Reproductive Health Clinics Research Articles

Validity and reliability of the Spanish version of the "Wijma Delivery Expectancy/Experience Questionnaire" (W-DEQ-B).

The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-B) is an instrument that allows the experiences around fear of childbirth to be examined after the birth. It is currently the most widely used to measure different aspects related to the fear of childbirth and enables healthcare and additional assistance to women after birth to be adapted according to their needs. The objective of this study was to translate the W-DEQ-B into Spanish and analyse its reliability and validity. The study was carried out in two phases: (1) transcultural adaption of the questionnaire to Spanish and (2) a transversal study in a sample of 190 postpartum women from Sexual and Reproductive Health Clinics in the province of Barcelona (Spain). The psychometric properties were examined in terms of reliability (internal consistency and temporal stability) and construct validity (confirmatory factorial analysis [CFA] and exploratory factorial analysis [EFA]). The results of the CFA did not confirm unidimensionality of the W-DEQ-B questionnaire. The EFA suggested four very similar, but not identical, dimensions to those obtained in other studies in which the W-DEQ-B has been evaluated. Both the Cronbach’s alpha and the omega coefficient were adequate for the total questionnaire and for each of the four dimensions. The results of this study confirm that the W-DEQ-B is multi-dimensional. In the Spanish version of the W-DEQ-B-Sp four dimensions have been identified that allow the experiences around fear of childbirth to be examined after the birth. The Spanish version of the WDEQ-B (WDEQ-B-Sp) is reliable and valid for the measurement of fear of childbirth in clinical practice and for use in future research.

Understanding forgotten exposures towards achieving Sustainable Development Goal 3: a cross\u2010sectional study on herbal medicine use during pregnancy or delivery in Tanzania

BackgroundIn most of the sub-Sahara African countries, use of herbal medications is widely practiced during pregnancy or delivery for various reasons despite uncertainties on their pharmacological profiles. Use of unregistered herbal medicines has the potential of causing adverse health effects to the mother and the newborn, thus deterring achievement of Sustainable Development Goal 3, which aims to “ensure healthy lives and promote well-being for all at all ages”. One of the targets is on reduction of morbidity and mortality among mothers and newborns. This study investigated use of herbal medicines and predictors of usage during pregnancy or delivery as a forgotten exposure towards understanding some of the challenges in achieving Sustainable Development Goal 3.MethodsThis cross-sectional quantitative study gathered information from women who delivered a live-born baby in the preceding two years. Using a two-stage-sampling technique, women attending reproductive, maternal and child health clinics in Tabora were selected and interviewed. Proportions were compared using chi-square test and Poisson regression analysis was performed to determine independent correlates of herbal medicine use.ResultsOf 340 recruited women, 208 [61.2 %; 95 % confidence interval: 55.4, 66.3 %] used herbal medicines during pregnancy or delivery. Major reasons for use included accelerating labour, 81 (38.9 %) and reducing labour pains, 58 (27.9 %). Women who made less than four antenatal visits had a 24 % higher adjusted prevalence ratio of using herbal medicines as compared to those who had at least four visits [adjusted prevalence ratio:1.24; 95 % confidence interval: 1.02, 1.50, p = 0.03]. Furthermore, the adjusted prevalence ratio of using herbal medicines was 35 % higher among women who were not discouraged by health care providers against their use as compared to those who were discouraged (adjusted prevalence ratio: 1.35; 95 % confidence interval: 1.13, 1.60, p = 0.01).ConclusionsUse of herbal medicines during pregnancy or delivery among women in Tanzania is common. Independent predictors of herbal medicine use were number of antenatal visits and stance of maternity health care providers on their use. Comprehensive investigations on the magnitude, patterns and predictors of use of herbal medicines during pregnancy or delivery are warranted.

Factors associated with cognitive developmental delay among infants attending Reproductive and Child Health clinics in Dar es salaam, Tanzania

Background; Early child cognitive development is important throughout one’s life span. It is estimated that more than 200 million children under five years of age fail to achieve full cognitive development in the world and 80% of them are in south Asia and sub-Sahara-Africa. Genetic and environmental factors play a role in early child development (ECD). Most of the ECD occurs in the first 2years of life, but largely during infancy. Malnutrition, poverty and poor health care to children have been found to have association with poor cognitive development and create a vicious cycle of poverty. This study gives the proportion and factors that are associated with infants’ cognitive developmental delay in our setting. Knowing these factors enhance early intervention to break the viscious cycle.This study aimed to determine the proportion and factors associated with cognitive developmental delay among infants attending RCH clinics in Dar es Salaam. Patients/ Material and Methods; This was a health facility based descriptive cross-sectional study conducted by using a structured data collecting tool done in three health centers in Dar es Salaam from July to December 2012. A two- stage sampling technique and Lottery were used to get the health centers. The data were analyzed using SPSS software by Pearson’s chi-square, Fisher exact test and logistic regressions. Results; A total of 350 infants were assessed for cognitive development in a period of six months. Male infants were the majority by 50.6%. Our study Participants aged 1to 12 months with a mean (SD) of 7.26 (3.43) months with their birth weight ranging from 1.3 to 4.6kg with mean (SD) of 3.11(0.50) kg. The Proportion of infants with cognitive developmental delay was 12.3%. Age of the child, caretakers and wasting were significantly associated with cognitive developmental delays even after adjusting for confounders. Infants aged less than 6months were 14 times more likely to have cognitive developmental delay compared to those aged six months and above (adjusted oddis ratio{aOR=14; 95%CI 5.3-38.3, P<0.001}). Infants cared by assistant caretakers especially during day-time, were 12 times more likely to have cognitive developmental delay compared to infants who stayed with their mothers (aOR=12.1; 95%CI 3.0-53, P=0.001). Wasted infants were 4 times more likely to have cognitive developmental delay (aOR=3.9; 95%CI 1.1-13.3, P=0.032) compared to infants with good nutritional status. Conclusion; The proportion of cognitive developmental delay among infants attending Reproductive and Child Health( RCH) clinics in Dar es Salaam was 12.3%. Young age of the child, use of other caretakers in absence of the mother, and wasting were associated with cognitive developmental delays. Infants need Mothers to spend time with them and prevention of malnutrition plays a role in cognitive development.

Factors associated with cognitive developmental delay among infants attending Reproductive and Child Health clinics in Dar es salaam, Tanzania

Factors associated with cognitive developmental delay among infants attending Reproductive and Child Health clinics in Dar es salaam, Tanzania

High Satisfaction with Family Planning Health Education Among Women of Reproductive Age in Tanzania: An Exit Survey

Background: Reproductive and child health clinic attendance is vital in offering family planning health education among women of reproductive age in Tanzania. During these visits, group education sessions on modern contraception is offered to women before receiving the specific services they went for. Those who show interest with modern contraception proceed to individualized sessions on adopting one of the methods. Therefore, being satisfied during the group session is paramount to adopting modern contraception. This study therefore sought to assess the level of client satisfaction with the family planning health education among women of reproductive age from selected clinics in Dar es Salaam.
 Methodology: This was an observational study conducted in selected Reproductive Health clinics in three municipalities within Dar es Salaam region. Facilities were grouped by districts and ownership from which one third were systematically picked to provide 8 participants each. Interviewer led completion of the study tool was employed to assess satisfaction parameters. Analysis on satisfaction was all or none from a 5-point rating scale and association calculated with significance set at a p-value of less than 5% and 95% confidence interval.
 Results: There was a general higher satisfaction with the family health education offered during the visit period. Satisfaction with family planning health education was significantly higher among women with higher parity (p=0.009), employed (p=0.00001), and were attended to by a clinician (p=0.0006). A significant disparity within municipalities was also noted (p=0.005). Private facilities, shorter time in facilities, and non-cash payments did not significantly influence satisfaction.
 Conclusion: Family planning health education satisfaction is high among women of the reproductive age group in Dar es Salaam clinics. We need to explore how this satisfaction is translated to reduce the unmet needs for modern contraception in Tanzania. Furthermore, whether this high satisfaction translates into good knowledge remains unexplored.

Diminished ovarian reserve is associated with reduced euploid rates via preimplantation genetic testing for aneuploidy independently from age: evidence for concomitant reduction in oocyte quality with quantity

To determine whether women with diminished ovarian reserve (DOR) (quantitatively) had lower rates of euploid blastocysts, as a proxy for oocyte quality. Retrospective cohort study. University reproductive health clinic. A total of 1,152 women aged 19-42 years underwent 1,675 IVF cycles yielding 8,073 blastocysts for biopsy from 2010 to2019. Preimplantation genetic testing for aneuploidy. Euploid rates, defined as the number of euploid blastocysts divided by the number of biopsied blastocysts per cycle. A total of 225 women (20%) had DOR as infertility diagnosis per the Bologna criteria. Age was higher among the women with DOR (39.5 y vs. 37.0 y). Euploid rates were lower among women with vs. without DOR (29.0% vs. 44.9%). In generalized linear models controlling for age, women with DOR had 24% reduced odds of a biopsied blastocyst being euploid versus women without DOR. In a secondary analysis assigning DOR status to women producing the lowest quartile of age-adjusted mature oocyte yield, this relationship remained. No differences were identified in live birth rates between women with and without DOR after euploid single-embryo transfer independently from age (n = 944 transfers; 56.8% vs. 54.8%, respectively). Blastocysts from women with DOR are less likely to be euploid than those from women without DOR after adjustment for age. Given the concomitant reduction in euploid rates with quantity of oocytes observed in this study, quantitative ovarian reserve assessments (i.e., follicular machinery) may yield insight into relative ovarian aging.

Women's contraceptive choice following the use of Implanon NXT: Findings from a study in Durban, South Africa.

Implanon NXT was introduced in South Africa (SA) in 2014 to expand the contraceptive method mix. While studies have explored patterns of implant use, data on contraceptive choice following implant removal is limited. Here, we describe contraceptive choice among 120 women requesting Implanon NXT removal, between 2017 and 2018, at an urban reproductive health clinic in Durban, SA. Among women who used the implant for three years (n=91), >50% chose to reinsert Implanon NXT. Reasons for choosing to reinsert included satisfaction with the implant, the desire for a long-acting method and having had no side effects. A third of women chose not to reinsert Implanon NXT after three years due to side effects such as problematic bleeding. Most women requesting early removal of the implant switched to male condoms, injectables or oral contraceptives. Contraceptive services should provide women with contraceptive options and allow women to make informed decisions regarding contraceptive choice, in addition to providing support and managing side effects among Implanon NXT users.

Immune Response After Three Doses of Hepatitis B Vaccine among Children Below Five Years of Age in Mwanza, Tanzania

Background: Hepatitis B virus (HBV) infections is moderately endemic in many countries in the sub-Saharan Africa including Tanzania. Immunization of children below five years of age has been found to be an effective strategy in controlling infectious diseases. However, the data regarding immune responses following vaccination are very limited in low-income countries. Here, we report the sero-conversion among children below five years of age after three doses of HBV vaccine in Mwanza, Tanzania. Methodology: A cross-sectional study involving children below five years of age was conducted at Makongoro Reproductive and Child Health (RCH) clinic between May and June 2017. Socio-demographic data were collected, and vaccination status was confirmed from reproductive and child health (RCH) cards. Serum HBV surface antibodies (anti-HBs) were quantified using enzyme immunoassay (Enzygnost Anti-HBs II). Data were analysed by using STATA version 13 software.

Vitamin D Status among Infants Attending a Reproductive and Child Health Clinic in Arusha, Tanzania: A Cross-Sectional Study

Background: Globally there is a high burden of low serum vitamin D deficiency (VDD) with children being acknowledged at risk due to low vitamin D content in both breastmilk and available foods and inadequate cutaneous synthesis of vitamin D. Even in countries with abundant sunshine, vitamin D deficiency (VDD) remains a problem. There is little characterization of the status of vitamin D among infants in East Africa. This study aimed to determine the prevalence and factors associated with vitamin D deficiency among infants attending the Reproductive and Child Health (RCH) Clinic in Arusha, Tanzania. Methods: A cross-sectional study of 304 infants aged 6 weeks to 12 months was conducted at Arusha Lutheran Medical Centre (ALMC). Infants were enrolled during the warm season between November 2018 and January 2019. A pre-coded questionnaire was used to collect data on sociodemographic characteristics of the infant with consent from their caretakers. Physical examination was done for anthropometric measures and signs of rickets. Blood was drawn for assessment of serum 25-hydroxyvitamin D 25(OH)D, calcium, phosphorus and alkaline phosphate. Vitamin D deficiency was defined as 25(OH)D level below 20 ng/ml (analysis was performed using STATA 14 version and factors associated with VDD explored with multivariate analysis. Results: The mean serum 25(OH)D among infants was 34.51 ng/ml (±15.53). Vitamin D deficiency was found in 67/304 (22%) infants and Vitamin D insufficiency in 50 (16.5%) infants. Hypocalcemia was observed in 33 (10.9%) infants and clinical findings of rickets were found in 11 infants (3.6%). Factors independently associated with VDD included age Conclusion and Recommendation: A high prevalence of Vitamin D deficiency (22%) and insufficiency (16.5%) was observed among infants attending RCH Clinic in Arusha, Tanzania. Age

Perception and Level of Knowledge on Preconception Care Uptake Among Women of Child Bearing Age Attending Reproductive Health Clinic at Kenyatta National Hospital

Background: Provision of care to adolescent girls and women before and between pregnancies improves their overall health. It also improves the pregnancy outcomes and the health of the new-born. There are many health related conditions that have an impact on maternal and neonatal health. There is paucity of information regarding the uptake of pre-conception care and the effects thereof in regard to maternal and neonatal morbidity and mortality. The main aim of this study was to assess the Preconception Care (PCC) given to women of child bearing age at Kenyatta National Hospital Reproductive Health clinic. Methods: This was a descriptive prospective study that employed both qualitative and quantitative methods of data collection. The targeted population included the antenatal and postnatal women attended to at these clinics. Questionnaires were used to collect data from the respondents and the care providers were also interviewed. A total of 224 women of childbearing age who met the inclusion criteria were selected by convenient sampling technique and interviewed by use of questioners between December 2017 and March 2018. Content validity was ascertained by use of the test re-test method to establish reliability comparing with a Cronbach Alpha Reliability coefficient value. Data analysis was done by use of SPSS version 22; descriptive and inferential statistical tools like simple and multiple regressions were employed to establish association between the study variables and Chi square was used to establish if the association between independent and dependent variables were significant. Findings: Nineteen percent (19%, n=40) of the women knew about preconception care. There was positive attitude with 75.5% of the respondents stating that preconception care would improve the chances of having a healthy baby. Uptake was poor with only 23.1% had uptake of preconception care services despite the fact that 49.1% had received information on PCC. Conclusion: Women attending KNH reproductive clinic have –limited knowledge about PCC. Most of the women have positive attitude towards PCC but poor PCC practices.

Pattern of spousal support and communication among family planning clients in a tertiary care centre in north western Nigeria

Background: Globally, there has been the recognition of the importance of male involvement in family planning and providers sees their support as an effective way of reducing barrier to accessing Family Planning services. Aim: Assess the pattern of spousal support and communication for family planning. Methodology: This was a mixed study design. A structured questionnaire was used to collect information from Family Planning client, attending Ahmadu Bello University Teaching Hospital’s Reproductive Health clinic and Ahmadu Bello University Medical Centre. An in-dept. interview (with FP providers) and FGDs (with clients) were also conducted. Result: A total of 280 clients that were served with questionnaire across the two facilities within three months. Of the 280 respondents only 65% had tertiary level of education. Prior discussion of family planning with spouse was found in 82.5% of respondents and in 80.3% of the respondents said their spouses were aware of the chosen method. However, it was only in 39.5% of clients that, the chosen method was influenced by their spouses. Financial support by spouse was found in 69% of respondents. In 90% of respondents, there was the influence of the spouse on the intended duration of the chosen method. However, it was only in 33.5% of the respondents that the spouse influenced the discontinuation of previous method. Conclusion: Couple communication and spousal support were present in over two-third of family planning clients in Zaria, Northern Nigeria. Targeting men in behavioral change communication will improve the uptake of family planning services and improve the continuation of use of long-term contraceptives.

DNA methylation differences at birth after conception through ART.

STUDY QUESTIONIs there a relation between ART and DNA methylation (DNAm) patterns in cord blood, including any differences between IVF and ICSI?SUMMARY ANSWERDNAm at 19 CpGs was associated with conception via ART, with no difference found between IVF and ICSI.WHAT IS KNOWN ALREADYPrior studies on either IVF or ICSI show conflicting outcomes, as both widespread effects on DNAm and highly localized associations have been reported. No study on both IVF and ICSI and genome-wide neonatal DNAm has been performed.STUDY DESIGN, SIZE, DURATIONThis was a cross-sectional study comprising 87 infants conceived with IVF or ICSI and 70 conceived following medically unassisted conception. The requirement for inclusion in the study was an understanding of the Swedish language and exclusion was the use of donor gametes.PARTICIPANTS/MATERIALS, SETTING, METHODSParticipants were from the UppstART study, which was recruited from fertility and reproductive health clinics, and the Born into Life cohort, which is recruited from the larger LifeGene study. We measured DNAm from DNA extracted from cord blood collected at birth using a micro-array (450k array). Group differences in DNAm at individual CpG dinucleotides (CpGs) were determined using robust linear models and post-hoc Tukey’s tests.MAIN RESULTS AND THE ROLE OF CHANCEWe found no association of ART conception with global methylation levels, imprinted loci and meta-stable epialleles. In contrast, we identify 19 CpGs at which DNAm was associated with being conceived via ART (effect estimates: 0.5–4.9%, PFDR < 0.05), but no difference was found between IVF and ICSI. The associated CpGs map to genes related to brain function/development or genes connected to the plethora of conditions linked to subfertility, but functional annotation did not point to any likely functional consequences.LIMITATIONS, REASONS FOR CAUTIONWe measured DNAm in cord blood and not at later ages or in other tissues. Given the number of tests performed, our study power is limited and the findings need to be replicated in an independent study.WIDER IMPLICATIONS OF THE FINDINGSWe find that ART is associated with DNAm differences in cord blood when compared to non-ART samples, but these differences are limited in number and effect size and have unknown functional consequences in adult blood. We did not find indications of differences between IVF and ICSI.STUDY FUNDING/COMPETING INTEREST(S)E.W.T. was supported by a VENI grant from the Netherlands Organization for Scientific Research (91617128) and JPI-H2020 Joint Programming Initiative a Healthy Diet for a Healthy Life (JPI HDHL) under proposal number 655 (PREcisE Project) through ZonMw (529051023). Financial support was provided from the European Union’s Seventh Framework Program IDEAL (259679), the Swedish Research Council (K2011-69X-21871-01-6, 2011-3060, 2015-02434 and 2018-02640) and the Strategic Research Program in Epidemiology Young Scholar Awards, Karolinska Institute (to A.N.I.) and through the Swedish Initiative for Research on Microdata in the Social And Medical Sciences (SIMSAM) framework grant no 340-2013-5867, grants provided by the Stockholm County Council (ALF-projects), the Strategic Research Program in Epidemiology at Karolinska Institutet and the Swedish Heart-Lung Foundation and Danderyd University Hospital (Stockholm, Sweden). The funders had no role in study design, data collection, analysis, decision to publish or preparation of the manuscript. The authors declare no competing interests.TRIAL REGISTRATION NUMBERN/A.

Certainty and intention in pregnancy decision-making: An exploratory study

ObjectiveAbortion is often characterized as an inherently difficult decision, despite research demonstrating high decision certainty among abortion patients. Minimal research has examined decision certainty among people planning to continue a pregnancy. We examined whether women seeking abortion experience lower decision certainty than those planning to continue pregnancies and whether certainty differs by pregnancy intendedness. Study designWe administered the decisional conflict scale (DCS) to pregnant women (n = 149) at 8 U.S. primary and reproductive health clinics. Using Poisson regression models adjusted for sociodemographic and pregnancy characteristics, we evaluated differences in DCS scores (<25/100 vs ≥25/100) by pregnancy decision and whether pregnancy intention modified the effect of pregnancy decision on certainty. ResultsOver one-half (58%) of respondents planned to have an abortion, 32% to continue the pregnancy, and 10% were unsure. DCS scores were low overall (median 9.4/100; IQR: 1.6, 25.0), indicative of high certainty, and the percentage scoring ≥25/100, reflecting any uncertainty, did not differ by pregnancy decision (23% abortion vs 19% continuing, p = 0.55). In a multivariable model, there was no statistically significant interaction between pregnancy decision (abortion vs continuing pregnancy) and intention. However, the predicted percentage reporting any uncertainty among respondents with intended pregnancies was comparable among those decided on abortion (13%) and continuing the pregnancy (16%). Among those with unintended pregnancies, these figures were 25% among those decided on abortion vs 36% among those continuing. ConclusionLevels of certainty about a pregnancy decision were high and appeared to depend more on whether the pregnancy was intended or unintended than on the pregnancy decision itself. ImplicationsSimilar levels of uncertainty among individuals who decided to have an abortion versus continue a pregnancy challenge the narrative that abortion is a particularly difficult medical and personal decision. The prevalence of some uncertainty among respondents continuing pregnancies suggests voluntary options counseling may be useful for some patients in prenatal care settings.

Use of effective contraception following provision of the progestogen-only pill for women presenting to community pharmacies for emergency contraception (Bridge-It): a pragmatic cluster-randomised crossover trial

SummaryBackgroundUnless women start effective contraception after oral emergency contraception, they remain at risk of unintended pregnancy. Most women in the UK obtain emergency contraception from community pharmacies. We hypothesised that pharmacist provision of the progestogen-only pill as a bridging interim method of contraception with emergency contraception plus an invitation to a sexual and reproductive health clinic, in which all methods of contraception are available, would result in increased subsequent use of effective contraception.MethodsWe did a pragmatic cluster-randomised crossover trial in 29 UK pharmacies among women receiving levonorgestrel emergency contraception. Women aged 16 years or older, not already using hormonal contraception, not on medication that could interfere with the progestogen-only pill, and willing to give contact details for follow-up were invited to participate. In the intervention group, women received a 3-month supply of the progestogen-only pill (75 μg desogestrel) plus a rapid access card to a participating sexual and reproductive health clinic. In the control group, pharmacists advised women to attend their usual contraceptive provider. The order in which each pharmacy provided the intervention or control was randomly assigned using a computer software algorithm. The primary outcome was the use of effective contraception (hormonal or intrauterine) at 4 months. This study is registered, ISRCTN70616901 (complete).FindingsBetween Dec 19, 2017, and June 26, 2019, 636 women were recruited to the intervention group (316 [49·6%], mean age 22·7 years [SD 5·7]) or the control group (320 [50·3%], 22·6 years [5·1]). Three women (one in the intervention group and two in the control group) were excluded after randomisation. 4-month follow-up data were available for 406 (64%) participants, 25 were lost to follow-up, and two participants no longer wanted to participate in the study. The proportion of women using effective contraception was 20·1% greater (95% CI 5·2–35·0) in the intervention group (mean 58·4%, 48·6–68·2), than in the control group (mean 40·5%, 29·7–51·3 [adjusted for recruitment period, treatment group, and centre]; p=0·011).The difference remained significant after adjusting for age, current sexual relationship, and history of effective contraception use, and was robust to the effect of missing data (assuming missingness at random). No serious adverse events occurred.InterpretationProvision of a supply of the progestogen-only pill with emergency contraception from a community pharmacist, along with an invitation to a sexual and reproductive health clinic, results in a clinically meaningful increase in subsequent use of effective contraception. Widely implemented, this practice could prevent unintended pregnancies after use of emergency contraception.FundingNational Institute for Health Research (Health Technology Assessment Programme project 15/113/01).

Structuring Evaluation Partnerships: Exploring Contrasts in Researcher–Practitioner Roles and Responsibilities When Implementing Randomized Experiments in Real-World Settings

Despite the increase in federal tiered evidence initiatives that require the use of rigorous evaluation designs, such as randomized experiments, there has been limited guidance in the evaluation literature on practical strategies to implement such studies successfully. This paper provides lessons learned in executing experiments in applied settings, such as schools, juvenile justice agencies, mental health clinics, reproductive health clinics, and job centers. To promote successful study implementation, evaluators must understand study roles, select suitable partners, and employ appropriate partnership models. In this article, we describe partner types and study roles, concretely illustrate how partnerships might be structured, discuss specific strategies to assess implementation partner capacity and maintain partner engagement, and consider how an evaluator can leverage the skills and resources of study partners to improve participant recruitment, enrollment, and retention. While the lessons are drawn from our experiences conducting 10 experimental studies, some may also apply to non-experimental evaluations.

Prevalence of and factors associated with early initiation of breastfeeding among women with children aged

BackgroundEarly initiation of breastfeeding offers nutritional and immunological benefits to the newborn, which is critical for health and survival. Understanding factors associated with timely initiation of breastfeeding is crucial for healthcare providers and policy-makers. This study aimed to assess the prevalence and factors associated with early initiation of breastfeeding among mothers with children < 24 months of age in the Kilimanjaro region, Northern Tanzania.MethodsThis study utilized secondary data from a cross-sectional survey conducted in April 2016 and April 2017 in the Kilimanjaro region. A multistage sampling technique was used to select study participants and interviewed using a questionnaire. A total of 1644 women with children aged < 24 months were analyzed. Modified Poisson regression models were used to determine factors independently associated with early initiation of breastfeeding, within first hour of life.ResultsThe prevalence of early initiation of breastfeeding in the Kilimanjaro region was 70%, ranging from 64% in Same to 80% in Siha districts. The prevalence of early initiation of breastfeeding was lower among women who initiated prelacteal feeding compared to their counterparts (prevalence ratio [PR] 0.42; 95% Confidence Interval [CI] 0.34, 0.53). Likewise, women living in Same and Hai district had lower prevalence of early initiation of breastfeeding compared to women in Rombo (PR 0.8; 95% CI 0.76, 0.93) and (PR 0.89, 95% CI 0.80, 0.98) respectively. Higher prevalence of early initiation of breastfeeding was found in women with primary education compared to those with secondary education (PR 1.09; 95% CI 1.003, 1.18), and among women with two children compared to one child (PR 1.14, 95% CI 1.03, 1.26).ConclusionsEarly initiation of breastfeeding practice was suboptimal in this study. To improve early initiation of breastfeeding, healthcare providers at reproductive and child health clinics and labour wards should discourage women from prelacteal feeding, give more support to women with one child and those with secondary level of education and above. Furthermore, a qualitative study is crucial to understand the reasons for low prevalence of early initiation of breastfeeding in Same and Hai districts.

Adolescent Barriers in Accessing Reproductive Health Services in Developing Countries

Background : Adolescents (10–19 years) are the future leaders of our society and an untapped human resource. About one-fifth (more than 1.2bn) of the global population are adolescents, and many of the world’s adolescents live in developing nations. Adolescents are perceived to be healthy, however, they are vulnerable and exposed to many health risks leading to premature deaths. In 2015, about 1.3m adolescents died globally from causes that could have been prevented. Over two-thirds of these deaths occurred in low- and middle-income countries (LMICs) with 45 percent from Africa. Approximately 16m girls aged 15–19 years and 2.5m girls under 16 years give birth each year in developing regions. About 3m girls aged 15–19 years undergo unsafe abortions every year. Moreover, about 2m adolescents are living with human immune virus (HIV) globally, and over 41 percent of new HIV infections in every year occur among adolescents. Purpose : to explore adolescent barriers to accessing reproductive health services in developing countries. Method : Apprasial studies program using Critical Appraisal Skills Program (CASP) data sources obtained from PubMed with year period of 2009 – 2019. Results : inadequate space, no privacy, limited service hours, poor service attitude, lack of information, distance of clinics, high transportation costs, clinics aimed at married couples. lack of human resources, parental support, peer influence, religion and weak community traditions for adolescent health interventions also trigger adolescents not to access reproductive health clinics. Conclusion : adolescent barriers to accessing reproductive health services are facility level, personal level, service provider level and community level.

Extragenital Screening for Chlamydia and Gonorrhea Among Adolescents and Young Adults at a Sexual Health Clinic

ObjectiveTo increase screening rates for oropharyngeal and rectal (extragenital) chlamydia and gonorrhea infections among adolescents and young adults by 20% and for 90% of nurses to demonstrate a change in behavior and knowledge surrounding extragenital screening. DesignA pre- and posttest design to evaluate nurse knowledge and the percentage of extragenital chlamydia and gonorrhea screenings completed before and after a 2-month intervention period. SettingReproductive health clinic for adolescents and young adults up to age 25 years in the Twin Cities metropolitan area of Minnesota. ParticipantsFour registered nurses who provide direct client care at the identified sexual and reproductive health clinic. Intervention/MeasurementsWe implemented an education session for four staff nurses, a standardized sexual history taking tool, and protocols for obtaining oropharyngeal and rectal specimens. We measured extragenital chlamydia and gonorrhea screening rates, as well as knowledge and behavior change among registered nurses. ResultsData came from records for 623 individuals who were deemed at risk for extragenital chlamydia and gonorrhea infection. Extragenital chlamydia and gonorrhea screening rates increased by more than 700% from before to after the intervention. Five out of nine (55.6%) extragenital chlamydia and gonorrhea infections diagnosed would have been missed with urogenital screening alone. One hundred percent of nurses demonstrated an increase in their knowledge of the 5 P’s of sexual health (Partners, Practices, Protection from sexually transmitted infections, Past history of STIs, and Prevention of pregnancy) to conduct a risk assessment, the eligibility criteria for extragenital testing, and the actual collection processes of pharyngeal and rectal swabs. ConclusionUse of evidence-based recommendations and a collaborative team facilitated a more consistent approach to the assessment and diagnosis of extragenital chlamydia and gonorrhea infections. Generalizability is limited to the project site; however, this process could be implemented in other clinics to determine if similar results can be achieved.

Assessment of the Knowledge and Practice of Nurses about Family Planning Counseling in Health Care Centers – Lattakia

Objective: This study aimed to assess the knowledge and practice of nurses about family planning counseling in health care centers- Lattakia city to identify gaps in nurses' information and practice. Design: This was a purposive analytical study using a structured questionnaire that assessed the demographic characteristics of the nurses, and the nurses' knowledge about family planning counseling, and observation checklist to assess the practice of nurses during family planning counseling sessions. The data were analyzed with the SPSS software version stata 6.0. Settings: This study was conducted at the reproductive health clinics of health care centers, Lattakia. Subjects/participants: All nurses who work in reproductive health clinics in the time of the study (n= 29). Results: The nurses who had a good and medium level of knowledge constituted (62.07%, 37.93%) respectively, none of them had low level. The nurses who had a low and medium level of practice constituted (62.07%, 37.93%) respectively, none of them had a good level. Knowledge and practice about family planning counseling were statically connected. A significant statistical relation was found (P= 0.015). Conclusion: The nurses had a good level of knowledge and a low level of practice about family planning counseling, so they need training programs and a guide on family planning counseling.

Pregnant Women Level of Satisfaction on Quality of Care in Reproductive and Child Health clinic at Huruma Designated District Hospital in Rombo District, Kilimanjaro Region, Tanzania.

Background:The clients' level of satisfaction is an important measure in assessing the quality of health care services provided in health facilities, and is important in enhancing the utilisation of health care services.Objectives:This study aimed to determine pregnant women's level of satisfaction on the quality of care in the Reproductive and Child Health (RCH) clinic at Huruma Designated District Hospital, Rombo Kilimanjaro.Methodology:A cross-sectional study was conducted from May to June 2018 using the Donabediean model. Using systematic sampling, 270 pregnant women were selected to participate in the study. Data was collected using a pre-tested Service Quality(SERVQUAL) questionnaire. Descriptive statistics were performed using univariate and bivariate analysis, and one sample t-test to compare mean gap scores. The principal component analysis was employed to identify key items that measure the quality of care. A p-value of <.05 was considered statistically significant.Results:Overall, pregnant women's level of satisfaction on the quality of care in the Reproductive and Child Health clinic at Huruma DDH was 48.5%. The overall mean gap score (±SD) for the level of satisfaction was -0.53 (±1.69) signifying dissatisfaction with the quality of care. The overall level of satisfaction was associated with level of education (p<.001), occupation (p=.003), residence (p=.035). The levels of dissatisfaction in the 5 service dimensions were: empathy (-0.05), responsiveness (-0.09), assurance (-0.10), tangible (-0.13), and reliability (-0.17).Conclusion:Overall, pregnant women were dissatisfied with the quality of care provided. Pregnant women who are educated, being employed, and residing in Rombo were more likely to report dissatisfied with the quality of care. To improve the quality of care, lack of adequate staff and inadequate knowledge of the staff at RCH, and improvement in staff-clients interactions, and keeping scheduled appointments need to be improved.