Magnitude Of Unmet Need Research Articles

Unmet need for family planning among pastoralist community of West Omo zone, Ethiopia: A community based cross-sectional study

Introduction: Family planning is among the best suggested strategies to decrease the high maternal mortality and morbidity prevailing among pastoral communities. Despite this fact, there is no sufficient information regarding the unmet need for family planning in the study area. Therefore, this study was intended to assess the prevalence of unmet need for family planning and its associated factors among currently married women residing in pastoralist community of West Omo zone, Ethiopia. Methods: Community-based cross-sectional study was conducted from 01 January to 01 April 2021 in West Omo zone. Five-hundred-sixty currently married women aged 15–49 were interviewed, and the study participants were randomly selected by employing a modified random walk approach. Data were checked manually for completeness and consistency, then entered into Epidata 3.1 and exported to SPSS version 22 for analysis. Multivariate binary logistic regression was used to identify the associated factors, and Adjusted Odds Ratio (AOR) at 95% CI with p-value < 0.05 was considered as significant variables. Result: A total of 560 currently married women agreed to participate in this study making a response rate of 93.17%. Two hundred three, that is, about 36.3% (95% CI: 32.1, 40.2%) currently married women had an unmet need for family planning, with 119 (58.6%) wishing to delay childbirth and 84 (41.4%) seeking to limit. Have no formal education (AOR = 2.86 (95% CI: 1.61, 5.10)), having poor knowledge of family planning (AOR = 2.83 (95% CI: 1.45, 5.54)), and lack of husband support of family planning (AOR = 2.38 (95% CI: 1.22, 4.67)) are positively associated with unmet need for family planning. Conclusion: The magnitude of unmet need for family planning in this study is fairly high as compared to previous studies done among non-pastoral community. Hence, it’s important to consider the above identified factors while designing effective public health intervention.

A Study of Unmet Need for Family Planning Among Married Women of Reproductive Age Group Attending Immunization Clinic in Selected Urban Hospital, West Bengal

Descriptive study on unmet need for family planning among married women of reproductive age group (15-49 years) attending immunization clinic in selected urban hospital, West Bengal. Objectives were-1) To estimate the magnitude of unmet need for family planning. 2) To find out the reasons behind unmet need. 3)To determine the association between unmet need and selected factors. Sample size was 100, setting- immunization clinic of N.R.S medical college and Hospital, Kolkata. Purposive sampling technique and semi structured interview schedule was used. unmet need for family planning was 23% (need for spacing 7% and need for limiting 16%). It includes pregnancy mistimed (1%), pregnancy unwanted (2%), non-pregnant fecund women (want later 6%), want no more (14%).

Magnitude of unmet need for family planning and associated factors among women in the extended postpartum period in Dabat district, Northwest Ethiopia. evidence from Dabat demographic health surveys

BackgroundDue to additional roles and emotional changes that occur during postpartum period, women use contraceptives differs from other times in their life. However, there is limited information about the unmet need for family planning (FP) among women in the extended postpartum period in the study area. Therefore, this study aimed to assess magnitude of unmet need for family planning and associated factors among women in the extended postpartum period in Dabat district, Northwest Ethiopia.MethodsA secondary data analysis was performed using the Dabat Demographic and Health Survey 2021. A total sample of 634 women during the extended postpartum period was included in this study. Stata version 14 statistical software was used for data analysis. Descriptive statistics were described using frequencies, percentages, mean, and standard deviation. Multicollinearity was tested using the variance inflation factor (VIF) and we computed Hosmer and Lemeshow goodness of fit. Both bivariable and multivariable logistic regression analyses were carried out to determine the association between independent variables and outcome variable. Statistical significance was declared at a p-value ≤ 0.05 with a corresponding 95% confidence interval.ResultsThe overall unmet need for FP during the extended postpartum women was 42.43% (95% CI: 38.62, 46.33), of which 33.44% was unmet need for spacing. Place of residence (AOR = 2.63, 95%CI: 1.61, 4.33), place of delivery (AOR = 2.09, 95%CI: 1.35, 3.24), and availability of radio and or TV (AOR = 1.58, 95% CI: 1.22, 2.13) were significantly associated with unmet need for family planning.ConclusionThe magnitude of unmet need for family planning among women during the extended postpartum period in the study area was high when compared to the national average and the United Nations sphere standard of unmet need for family planning. Place of residence, place of delivery, and availability of radio and or TV were significantly associated with unmet need for family planning. Hence, the concerned bodies are recommended to promote intuitional delivery and give spatial attention to those who are residing in rural areas and to those who have had no media exposure in order to reduce the unmet need for family planning among postpartum women.

Unmet need for family planning and associated factors among currently married women in Hawella Tulla subcity, Hawassa, southern Ethiopia: community-based study

BackgroundThe unmet need for family planning remains a major public health concern in developing countries, especially in sub-Saharan Africa. Similarly, in Ethiopia, the unmet need for family planning is considerably high. However information regarding associated factors of unmet need of family planning is limited, the study area in particular. Thus, this study was aimed at assessing unmet family planning and associated factors among currently married women in Hawella Tulla Subcity.MethodsA community based cross-sectional study was employed on 436 currently married women. Both bivariable and multivariable logistic regression model were used and having P-value of < 0.05 was considered as independently associated factors. Strength of association of the variable was described using adjusted odd ratios with their 95% confidence interval.ResultThe overall unmet need for family planning among currently married women was found to be 18.1% (95% CI: 14.5%, 21.8%). Having age of below 18 years at first marriage AOR = 1.95 (95% CI: 1.14, 3.33), woman’s not attained formal education AOR = 2.23 (95% CI: 1.02, 4.84), women whose partner had non-supportive for family planning use AOR = 2.32 (95% CI: 1.35, 3.99) and women without media access AOR = 2.13 (95% CI: 1.19, 3.81) were significantly associated with increasing unmet need for family planning.ConclusionsDespite the presence of high family planning services coverage in the study area, the magnitude of unmet need for family planning is still reasonably high. Having age of below 18 years at first marriage, woman’s not attained formal education, women whose partner had non-supportive for family planning use and inavailability of media access in the house were found to be associated with high unmet need for family planning. Therefore, efforts are needed to empower women through education, avoiding early marriage and encouraging couple-based family planning interventions. Increasing media access is also advisable intervention.

Magnitude of unmet need for family planning and its predictors among reproductive age women in high fertility regions of Ethiopia: Evidence from Ethiopian Demographic and Health Survey

BackgroundUnmet need for family planning refers to fertile women who want to limit or space their delivery but are not using contraceptive methods. Despite multiple studies were conducted to address family planning in Ethiopia, there is limited information on unmet need in high fertility regions. Knowing the magnitude and predictors of unmet need in the study area helps as an impute for interventions. Therefore, this study aims to assess the magnitude and predictors of unmet need for family planning among reproductive age women in high fertility regions of Ethiopia.MethodsA secondary data analysis was performed using the Ethiopian Demographic and Health Survey 2016. A total sample weight of 4312 currently married reproductive age women were included in this study. A multilevel mixed-effect binary logistic regression model was fitted. Finally, the odds ratios along with the 95% confidence interval were generated to determine the individual and community level factors of unmet need for family planning. A p-value less than 0.05 was declared as statistical significance.ResultsThe overall unmet need for family planning among currently married reproductive-age women in high fertility regions of Ethiopia was 29.78% (95% CI: 28.26, 31.3). Women with no formal education (AOR: 1.65, 95% CI: 1.17, 2.15), women in the poor wealth quantile (AOR: 1.67, 95% CI: 1.34, 2.09), women with no media exposure (AOR: 1.32, 95% CI: 1.09, 1.58), multiparous women (AOR: 1.57, 95% CI: 1.15, 2.16), sex of household head (AOR: 1.39, 95% CI: 1.11, 1.77) and rural residency (AOR: 2.45, 95% CI: 1.12, 3.59) were predictors of unmet need for family planning.ConclusionThe magnitude of unmet need for family planning among currently married reproductive-age women in high fertility regions of Ethiopia was high when compared to the national average and the United Nations sphere standard of unmet need for family planning. Education, wealth index, mass media, parity, sex of household head, and residence were independent predictors of unmet need for family planning among reproductive-age women in high fertility regions of Ethiopia. Any interventional strategies that reduce the unmet need for family planning should consider these factors to overcome the problems in the regions.

Magnitude and determinants of unmet need for family planning among reproductive age women in East Africa: multilevel analysis of recent demographic and health survey data

IntroductionUnmet need for family planning is the main obstacle to achieve healthy timing and desired number of children. Decreasing the unmet need for FP respects and protects human right and help to decrease the influence on biodiversity. Unmet need for family planning is the contributor and devastating issue of maternal health. Therefore, meeting the unmet need of contraceptive averts the maternal death and poverty. Therefore, determining the magnitude and its determinants is very important to intervene and design appropriate program umbrella.ObjectiveTo determine the magnitude and its determinants of unmet need for family planning among reproductive age women in East Africa.MethodThis study was analyzed secondary data from Demographic and Health Surveys (DHS) of which contained detailed family planning for all interviewed women aged 15 to 49 years. The data were weighted using sampling weight before any statistical analysis to account the sampling design. STATA version 15 was used for extracting, editing, recoding, and multilevel analysis. Median odds ratio (MOR), proportional change in Variance (PCV), Intraclass correlation coefficient (ICC), and Akaike Information Criteria (AIC) was analyzed. Four model was build and the best model was selected based on the smallest Akaike Information Criteria (AIC). Both bivariable and multivariable multilevel analysis was done. Variable with p-value< 0.25 were selected for multivariable multilevel logistic regression analysis. Variables with p-value ≤5% declared as statistical significant with outcome variable.ResultsThe magnitude of unmet need for family planning was 24.66% (95%CI: 24.1–25.2). The identified determinants of unmet need for family planning was 30–39 years (AOR = 0.7; 95% CI 0.54–0.91), age of 40–49 (AOR = 0.76; 95% CI 0.58–0.99), rural residence (AOR = 1.17; 95% CI 1.02–1.34), female household head (AOR = 0.66; 95% CI 0.61–0.73), women having 4–6 child (AOR = 1.76; 95% CI 1.55–1.99), women having 7–9 child (AOR = 2.77; 95% CI 2.34–3.28) women having ≥10 child (AOR = 3.51; 95% CI 2.58–4.78), women who give their first birth 19-25 years (AOR = 1.1; 95% CI 1.0–1.26), 26–34 years (AOR = 1.4; 95% CI 1.19–1.83) ≥35 years (AOR = 2.1; 95% CI 1.1–4.27) and no fertility desire (AOR = 1.52; 95% CI 1.36–1.67) were the determinants of unmet need for family planning in east Africa.ConclusionUnmet need in east Africa is high as compare to other previous study. Maternal age, residence, sex of household head, number of children, age at first birth and fertility desire were the determinants identified in this study. Therefore, health interventions that reduce unmet need which enhance family planning service delivery among rural, male-headed household, women having more than three children and women who had no fertility desire needed in advance. Policies and programs of unmet need should be tailored the rural, young and no fertility desire women as well as male headed households.

Unmet need for family planning and associated factors among married women attending anti-retroviral treatment clinics in Dire Dawa City, Eastern Ethiopia.

BackgroundUnmet need for family planning is a measure of the gap between women’s contraceptive behavior and their fertility desires. It should be measured among different population groups to effectively implement public health interventions. Thus, this study aimed to determine the magnitude of unmet need for family planning and associated factors among HIV- positive women in Dire Dawa city Anti-retroviral treatment (ART) clinics, Eastern Ethiopia.MethodsWe carried out a facility-based cross-sectional study (March-June 2020) among 409 married women aged 15–49 on ART, using systematic random sampling. A face-to-face interview was done using a structured questionnaire. Bivariable and multivariable logistic regression was done to identify factors associated with unmet need for family planning.ResultsOverall, 33% [95% confidence interval (CI): 28.9–37.9] of the respondents had unmet need for family planning. Woman’s residing in a rural area (adjusted odds ratio (AOR): 2.41 [95% CI: 1.24–4.67]), woman’s not attained formal education (AOR: 4.14 [95% CI: 1.73–9.93]) and attaining primary education (AOR: 2.97 [95% CI: 1.54–5.74]), poor knowledge (AOR: 2.87 [95% CI: 1.52–5.40]), and unfavorable attitude towards family planning (AOR: 2.21 [95% CI: 1.12–4.34]), clients not satisfied with family planning service (AOR: 6.34 [95% CI: 3.31–12.15]), the woman not having decision making power on family planning (AOR:3.97 [95% CI: 2.14–7.38]) and not getting family planning counseling in ART clinics (AOR: 2.87 [95% CI: 1.54–5.35]) were positively associated with having unmet need for family planning.ConclusionThis study indicates there a high unmet need for family planning among married HIV-positive women. Factors like a place of residence, educational status of women, knowledge and attitude towards family planning, client satisfaction with FP service, women decision-making power, and FP counseling service in ART. Therefore, we recommend that the concerned bodies should collaborate with ART clinics to design interventions that enhance access to family planning programs to combat the high unmet need for family planning among HIV-positive women.

Lines of Therapy in Patients with Relapsed or Refractory Large B-Cell Lymphoma and Stem Cell Transplant-Intended Treatment

Introduction: Large B-cell lymphoma (LBCL) is the most common subtype of non-Hodgkin lymphoma. Front line therapy is curative in about 60% of patients; however, about 30% of patients relapse and about 10% are refractory. For patients failing the front line, stem cell transplant (SCT) is currently the only curative option in second line of therapy (LOT2). This study examined real-world treatment patterns with curative intent in patients with relapsed or refractory LBCL to understand the unmet medical need in the United States. Methods: This retrospective study used IBM MarketScan® Commercial and Medicare Supplemental Databases. Patients with ≥2 LBCL diagnoses on different days in 1/1/2012 - 3/31/2019 were identified (index date = date of the earliest LBCL diagnosis). Patients who were ≥18 years of age on the index date, had ≥1 claim for any LBCL treatment on or following the index date, ≥6 months of data prior to (baseline) and ≥12 months of data after (follow up period) the index date, and had no baseline LBCL diagnosis were included. Treatment patterns, including lines of therapy (LOT), treatment regimen, duration of LOT and time from the end of a previous LOT to the subsequent LOT, were examined. All patients were required to receive first LOT (LOT1) of R-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone +/- rituximab), EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin hydrochloride +/- rituximab), or regimens with anthracycline. Of those, patients were further required to receive LOT2 with SCT-intended intensive therapy or platinum-based chemotherapy as recommended by the National Comprehensive Cancer Network (NCCN). Patients were intended for SCT if they received an SCT-intended LOT2 regimen or received SCT regardless of LOT2 regimen. SCT was identified from the LOT2 start date to the end of the study period. All analyses were stratified by whether a patient was intended for SCT and by receipt of SCT. Results: A total of 3,443 patients with LBCL received an eligible front-line therapy (mean age 59.2 years, male 56.9%, length of follow up 2.5 years, National Cancer Institute (NCI) adapted Deyo-Charlson comorbidity index 0.83). Top comorbidities were other malignancy (63.3%), diabetes (23.3%), psychiatric disturbance (13.9%), and chronic pulmonary obstructive disease (13.2%). Among the LBCL patients, 564 (16.4%) received LOT2 with 197 (34.9%) patients SCT-intended and 367 (65.1%) not SCT-intended (Figure 1). SCT-intended patients were significantly younger than SCT-non-intended patients (55.9 vs. 60.9 years, p&amp;lt;0.001), and patients who received SCT were younger than those who did not receive SCT (53.6 vs. 59.7 years, p&amp;lt;0.001). Among the 197 patients intended for SCT, only 55.3% (n=109/197) received NCCN recommended LOT2 for intensive therapy: ICE (ifosfamide, carboplatin, etoposide) +/- rituximab (32.5%) and GemOx (gemcitabine, oxaliplatin) +/- rituximab (19.3%) were the most common regimens. SCT-intended patients initiated LOT2 nearly one year (345 days) after and third line of therapy (LOT3) 501 days after their LBCL index diagnosis (Figure 2). Duration of LOT decreased as patients moved on to later LOTs (LOT1=121 [standard deviation (SD)=69], LOT2=89 [SD=145] and LOT3=46 [SD=23] days). Likewise, the time between 2 consecutive LOTs decreased (194 [SD=258] days between end of LOT1 and start of LOT2, 124 [SD=182] days between end of LOT2 and start of LOT3). Steroids were often prescribed during LOT1 (82.2%) and LOT2 (74.6%) as concomitant therapy. Among the 109 patients receiving SCT-intended regimens, only 34 (31.2%) went on to receive SCT. An additional 88 patients received SCT without being observed to receive an SCT-intended regimen. They might have received therapy in the inpatient setting, which could not be captured in claims data. Among the 82 patients with LOT3, 60.1% received SCT and 9.8% received Chimeric antigen receptor (CAR) T cell therapy. Conclusion: The findings provide insight into real-world treatment patterns in patients with LBCL who received SCT-intended therapy. A small proportion of LBCL patients received NCCN recommended SCT-preparative regimens in LOT2 and only 31% of them received SCT. This highlights the magnitude of unmet need for relapsed or refractory LBCL patients. Future studies should examine the impact of new therapies on the management of LBCL. Disclosures Thornton Snider: Kite, A Gilead Company: Current Employment; Gilead Sciences: Current equity holder in publicly-traded company, Research Funding; Precision Medicine Group: Ended employment in the past 24 months, Research Funding. Cheng:Kite, A Gilead Company: Current Employment, Current equity holder in publicly-traded company. Song:IBM Watson Health: Research Funding. McMorrow:IBM Watson Health: Current Employment. Diakun:IBM Watson Health: Current Employment, Research Funding.

Unmet need for presbyopia correction and its associated factors among school teachers in Hawassa city, South Ethiopia

BackgroundPresbyopia is a decline in the amplitude of accommodation with the onset in the age range 40–45 years affecting near visual task performance. As the age of presbyopia onset coincides with productive age, it results in great productivity loss especially in those with high near visual demand like teachers. A maximum near vision potential is essential for teachers in ensuring the quality of education, as most of the students’ evaluations and scripts are assessed manually in Ethiopia. The prevalence of unmet need for presbyopia correction among school teachers ranges from 38.5–70.4% worldwide. Though presbyopia is a common ocular condition, there is limited evidence regarding the unmet need for presbyopia correction in Ethiopia as well as in Hawassa city. Therefore, this study aimed to determine the magnitude of unmet need for presbyopia correction and its associated factors among school teachers in Hawassa city, South Ethiopia.MethodsA school-based cross-sectional study was conducted among teachers older than 35 years. A simple random sampling technique was used to select participants using name lists as a sampling frame from 69 schools. The participants selected underwent for distance and near visual acuity test. Those with distance visual acuity of 6/12 or worse were refracted before near visual acuity test. Information on the spectacle use and associated factors was obtained using the interviewer-administered questionnaire. Data analysis was done using Statistical Package for Social Sciences software version 20. Binary logistic regression analysis was performed to assess association between independent variables and the unmet need for presbyopia correction.ResultsA total of 459 study participants were included in the study with a response rate of 95.21%.The unmet need for presbyopia correction was 51.26% (95%CI: 46.7–55.6%). Female gender (AOR = 2.50; 95%CI: 1.51–4.15), age 36–45 (AOR = 4.12; 95%CI: 1.46–11.76), unaware of presbyopia (AOR = 2.36; 95%CI: 1.2–4.66) and self-rating of current vision as good (AOR = 3.5; 95%CI: 1.61–7.6) were factors significantly associated with the unmet need for presbyopia.ConclusionsThe burden of unmet need for presbyopia correction is a moderate priority according to the World Health Organization for presbyopia correction services criteria. A school-based presbyopia awareness creation program is important to reduce this huge burden.

Prevalence and pattern of contraceptive use and unmet need among women of reproductive age in urban Mysuru

BackgroundUncontrolled population growth is an ongoing global concern. Rapid population growth contributes not only to the incidence of poverty but also to the transmission of poverty across generations. Adoption of family planning is crucial to limiting the unsustainable growth of the population. Although family planning services are offered free of cost, the acceptance of contraceptive methods shows wide regional variations. ObjectivesTo determine the prevalence and pattern of contraceptive usage and to determine the magnitude of unmet need among the married women of reproductive age in an urban area of Mysuru. Material and methodsA community based Cross-Sectional study was carried out among 457 married women in the reproductive age group. House to house survey was conducted and data was collected by interview method using a pre-tested, semi-structured proforma after obtaining informed consent. Data was coded and entered into MS Excel 2016 and analysed. ResultsThe prevalence of contraceptive use was found to be 55.1%. The most common contraceptive used was the terminal method of tubectomy. Male Condom was the most common temporary method of contraception used. The unmet need for contraception was found to be 18.16% with an 8.06% unmet need for spacing and a 10.6% unmet need for limiting. ConclusionContraceptive prevalence was 55.1% with 18.16% unmet need for contraception. Misapprehension and fear of side effects was a major reason for non-utilization of contraceptives. Routine Family Planning counselling and peer discussions will go a long way in dispelling the myths associated with family planning.

Unmet need for family planning among women in rural Egypt

Background: Although Egypt has a strong family planning program; the downward trend in the unmet need has been reversed recently. Thus the present study aimed to assess the magnitude of unmet need for family planning, its common reasons and the associated factors among women of reproductive age group.Methods: this is a community-based cross sectional household survey study conducted in Awish El-Hagar village, Mansoura, Egypt during the year 2015-2016. Using an interviewer questionnaire; 394 rural women in childbearing period were surveyed via a systematic random sampling technique with the help of the outreach community health workers affiliated to Awish El-Hagar family medicine center.Results: The overall prevalence rates of unmet need for family planning and contraceptive use were 11.2% and 69.5% respectively, while the total demand for family planning was 80.7%. Infrequent sex (27.3%), fear from the side effects (25%) and husband opposition (15.9%) were the most frequent reasons for non-use of family planning methods among unmet need women. Logistic regressions explored that risk factors for unmet need women were having husband disapproved family planning, having only girls, perception that having &gt;3 children to be ideal, working, having husband with the main family planning decision maker, with no past history of unintended pregnancy and having only boys.Conclusions: A considerable proportion of Egyptian women still have an unmet need for family planning that need to be addressed by more effective family planning and health education programs together with improving counseling strategies and enforcing the role of outreach workers.

Assessment of the Magnitude and Associated Factors of Unmet Need for Family Planning among Women of Reproductive Age Group with Disabilities in Bahir Dar City, Amhara Region, North West Ethiopia

The study was conducted to assess the magnitude and associated factors of unmet need for family planning among women of reproductive age group with disabilities who are members of disabled associations in Bahir Dar town. Institution based cross-sectional study was carried out. A total of 337 women of reproductive age group with disabilities were included in the study with simple random sampling. Data were collected through face-to-face interview, coded, cleaned and entered by Epi info 2002 and analyzed with SPSS version 16 computer software. Logistic regression was used to assess possible associations. The magnitude of unmet need for family planning among women with disabilities was 24.3%. Women with disabilities in the age group of 25-29 had 80% less likely to have unmet need than women above 35 years old. Women with disability who have no education were 11 times more likely to have unmet need than those who have secondary education. Women who desire to have more than 3 children have more likely to have unmet need than those who need to have 1-2 children. Unmet need for family planning among women with disabilities was high in Bahir Dar town. Age, Educational status and desired number of children were found to have statistically significant association with unmet need for family planning. Hence, it is important to encourage people with disabilities to attained formal education and the associations should provide short term trainings in accordance with their age group.

Regulators should better leverage effectiveness standards to enhance drug value.

Regulators show some flexibility in the evidentiary standards of effectiveness that must be demonstrated for a drug prior to its market authorization. Adopting a more formal framework for when and how effectiveness standards should vary would improve the therapeutic value of new medicines at the time of market entry. We identify three factors-the number and effectiveness of existing treatment alternatives, magnitude of unmet need, and expected clinical application-to guide the effectiveness threshold for a given therapy. Using these factors, regulators should actively guide sponsors regarding appropriate comparators and end points in pivotal trials, as well as determining the size and characteristics of the patient populations enrolled.

Ruxolitinib Discontinuation In Patients With Myelofibrosis: An Analysis From Clinical Practice

IntroductionThe objective of this study is to evaluate the persistence patterns and discontinuation rates from ruxolitinib in clinical practice. Ruxolitinib was the first Janus kinase (JAK) inhibitor approved for treating intermediate-risk or high-risk myelofibrosis, including primary myelofibrosis, post‒polycythemia vera myelofibrosis, and post‒essential thrombocythemia myelofibrosis. Ruxolitinib was investigated in 2 randomized, controlled, phase 3 efficacy trials in patients diagnosed with myelofibrosis (COMFORT-I and COMFORT-II). MethodsA retrospective database inception cohort study is developed from 2 large US claims databases, the IMS Health® database containing National Council for Prescription Drug Programs pharmacy-dispensed prescription claims and the MarketScan® database containing patient-level data from approximately 100 health plans (data from active employees, early retirees, COBRA continues, and dependents) and from Medicare Supplemental data. We identify a cohort of myelofibrosis patients who were prescribed ruxolitinib between November 1, 2011 and August 31, 2012 in the IMS database and between November 1, 2011 and June 30, 2012 from the MarketScan database. Patients are followed from the date of the first ruxolitinib claim, defined as the index date, until the last enrollment date or date of last claim recorded if greater than the last enrollment date in the MarketScan database or for a fixed 3- and 6-month period in the IMS database. When analyzing treatment discontinuation, patients with primary or secondary myelofibrosis are required to have ≥1 ruxolitinib dispensed prescription(s) and to have ≥3 months of pre-index data and ≥3 or 6 months of follow-up post-index data. Discontinuation of ruxolitinib was defined as a >30-day gap from the last day of supply from the prior prescription fill. Demographic and ruxolitinib discontinuation rates at 3 and 6 months post-index date for patients in each database are reported in this analysis with the Clopper-Pearson confidence interval. ResultsIn patients prescribed ruxolitinib in the IMS database, mean (SD) age at the index date was 63.4 (13.2) years for patients followed for 3 months (n=183) and 63.3 (13.6) years for patients followed for 6 months (n=115). The MarketScan database inception cohort comprised 161 patients with mean (SD) age of 66.8 (12.2) years. Age was comparable and not substantially different across the 2 databases. Discontinuation rates in the IMS database were 60.9% and 73.0% at 3 and 6 months follow-up, respectively; in the MarketScan database, discontinuation rates were 41.1% and 48.4% for patients with a minimum of 3 and 6 months follow-up, respectively. ConclusionsThese analyses indicate that the discontinuation rates for patients receiving treatment with ruxolitinib for myelofibrosis are not low and are most pronounced within the first 3 months of treatment. Results suggest the magnitude of unmet need in myelofibrosis and for additional medications that can improve treatment outcomes.Limitations of this study pertain to a traditional claims database inquiry. As patients were identified from 2 distinct databases, there may be some data overlap. Diagnostic information on the basis of claims databases is not always accurate. Future research using rich clinical data from chart reviews is needed to identify clinical determinants of persistence/discontinuation. The discontinuation rates observed from these 2 large representative databases are substantial, reflecting inherent variability of point estimates and differences in data collection for the 2 data sources. Future studies should examine the reasons for discontinuation so that findings may be incorporated into disease/medication adherence management programs. Disclosures:Fonseca:IMS Health - a company that received funds from Sanofi to conduct the study: Employment. Silver:Sanofi : Consultancy, Research Funding. Kazis:Sanofi and IMS: Consultancy. Iqbal:Sanofi: Employment, Equity Ownership. Rose:Sanofi: Employment. Khan:IMS Health: Employment.Table. Discontinuation Rates From RuxolitinibDatabaseFollow-up Time% [95% CI]IMS®3 months60.9 [53.2-67.8]6 months73.0 [64.0-80.9]MarketScan®≥3 monthsa41.1 [32.9-49.7]≥6 monthsb48.4 [37.9-59.0]Median follow-up time is a207 days and b241 days.This study was sponsored by Sanofi.

Study of Unmet Need for Family Planning in Urban Slum Population of Davangere- A Cross Sectional Study

Background: Unmet need for family planning is the gap between women's reproductive intensions and their contraceptive behavior. Good fraction of married women in the reproductive age group would prefer to avoid pregnancy but are not using any form of family planning because of various reasons. Objectives: 1. To find out the magnitude of unmet need for family planning. 2. To find out the determinants of unmet need for the family planning. Materials & Method: This is a community based cross sectional study among married women of reproductive age group residing in slums of urban field practice area of SSIMSRC, Davangere, Karnataka, India. Personal interview method with house to house visit was adopted. Results: Unmet need for family planning was 107(16%), unmet need for spacing was 55(51%) and that for limiting was 52(49%). Mean age of mothers was 31.63±7.2. There was significant association between prevalence of unmet need and literacy, number of children and knowledge of contraceptives. There was no significant association between age, religion, type of family etc. Commonest contraceptive method used was tubectomy, the most common source of information about contraceptives was health workers. Commonest reason for unmet need was found to be lack of knowledge. Conclusion: The high prevalence of unmet need for contraception calls for health education campaigns regarding availability, sources and side effects of contraceptives especially in under-privileged areas like urban slums.

A Study On The Extent And Reasons Of Unmet Need for Family Planning Among Women Of Reproductive Age Group In Rural Area Of Haryana

Research Question: To find out the extent and reasons of unmet need for Family Planing among rural women of reproductive age group and its association with some demogaphic factors. Objectives: (a) To estimate the magnitude of unmet need for family planing among women of reproductive age group. (b) To find out the association of socio-demographic factors with the unmet need for family planning and contraceptive users. (c) To explore common reasons for unmet need for family planning. Study Design: Community based cross-sectional study. Setting: Primary Health Training Centre (PHTC), Agroha (Hisar). Participants: Four hundred and eighty three willing women of reproductive age group. Materials and Methods: The primary tool in this study was predesigned and pretested questionnaire for recording of individual informations. Statistical analysis: Proportions & Univariate analysis (Chi Square test). Results : The extent of unmet need for family planning was 41.61%, of which 25.46% were limiters and 16.15% were spacers. Only 45.55% women were contraceptive users. Contraceptive use rate increased significantly X2(4, N = 483) = 11.00, p = .026 with the advancement of age. Limiters increased significantly X2(4, N = 201) = 15.67, p = .003 with advancement of age with proportionate decrease of spacers. Women’s education exert a powerful influence on unmet need X2(4, N = 483) = 14.56, p = .005. With increasing level of literacy, significant X2 (3, N = 201) = 28.59, p = <.001 increase in the prevalence of spacers with reciprocal decrease in the limiters were noticed. Neither the type of family nor the number of living children was significantly associated with the unmet need for family planning. However the prevalence of spacers had significantly decreased and limiters increased with increase in numbers of living children. The major reasons for unmet need were opposition from husband & family members (34.83%) and lack of information regarding the different methods of family planning (29.35%). Conclusions: Prevalence of unmet need was higher in more fertile age group (i.e.<30 years), therefore family planning program should focus more on this age group along with targetting illiterate people in rural areas.

Drug treatment of urological symptoms: estimating the magnitude of unmet need in a community-based sample.

To examine, in a community-based sample, the use of prescription drugs for lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH), overactive bladder, erectile dysfunction, urinary incontinence, and painful bladder syndrome; and to determine whether the use of recommended medications varied by sociodemographics, symptom severity, access to care, and other factors. In a cross-sectional analysis of data obtained from 5503 men and women residents participating in the Boston Area Community Health Survey of Boston, MA, urological symptoms were ascertained by in-person interviews conducted during 2002-2005, using validated symptom scales. Medication use in the past 4 weeks was captured using a combination of drug-inventory methods and self-report. Compared to the prevalence of symptoms, the prevalence of use of medications for urological conditions was very low among men and women. The highest prevalence of use was among men with moderate-to-severe LUTS/BPH symptoms, where 9.6% used recommended drugs. Use of medications did not vary consistently by race/ethnicity or socioeconomic status, but was often associated with symptom severity. More frequent and more recent use of medical care was also associated with greater use of urological medications. Only a small proportion of community-dwelling men and women with urological symptoms are receiving recommended effective drug treatments for urological conditions. While not all persons are candidates for drug treatment, our results suggest that there is a substantial unmet need in the general population.

Unmet Need of Contraceptives among Eligible Couples of Urban Slum Dwellers in Dhaka

This cross-sectional study was conducted on married women residing in urban slums of Kamrangirchar in Dhaka to determine the magnitude of unmet need for family planning. A total of 265 married women of reproductive age who were fecund and living with husband were the sample of the study. The mean age of the respondents was 26.8±6.7 years. A little above 14% of the women were in the age group of 15-19 years. Almost equal proportion of respondents and their husbands were found to be illiterate. Nearly one-tenth of the respondents have not had ever experienced pregnancy, while 23% experienced pregnancy once, 18.1% twice and 33.6% three-four times, 17% more than four times. Among the respondents, 51.3% were currently using a contraceptive method. Around 5% were pregnant, which was intended. Another 3% wanted to conceive. The rest 41.1% wanted to use a contraceptive but certain barriers did not allow them to use the same suggesting that their family planning need was unmet. This need included limiting (21.5%) and spacing (19.6%). Lactational amenorrhea, no specific reasons, side effect of past contraceptive use, lack of support from husband or other family members, lack of proper knowledge of contraceptive and difficulties in obtaining contraceptive supplies were the cited reasons. Unmet need of contraceptive is high despite an extensive family planning programme in Bangladesh. Mean age at marriage is still below the legal age and gender discrimination plays a vital role in this unmet need. Ibrahim Med. Coll. J. 2009; 3(1): 24-28 Key words: Unmet need, contraceptive, reasons of unmet need doi: 10.3329/imcj.v3i1.2916