Assessment Of Reproductive Health Research Articles

SYSTEM OF MEASURES FOR REPRODUCTIVE HEALTH IMPROVEMENT IN WOMEN OF LATE REPRODUCTIVE AGE WITH INFERTILITY

Aim - to develop and evaluate the effectiveness of the system of the medical and organizational measures aimed at improvement of reproductive health in women of late reproductive age with infertility, and at increase in the effectiveness of the IVF programs. Materials and methods. The study of the efficiency of the developed system of measures was carried out in a representative group (650) of women 35-44 years old (mean age - 37.01+ 1.74 years) with infertility, living in the Samara region and referred to the medical center «Dynasty» for treatment with in vitro fertilization. The following methods of research were used: direct observation, organizational experiment, sociological and analytical methods. Results. The main components of the developed system of events are: medical measures (extended timely examination and treatment; comprehensive assessment of women's reproductive health based on proposed medical criteria, the use of new medical technologies); social measures (individual program of social and hygienic rehabilitation); organizational measures (automation of infertility register control, routing of patients depending on the initial state of health). Implementation of the developed system of measures can improve women's reproductive health according to the criteria of objective and subjective evaluation: it reduces the incidence of miscarriage from 37.5% to 15.3% (p

КОМПЛЕКСНАЯ ОЦЕНКА РЕПРОДУКТИВНОГО ЗДОРОВЬЯ ПАЦИЕНТОК С НАРУЖНЫМ ГЕНИТАЛЬНЫМ ЭНДОМЕТРИОЗОМ ПОСЛЕ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ

Aim. Complex assessment of reproductive health in patients with external genital endometriosis after surgery. Materials and Methods. The study involved 55 women of childbearing age who received treatment in the department of gynecology of Bauman City Clinical Hospital № 29 and 30 women observed in Central Clinical Hospital № 6. In 2014–2016 the patients underwent laparoscopic surgery for external genital endometriosis. External genital endometriosis of different extent and severity (according to R-AFS) was diagnosed and confirmed using laparoscopic and morphologic assessment methods. 70 patients underwent endometrioma nucleation, and 15 patients with retrocervical endometriosis were subjected to excision of endometrioma with mobilization of the anterior wall of the colon as well as coagulation of endometrioid heterotopias of various sites; all patients were subjected to adhesiolysis. Results. 48 (64%) patients had III–IV stage endometriosis. In 20% endometriosis was diagnosed during surgery. Anthropometric indicators were mostly associated with asthenic type. Emotional and behavioral disorders were observed in 25 (33.3%) patients with tendency to hysterical personality disorder; the rest had mood swing and liability to depression. In less than 60% of patients the severity of endometriosis was significantly related to pelvis pain intensity. The majority of patients were women of asthenic type and with expressed pain syndrome, and hysterical personality disorder according to Beck scale. Conclusion. Individual assessment of pain, anthropometric and personal traits in patients together with complex assessment of morphologic and anatomic changes in reproductive organs make it possible to see a real pattern of disease and condition in women with external genital endometriosis, which helps in choice of surgery volume and appropriate medical treatment.

Reproductive Health Assessment of Female Elephants in North American Zoos and Association of Husbandry Practices with Reproductive Dysfunction in African Elephants (Loxodonta africana).

As part of a multi-institutional study of zoo elephant welfare, we evaluated female elephants managed by zoos accredited by the Association of Zoos and Aquariums and applied epidemiological methods to determine what factors in the zoo environment are associated with reproductive problems, including ovarian acyclicity and hyperprolactinemia. Bi-weekly blood samples were collected from 95 African (Loxodonta africana) and 75 Asian (Elephas maximus) (8–55 years of age) elephants over a 12-month period for analysis of serum progestogens and prolactin. Females were categorized as normal cycling (regular 13- to 17-week cycles), irregular cycling (cycles longer or shorter than normal) or acyclic (baseline progestogens, <0.1 ng/ml throughout), and having Low/Normal (<14 or 18 ng/ml) or High (≥14 or 18 ng/ml) prolactin for Asian and African elephants, respectively. Rates of normal cycling, acyclicity and irregular cycling were 73.2, 22.5 and 4.2% for Asian, and 48.4, 37.9 and 13.7% for African elephants, respectively, all of which differed between species (P < 0.05). For African elephants, univariate assessment found that social isolation decreased and higher enrichment diversity increased the chance a female would cycle normally. The strongest multi-variable models included Age (positive) and Enrichment Diversity (negative) as important factors of acyclicity among African elephants. The Asian elephant data set was not robust enough to support multi-variable analyses of cyclicity status. Additionally, only 3% of Asian elephants were found to be hyperprolactinemic as compared to 28% of Africans, so predictive analyses of prolactin status were conducted on African elephants only. The strongest multi-variable model included Age (positive), Enrichment Diversity (negative), Alternate Feeding Methods (negative) and Social Group Contact (positive) as predictors of hyperprolactinemia. In summary, the incidence of ovarian cycle problems and hyperprolactinemia predominantly affects African elephants, and increases in social stability and feeding and enrichment diversity may have positive influences on hormone status.

Development and Psychometric Evaluation of a Reproductive Health Assessment Scale for HIV-Positive Women

Background Promoting the reproductive health of women with HIV is very important..Objectives The aim of this study was to design a reproductive health assessment scale for this vulnerable group and determine its psychometric properties..Patients and Methods This study adopted an exploratory mixed-methods design and included three phases. In the first qualitative phase, a sample of 25 HIV-positive women participated in semi-structured interviews and a focus group discussion. In the second part, item pools were generated. In the last phase, face validity, content validity, and construct validity were assessed using exploratory factor analysis. Internal consistency and test-retest methods were used to estimate the reliability of the scale..Results Forty-eight items were included in the psychometric evaluation stage of the scale. Based on the assessment of the content validity ratio (CVR), content validity index (CVI), and exploratory factor analysis, 12 items were omitted, leaving 36 items in the final scale. The exploratory factor analysis revealed six factors: disease-related concerns, life instability, coping with the illness, disclosure status, responsible sexual behaviors, and the need for self-management support. The reliability according to Cronbach’s alpha was 0.713, and the external reliability, as evaluated by the test-retest method and the intraclass correlation, was 0.952..Conclusions The proposed tool, which consists of six factors and 36 items, is a reliable and valid scale for assessing the reproductive health of HIV-positive women. The findings of these measurements will be helpful when identifying and planning for improved health outcomes of this group of patients..

Achieving maternal and child health gains in Afghanistan: a Countdown to 2015 country case study.

After the fall of the Taliban in 2001, Afghanistan experienced a tumultuous period of democracy overshadowed by conflict, widespread insurgency, and an inflow of development assistance. Although there have been several cross-sectional assessments of health gains over the last decade, there has been no systematic analysis of progress and factors influencing maternal and child health in Afghanistan. We undertook a comprehensive, systematic assessment of reproductive, maternal, newborn, and child health in Afghanistan over the last decade. Given the paucity of high-quality data before 2001, we relied mainly on 11 nationally representative surveys conducted between 2003 and 2013. We estimated national and subnational time trends for key reproductive, maternal, and child health indicators, and used linear regression methods to determine predictors of change in health-care service use. All analyses were weighted for sampling and design effects. Additional information was collated and analysed about health system performance from third party surveys and about human resources from the Afghan Ministry of Public Health. Between 2003 and 2015, Afghanistan experienced a 29% decline in mortality of children younger than 5 years. Although definite reductions in maternal mortality remain uncertain, concurrent improvements in essential maternal health interventions suggest parallel survival gains in mothers. In a little over a decade (2003-13 inclusive), coverage of several maternal care interventions increased-eg, for antenatal care (16% to 53%), skilled birth attendance (14% to 46%), and births in a health facility (13% to 39%). Childhood vaccination coverage rates for the basic vaccines from the Expanded Programme of Immunisation (eg, BCG, measles, diphtheria-tetanus-pertussis, and three doses of polio) doubled over this period (about 40% to about 80%). Between 2005 and 2013, the number of deployed facility and community-based health-care professionals also increased, including for nurses (738 to 5766), midwives (211 to 3333), general physicians (403 to 5990), and community health workers (2682 to 28 837). Multivariable analysis of factors contributing to overall changes in skilled birth attendance and facility births suggests independent contributions of maternal literacy, deployment of community midwives, and proximity to a facility. Despite conflict and poverty, Afghanistan has made reasonable progress in its reproductive, maternal, newborn, and child health indicators over the last decade based on contributions of factors within and outside the health sector. However, equitable access to health care remains a challenge and present delivery models have high transactional costs, affecting sustainability. To maintain and further accelerate health and development gains, future strategies in Afghanistan will need to focus on investments in improving social determinants of health and targeted cost-effective interventions to address major causes of maternal and newborn mortality. US Fund for UNICEF under the Countdown to 2015 for Maternal, Newborn, and Child Survival grant from the Bill & Melinda Gates Foundation, and from the Government of Canada, Foreign Affairs, Trade and Development Canada. Additional direct and in-kind support was received from the UNICEF Country Office Afghanistan, the Centre for Global Child Health, the Hospital for Sick Children, Toronto, the Aga Khan University, and Mother and Child Care Trust (Pakistan).

ОЦІНКА РЕПРОДУКТИВНОГО ЗДОРОВ’Я СЕРЕД РІЗНИХ ВІКОВИХ ГРУП НАСЕЛЕННЯ ЧЕРКАСЬКОЇ ОБЛАСТІ

ОЦІНКА РЕПРОДУКТИВНОГО ЗДОРОВ’Я СЕРЕД РІЗНИХ ВІКОВИХ ГРУП НАСЕЛЕННЯ ЧЕРКАСЬКОЇ ОБЛАСТІ

Reproductive health assessment and quantitative real-time PCR analysis of estrogen receptor mRNA expression in Mytilus galloprovincialis gametes

Reproductive health assessment and quantitative real-time PCR analysis of estrogen receptor mRNA expression in Mytilus galloprovincialis gametes

Training Needs Assessment of Reproductive Health and Family Planning Leaders of Leadership Development Programs in Pakistan

The issue of workforce training and competency is central to the success of any public health system. The first step in designing training is to conduct a need assessment for an effective training program. In this research, we have accessed the training needs of the leaders of Leadership Development Program for mobilizing reproductive health; the vision of program was to develop a critical mass of diverse leaders, who can work individually and collectively and their efforts can improve reproductive health options and overall quality of life, especially for vulnerable populations in Pakistan. A cross-sectional study design was used to collect data by means of self-administered questionnaires from Reproductive Health and family planning leaders of the Leadership Development program from all over Pakistan. A total of 40 reproductive and family planning leaders participated after informed consent through non-probability convenience sampling. It was found that responding to felt needs is important for improving performance in health care system. Uses of practical, problem based learning methods are generally not included in the trainings. The priority areas in the current health scenario of Pakistan as identified by the study participants include training in disaster management, budget management, emergency preparedness and monitoring and evaluation. Need of communication skills training for health education was also highlighted for better reproductive health of the Pakistani population. The study indicated that training needs of Reproductive health and family planning leaders were heterogeneous and differed within professions by the tasks performed. Therefore, it is important to assess the tasks performed and training needs in leadership program participants in order to allocate training resources appropriately. There should be a permanent system for reviewing training needs.

Community Based Assessment of Reproductive Health and Related Problems of Communities at Quiha Town, Keble 02, Mekelle Zone, North Ethiopia

Background: Pregnancy at age interval of 15-19 years old and some of the community exercise <15 years old have shortage of health education for them about the harmfulness of the early marriage in a community Because reproductive health is such an important component of general health it is a prerequisite for social, economic and human Development. Most women have accepted traditional practice without any question, especially on subjecting themselves and their daughters to genital mutilation, early marriage, milk teeth extraction and domestic abuse with increased government efforts to expand family services. Hence, it is important to understand the exposure of communities to sexual and reproductive health knowledge attitude, and skill at different kebeles including each household. Objectives: The main objective of this study is to assess the major reproductive health status and communities problem in study area. Method: A cross sectional survey using self-administrated questionnaire was conducted in Keble, 02 Quha town, Mekelle zone from June, 2010 up to July, 2010. Data was collected by protested questionnaire though interview. After coding and cleaning, data was entered and analyzed using tally sheet and scientific calculator. The analyzed data was presented using tables, graphs and Charts. Result:- A total of 360 respondents on the study; the majority (47.5%) being in the age of 31-45 , and 108(30%) were male and 252 (70%) were female . of the total 75(20.8%) male were married but 110 (30%) female were divorced by marital status. out of the total 93 (37.6 %) respondents had knowledge on family planning, but also 79(81.4%) were use inject able method currently. Regarding using latrine among the communities, the majority of 126 (34%) participants were use pit latrine In addition 255 (77%) participants were utilized tape water and 126(66.83%) had also economical problem.

Reproductive health and endocrine disruption in women with breast cancer: a pilot study.

The purpose of this study was to assess whether incorporation of an original reproductive health assessment and algorithm into breast cancer care helps providers appropriately manage patient reproductive health goals and to follow laboratory markers for fertility and correlate these with menstruation. This prospective observational pilot study was set in an urban, public hospital. Newly diagnosed premenopausal breast cancer patients between 18 and 49 years old were recruited for this study prior to chemotherapy initiation. As the intervention, these patients received a reproductive health assessment and care per the study algorithm at 3-month intervals for 24 months. Blood samples were also collected at the same time intervals. The main outcome measures were to assess if the reproductive health management was consistent with patient goals and to track any follicle-stimulating hormone (FSH) and thyroid-stimulating hormone (TSH) level changes throughout treatment and post-treatment period. Two patients were pregnant at study initiation. They received obstetric consultations, opted to continue pregnancies, and postpone treatment; both delivered at term without complications. One woman desired future childbearing and received fertility preservation counseling. All women received family planning consultations and received/continued effective contraceptive methods. Seventy-three percent used long-term contraception, 18 % remained abstinent, and 9 % used condoms. During chemotherapy, FSH rose to menopausal levels in 82 % of patients and TSH rose significantly in 9 %. While 82 % of women experienced amenorrhea, 44 % of these women resumed menstruation after chemotherapy. The assessment and algorithm were useful in managing patients' reproductive health needs. Chemotherapy-induced endocrine disruption impacted reproductive health.

Assessment of reproductive health and violence against women among displaced Syrians in Lebanon

BackgroundThe current conflict in Syria continues to displace thousands to neighboring countries, including Lebanon. Information is needed to provide adequate health and related services particularly to women in this displaced population.MethodsWe conducted a needs assessment in Lebanon (June-August 2012), administering a cross-sectional survey in six health clinics. Information was collected on reproductive and general health status, conflict violence, stress, and help-seeking behaviors of displaced Syrian women. Bivariate and multivariate analyses were conducted to examine associations between exposure to conflict violence, stress, and reproductive health outcomes.ResultsWe interviewed 452 Syrian refugee women ages 18–45 who had been in Lebanon for an average of 5.1 (± 3.7) months. Reported gynecologic conditions were common, including: menstrual irregularity, 53.5%; severe pelvic pain, 51.6%; and reproductive tract infections, 53.3%. Among the pregnancy subset (n = 74), 39.5% of currently pregnant women experienced complications and 36.8% of those who completed pregnancies experienced delivery/abortion complications. Adverse birth outcomes included: low birthweight, 10.5%; preterm delivery, 26.5%; and infant mortality, 2.9%. Of women who experienced conflict-related violence (30.8%) and non-partner sexual violence (3.1%), the majority did not seek medical care (64.6%). Conflict violence and stress score was significantly associated with reported gynecologic conditions, and stress score was found to mediate the relationship between exposure to conflict violence and self-rated health.ConclusionsThis study contributes to the understanding of experience of conflict violence among women, stress, and reproductive health needs. Findings demonstrate the need for better targeting of reproductive health services in refugee settings, as well as referral to psychosocial services for survivors of violence.

Risk Factors of Posttraumatic Stress Disorder After an Earthquake Disaster

This study sought to predict posttraumatic stress disorder (PTSD) from women's reproductive health events after an earthquake experience. Data on antenatal care, pregnancy outcomes, family planning, socioeconomic status, earthquake experiences, and mental health were collected from a random sample of 425 women of reproductive age using the Centers for Disease Control and Prevention Reproductive Health Assessment Toolkit and the Harvard Trauma Questionnaire. Data were analyzed using multivariate regression analysis to predict PTSD symptoms from posttrauma care variables and reproductive health events. Restricted social participation, use of temporary accommodation, pregnancy complications, and use of injectable contraceptives were significant risk factors of PTSD. These factors may be exacerbated by the social context of conservative societies, traditions about health care-seeking behavior, and access to health care. Antecedent reproductive health events influence women's reaction to major trauma including events such as an earthquake.

Reproductive Health Assessment After Disasters: Embedding a Toolkit within the Disaster Management Workforce to Address Health Inequalities among Gulf-Coast Women

Gulf Coast women are especially vulnerable to the effects of disaster and for many this vulnerability is compounded by existing poor health-related quality of life. Post-Hurricane Isaac, a baseline survey battery utilizing the Reproductive Health Assessment After Disasters (RHAD) Toolkit, the Medical Outcomes Study Social Support Survey, and the Edinburgh Postnatal Depression Scale were used quantitatively to assess reproductive health risks, services, and outcomes and to explore the psychosocial effects of disaster among pregnant and postpartum women aged 18-45 years (N=300). The pilot study included trained community health workers and patient navigators to implement a community needs assessment in Southeast Louisiana. The community health navigation corps administered RHAD and the brief psychosocial battery to gain a closer understanding of post-disaster reproductive health needs. Findings demonstrate the importance of making a transition from patient navigation into disaster management in order to reduce fragmentation in health care systems and to implement innovative approaches in survey methodology.

Development and Adaptation of Iranian Youth Reproductive Health Questionnaire

Iran is a young country, and sexual behavior is shaped in this period. This research aimed to provide an assessment tool to evaluate Iranian youth reproductive health. This multistage research was conducted to design a valid questionnaire in the domains of knowledge, attitude, and behavior of the youth in order to evaluate behavior change programs. For this reason, after conducting a careful literature review and a qualitative research, the questionnaire was prepared. Forward and backward translations were performed. Professionals and students were used to make sure of qualitative and quantitative content and face validity. After conducting the pilot study on 100 students and eliminating defects in performance, reliability was evaluated by test-retest and Cronbach's alpha was calculated. In this study, out of 268 questions, 198 were retained after face and content validity. Self-efficacy of communication with father and mother, self-efficacy of condom use, and self-efficacy of abstinence had the highest Cronbach's alpha. Moreover, communication with parents regarding reproductive health issues and attitude to abstinence had a high Cronbach's alpha, as well. It seems to be a good instrument for assessment of Iranian reproductive health, and we are going to assess youth reproductive health in the future.

Immunological and reproductive health assessment in herring gulls and black‐crowned night herons in the Hudson–Raritan Estuary

Previous studies have shown inexplicable declines in breeding waterbirds within western New York/New Jersey Harbor between 1996 and 2002 and elevated polychlorinated dibenzo-p-dioxins and polychlorinated biphenyls (PCBs) in double-crested cormorant (Phalacrocorax auritus) eggs. The present study assessed associations between immune function, prefledgling survival, and selected organochlorine compounds and metals in herring gulls (Larus argentatus) and black-crowned night herons (Nycticorax nycticorax) in lower New York Harbor during 2003. In pipping gull embryos, lymphoid cells were counted in the thymus and bursa of Fabricius (sites of T and B lymphocyte maturation, respectively). The phytohemagglutinin (PHA) skin response assessed T cell function in gull and heron chicks. Lymphocyte proliferation was measured in vitro in adult and prefledgling gulls. Reference data came from the Great Lakes and Bay of Fundy. Survival of prefledgling gulls was poor, with only 0.68 and 0.5 chicks per nest surviving to three and four weeks after hatch, respectively. Developing lymphoid cells were reduced 51% in the thymus and 42% in the bursa of gull embryos from New York Harbor. In vitro lymphocyte assays demonstrated reduced spontaneous proliferation, reduced T cell mitogen-induced proliferation, and increased B cell mitogen-induced proliferation in gull chicks from New York Harbor. The PHA skin response was suppressed 70 to 80% in gull and heron chicks. Strong negative correlations (r = -0.95 to -0.98) between the PHA response and dioxins and PCBs in gull livers was strong evidence suggesting that these chemicals contribute significantly to immunosuppression in New York Harbor waterbirds.

61. Needs Assessment of Sexual and Reproductive Health Among Tibetan University Students in India

61. Needs Assessment of Sexual and Reproductive Health Among Tibetan University Students in India

Relationships of ultrasonographic and magnetic resonance image attributes to the histomorphology of ram testes

Declining male fertility has prompted investigations into the diagnostic methods that would permit frequent, non-invasive and accurate detection of changes in testicular histomorphology and the reproductive status of individuals. Ultrasonographic (U/S) and magnetic resonance (MR) imaging both have the potential to be used in this manner as associations have previously been described between the U/S and MR image attributes and histopathological changes in testicular tissue. The present study set out to determine if correlations exist between quantitative U/S and MR image attributes and histomorphological characteristics (total and luminal seminiferous tubule, ST area, and parenchymal cell density) of the excised ram testes, and to compare relative sensitivities of the imaging techniques. The echotextural/MR (input variables) and histological parameters (output variables) were analyzed by the Pearson's product moment correlations. Significant correlations were found for all imaging modalities, with the strongest overall correlation recorded for the T2 FAST SPIN ECHO (T2FSE) MR series (between mean numerical pixel values (NPVs) and total ST area; r=−0.93, p<0.001). The greatest number of significant correlations among quantitative image characteristics and histological attributes of testicular tissue were found for the 3 PLANE LOCALIZER (3 PLANE LOC) MR series, followed by the T2FSE MR, 3D FAST-SPOILED GRADIENT ECHO (3D FSPGRE) MR, U/S (7.5MHz) imaging, and finally T1 SPIN ECHO (T1SE) MR series. No significant correlations were recorded between the quantitative attributes of T1SE images and ST lumen area or parenchymal cell density, or between the attributes of the 3D FSPGRE images and cell density. We concluded that there existed a potential practical application for both U/S and MR image techniques, combined with computer-assisted image analysis, to monitor the changes in testicular histomorphology and male reproductive health and fertility. Scrotal U/S remains a first-line imaging technique for the assessment of male reproductive health due mainly to its versatility and lower cost.

Multiscale forward electromagnetic model of uterine contractions during pregnancy

BackgroundAnalyzing and monitoring uterine contractions during pregnancy is relevant to the field of reproductive health assessment. Its clinical importance is grounded in the need to reliably predict the onset of labor at term and pre-term. Preterm births can cause health problems or even be fatal for the fetus. Currently, there are no objective methods for consistently predicting the onset of labor based on sensing of the mechanical or electrophysiological aspects of uterine contractions. Therefore, modeling uterine contractions could help to better interpret such measurements and to develop more accurate methods for predicting labor. In this work, we develop a multiscale forward electromagnetic model of myometrial contractions during pregnancy. In particular, we introduce a model of myometrial current source densities and compute its magnetic field and action potential at the abdominal surface, using Maxwell’s equations and a four-compartment volume conductor geometry. To model the current source density at the myometrium we use a bidomain approach. We consider a modified version of the Fitzhugh-Nagumo (FHN) equation for modeling ionic currents in each myocyte, assuming a plateau-type transmembrane potential, and we incorporate the anisotropic nature of the uterus by designing conductivity-tensor fields.ResultsWe illustrate our modeling approach considering a spherical uterus and one pacemaker located in the fundus. We obtained a travelling transmembrane potential depolarizing from −56 mV to −16 mV and an average potential in the plateau area of −25 mV with a duration, before hyperpolarization, of 35 s, which is a good approximation with respect to the average recorded transmembrane potentials at term reported in the technical literature. Similarly, the percentage of myometrial cells contracting as a function of time had the same symmetric properties and duration as the intrauterine pressure waveforms of a pregnant human myometrium at term.ConclusionsWe introduced a multiscale modeling approach of uterine contractions which allows for incorporating electrophysiological and anatomical knowledge of the myometrium jointly. Our results are in good agreement with the values reported in the experimental technical literature, and these are potentially important as a tool for helping in the characterization of contractions and for predicting labor using magnetomyography (MMG) and electromyography (EMG).

Reproductive health and access to healthcare facilities: risk factors for depression and anxiety in women with an earthquake experience

BackgroundThe reproductive and mental health of women contributes significantly to their overall well-being. Three of the eight Millennium Development Goals are directly related to reproductive and sexual health while mental disorders make up three of the ten leading causes of disease burden in low and middle-income countries. Among mental disorders, depression and anxiety are two of the most prevalent. In the context of slower progress in achieving Millennium Development Goals in developing countries and the ever-increasing man-made and natural disasters in these areas, it is important to understand the association between reproductive health and mental health among women with post-disaster experiences.MethodsThis was a cross-sectional study with a sample of 387 women of reproductive age (15-49 years) randomly selected from the October 2005 earthquake affected areas of Pakistan. Data on reproductive health was collected using the Centers for Disease Control reproductive health assessment toolkit. Depression and anxiety were measured using the Hopkins Symptom Checklist-25, while earthquake experiences were captured using the Harvard Trauma Questionnaire. The association of either depression or anxiety with socio-demographic variables, earthquake experiences, reproductive health and access to health facilities was estimated using multivariate logistic regression.ResultsPost-earthquake reproductive health events together with economic deprivation, lower family support and poorer access to health care facilities explained a significant proportion of differences in the experiencing of clinical levels of depression and anxiety. For instance, women losing resources for subsistence, separation from family and experiencing reproductive health events such as having a stillbirth, having had an abortion, having had abnormal vaginal discharge or having had genital ulcers, were at significant risk of depression and anxiety.ConclusionThe relationship between women's post-earthquake mental health and reproductive health, socio-economic status, and health care access is complex and explained largely by the socio-cultural role of women. It is suggested that interventions that consider gender differences and that are culturally appropriate are likely to reduce the incidence.

Reproductive Health Assessment After Disaster: Introduction to the RHAD Toolkit

This article reviews associations between disaster and the reproductive health of women, describes how Hurricane Katrina influenced our understanding about postdisaster reproductive health needs, and introduces a new toolkit that can help health departments assess postdisaster health needs among women of reproductive age.