intron 22 inversion was performed by inverse PCR. Of the 16 participants, seven (44%) were identified as carriers of the mutation. Among the carriers, the median (MED) age was 35 years (IQR 34 - 35.5) and the bleeding score MED was 6 (IQR 4.8 - 9). In addition, carriers reported pain in the joints of the shoulders (3 – 42.9%), hips (2 – 28.6%), knees (2 – 28.6%), and ankles (2 – 28.6%). For participants who were not carriers, the age MED was 36 years (IQR 30 - 56) and the bleeding score MED was 4 (IQR 1 - 7). In addition, participants who were not carriers had pain in all joints studied, i.e., shoulders (3 – 33.33%), elbows (1 – 11.11%), hips (2 – 22.22%), knees (4 – 44.44%), and ankles (2 – 22.22%). Molecular diagnosis was important to identify family members with intron-22 inversion and to provide appropriate genetic counseling for family planning. A significant statistical difference (p = 0.019) was found between carriers and non-carriers in bleeding score. This is an ongoing study and the number of participants needs to be increased in order to draw conclusions. We thank all participants, Fapemig, Fundação Hemominas, and the CGSH of the Ministry of Health.

Qualitative evaluation of the Systems Analysis and Improvement Approach as a strategy to increase HIV testing in family planning clinics using the Consolidated Framework for Implementation Research and the Implementation Outcomes Framework

BackgroundSignificant gaps remain in HIV testing and counseling (HTC) in family planning (FP) clinics. To address these gaps, our group tested an implementation strategy called the Systems Analysis and Improvement Approach (SAIA), an evidenced-based multi-component implementation strategy focused on improving entire care cascades. In a cluster randomized trial of 24 FP clinics in Mombasa County, Kenya, SAIA led to a significant increase in HTC in intervention clinics compared to control clinics. The objective of this manuscript was to evaluate SAIA using the Consolidated Framework for Implementation Research (CFIR) and assess the Implementation Outcomes Framework outcomes of acceptability, appropriateness, and feasibility.MethodsThis qualitative assessment was nested within the cluster-randomized trial. Data collection included questionnaires to assess modifiable and non-modifiable health system factors related to HTC and in-depth interviews to query clinic norms, priorities, communication strategies, and readiness for change. The primary outcomes of interest were feasibility, appropriateness, and acceptability of SAIA. Data on inner setting and structural characteristics of FP clinics were collected to inform how context may impact outcomes. All interviews were recorded and analyzed using a rapid assessment approach.ResultsOf the 12 intervention clinics, 6 (50%) were public facilities. Availability of resources varied by clinic. Most clinics had a positive implementation climate, engaged leadership, and access to resources and information. While not all clinics identified HTC as a clinic priority, most reported a strong culture of embracing change and recognition of the importance of HIV testing within FP clinics. Interviews highlighted very high acceptability, appropriateness, and feasibility of SAIA. The implementation strategy was not complicated and fit well into existing clinic processes. In particular, staff appreciated that SAIA allowed clinic staff to generate contextually relevant solutions that they implemented.ConclusionsSAIA was implemented in FP clinics of varying sizes, capacity, and management support and was found to be acceptable, appropriate, and feasible. The agency that clinic staff felt in proposing and implementing their own solutions was likely part of SAIA’s success. We anticipate this will continue to be a mechanism of SAIA’s success when it is scaled up to more clinics in future trials.Trial registrationClinicalTrials.gov (NCT02994355) registered 16 December 2016.

The role of job aids in supporting task sharing family planning services to community pharmacists and patent proprietary medicine vendors in Kaduna and Lagos, Nigeria

BackgroundCPs and PPMVs are an important source of modern contraceptives in Nigeria, yet many lack the requisite knowledge and skills to capably provide these services. This skills gap might be addressed through targeted family planning (FP) training. This study measures family planning knowledge retention of CPs and PPMVs after receiving training in FP counseling and services in Kaduna and Lagos States, in Nigeria.MethodsIn a quasi-experimental longitudinal design without a comparison group, 559 CPs and PPMVs who were enrolled in the IntegratE project between January and December 2019, completed a self-administered questionnaire to assess their knowledge related to the provision of FP counseling, and injectable and implant contraceptive services at three points in time: 1) before the training; 2) immediately after the training; and 3) 9-months after the training in Kaduna and Lagos states, Nigeria. Adjusted multivariate logistic regression analysis was used to assess the effect of provider characteristics and receipt of job aids on FP knowledge retention 9 months after the training. 95% confidence intervals and p-values were used to assess statistical significance.ResultsMajority of study participants were females (60.3%) and between 30 and 49 years old (63.4%). The study revealed the importance of jobs aids as influence on knowledge retention. CPs and PPMVs who reported having the Balanced Counseling Strategy plus (BCS+) counseling cards, were more likely to retain knowledge (AOR: 2.92; 95% CI: 1.01–8.40, p-value = 0.05) at 9 months follow-up. Similarly, in terms of knowledge of injectable contraceptives, CPs and Tier 2 PPMVs who reported receiving the Medical Eligibility Criteria (MEC) Wheel were 2.1 times more likely to retain knowledge of injectable contraceptives 9-months later on (95% CI: 1.14–3.99, p-value = 0.02).ConclusionCommunity Pharmacists and Proprietary Medicine Vendors had good retention of family planning knowledge, especially when combined with job aids. Training and providing them with job aids on FP will therefore support task shifting and task sharing on family planning services provision in Nigeria.

Integrated delivery of family planning and childhood immunization services: a qualitative study of factors influencing service responsiveness in Malawi.

Evidence from several countries in sub-Saharan Africa suggests that the integration of family planning (FP) with childhood immunization services can help reduce the unmet need for FP among postpartum women without undermining the uptake of immunizations. However, the quality and responsiveness of FP services that are integrated with childhood immunizations remain understudied. A qualitative study was conducted in two districts of Malawi, which examined the factors influencing the responsiveness of FP services that were integrated with childhood immunizations in monthly public outreach clinics. Semi-structured interviews with clients (n = 23) and FP providers (n = 10) and a clinic audit were carried out in six clinics. Hardware (material) and software (relational) factors influencing service responsiveness were identified through thematic and framework analyses of interview transcripts, and clinic characteristics were summarized from the audit data to contextualize the qualitative findings. Overall, 13 factors were found to influence service responsiveness in terms of the ease of access, choice of provider, environment, service continuity, confidentiality, communication, dignity and FP counselling afforded to clients. Among these factors, hardware deficiencies, including the absence of a dedicated building for the provision of FP services and the lack of FP commodities in clinics, were perceived to negatively affect service responsiveness. Crucially, the providers’ use of their agency to alter the delivery of services was found to mitigate the negative effects of some hardware deficits on the ease of access, choice of provider, environment and confidentiality experienced by clients. This study contributes to an emerging recognition that providers can offset the effect of hardware deficiencies when services are integrated if they are afforded sufficient flexibility to make independent decisions. Consideration of software elements in the design and delivery of FP services that are integrated with childhood immunizations is therefore critical to optimize the responsiveness of these services.

Does family planning counselling during health service contact improve postpartum modern contraceptive uptake in Ethiopia? A nationwide cross-sectional study

ObjectiveThis study examined the association between family planning counselling receipt during the 12 months preceding the survey and postpartum modern contraceptive uptake in Ethiopia. We hypothesised that receiving family planning...