Background: Long-acting and reversible contraceptive methods hold great potential as solutions to address the unmet need for contraception and the significant discontinuation rates, especially in sub-Saharan Africa. A...Background: Long-acting and reversible contraceptive methods hold great potential as solutions to address the unmet need for contraception and the significant discontinuation rates, especially in sub-Saharan Africa. Among these methods, the Implant has gained popularity in sub-Saharan Africa, whereas the utilization of Intrauterine Devices (IUDs) has remained comparatively low, particularly in Burkina Faso. This study aims to evaluate the shifts in IUD and Implant usage from 2010 to 2020 and to pinpoint the factors influencing the choice of IUDs among LARCs users in Burkina Faso. Data and Methods: We conducted an analysis using data from Burkina Faso, drawn from the 2010 Demographic and Health Survey (DHS) and the 2020 PMA Phase 1 data. The 2010 DHS garnered responses from 17,087 women aged 15 - 49, achieving a response rate of 98.4%. The 2020 PMA data collected responses from 6590 women aged 15 - 49, with a response rate of 95.8%. The final sample of Long-Acting Reversible Contraceptives (LARCs) users consisted of 1502 women, including 576 women from the 2010 survey and 926 women from the 2020 survey. Results: The study demonstrates an expansion of IUD usage to include socioeconomically disadvantaged segments among LARC users. However, higher levels of education, older age, and decisions influenced by healthcare providers are correlated with the preference for IUDs over Implants. The choice of IUDs is also connected to a comprehensive understanding of contraceptive methods, suggesting potential biases in the counseling process. Conclusion: Facilitating the broader adoption of IUDs among disadvantaged groups could be achieved by improving the accessibility of IUD products and services in rural areas. Nevertheless, there should be focused initiatives to enhance access to removal services, as this factor could dissuade specific users. Further efforts are required to train healthcare providers, aiming to mitigate biases in delivering Long-Acting Reversible Contraceptives (LARCs). Providers should provide impartial counseling, irrespective of the selected type of LARC.展开更多
Objectives: To determine the percentage of women who accepted a LARC after abortion, specify the interval time for the insertion of the LARC and compare such interval time with that of injectable and oral contraceptiv...Objectives: To determine the percentage of women who accepted a LARC after abortion, specify the interval time for the insertion of the LARC and compare such interval time with that of injectable and oral contraceptives. Patients and Methods: This is a prospective, descriptive and comparative study conducted in Libreville (Gabon), from February 1, 2013 to August 31, 2013. After receiving post-abortion care (PAC), all patients with stable general states were counseled about three types of contraceptive methods: combined oral contraceptive pills, LARCs (Jadelle? implants, Copper IUDs) and injectable Medroxyprogesterone Acetate (DMPA). Results: 231 women received PAC and among them 215 (93%) wanted to use one of the three proposed contraceptive methods. At the end of the study, only 193 women (89.7%) used contraception and 22 others (10.3%) abandoned their intentions. LARCs were used by 31 (16.0%) women. The average period for the insertion of LARCs was 15.4 ± 15.5 days with extremes of 1 to 53 days. This period for the insertion of LARCS was significantly longer than that of other methods (p < 0.001). LARCs were inserted more often after the 2nd day than immediately (same day) with a highly significant difference (p < 0.0001). Conclusion: LARCs could constitute an appropriate approach to reducing unintended pregnancies in Gabon. However, in order to increase their rates of use, it is necessary to improve women awareness.展开更多
Objective: The aim of the current study was to assess the impact of operative interventions for misplaced device among women who opted for PPIIUCD and the evaluation of reasons for PPIUCD removal within the follow up ...Objective: The aim of the current study was to assess the impact of operative interventions for misplaced device among women who opted for PPIIUCD and the evaluation of reasons for PPIUCD removal within the follow up period of two years. Design: A descriptive exploratory study was conducted over three months among fourteen PPIUCD acceptors at a tertiary care health facility in Delhi, India. Face-to-face & telephonic in-depth interviews were conducted with a selected sample of PPIUCD acceptors who had later opted for its removal. Results: Participants (n = 14) aged 24 – 40 exhibited generally positive attitudes towards PPIUCDs indicating an indicate an understanding of the importance of PPIUCD in preventing unintended pregnancies. Menstrual disturbance and misplaced IUCD were major reasons for removal. despite their own experience necessitating the removal of IUCD, positive experience by other family members (mothers in law) in this study helped to keep the confidence on the contraceptive. Themes included (a) general experience of PPIUCD use (b) Health Facility accessed for removal of IUCD (c) Would she recommend it to others? (d) preferred contraceptive after removal of IUCD. Conclusion: Misplaced IUCD, missing thread, menstrual irregularities, and pain are all associated with PPIUCD and are important reasons for dissatisfaction. Appropriate, timely and supportive individualized care that address knowledge gaps, societal perceptions, and healthcare system challenges would certainly help in reducing dissatisfaction due to PPIUCD and thereby the removal rates.展开更多
Background: About one-third of all pregnancies that occur in low income countries are unintended. An estimated 1.2 million unwanted pregnancies occur in Uganda annually. The majority of the unwanted pregnancies end in...Background: About one-third of all pregnancies that occur in low income countries are unintended. An estimated 1.2 million unwanted pregnancies occur in Uganda annually. The majority of the unwanted pregnancies end in unsafe abortion which is one of the five direct causes of maternal mortality. Abortion related complications are responsible for 26% of all maternal deaths in Uganda. Abortion complications can be avoided if women appropriately use contraception to avoid unwanted pregnancy. However, in Uganda the contraceptive prevalence is low at 30% and less than 4% of women rely on long acting reversible contraceptives. Aim: We aimed to explore post-abortion women’s perceptions of using of long acting reversible contraception (LARC). Methods: A qualitative research design was used for data collection and analysis. Thirty in-depth interviews with post abortion women in Mulago hospital were carried out using an interview guide. Interviews were transcribed and coded using nodes and subsequently through query, we derived themes. Results: Emergent themes regarding women perceptions of using LARC methods were myths and misinformation, fear of side effects, women’s lived experiences, relatives’ influence, health providers’ perceptions, lack of knowledge and women desire for spacing children for a long time. Conclusion and recommendations: The majority of women were skeptical about using LARC. There is a need to educate women to dispel myths, misinformation and quality counseling to address the benefits and side effects of LARC. There is also a need to revamp the knowledge and skills of the healthcare providers regarding LARC methods.展开更多
Objective The aim of this study was to evaluate the impact of serum carcinoembryonic antigen(CEA)in the prediction of pathological complete response(pCR)in locally advanced rectal cancer(LARC)patients treated with neo...Objective The aim of this study was to evaluate the impact of serum carcinoembryonic antigen(CEA)in the prediction of pathological complete response(pCR)in locally advanced rectal cancer(LARC)patients treated with neoadjuvant chemoradiotherapy(nCRT).Methods A total of 925 LARC patients who underwent nCRT followed by TME between March 2006 and February 2018 were enrolled at Fudan University Shanghai Cancer Center.Using logistic regression models,we investigated the associations between serum CEA levels and pathological complete remission(pCR).Further stratified analyses were performed according to different CEA thresholds.Results We found that pre-nCRT CEA and post-nCRT CEA were negatively correlated with pCR(P<0.001).Stratified analyses revealed that when the CEA cutoff value was set to 5 ng/mL,10.6%of patients with post-nCRT CEA levels>5 ng/mL achieved pCR.Meanwhile,when the CEA cutoff value was set to 10 ng/mL,only 6.8%of the patients with post-nCRT CEA levels>10 ng/mL achieved pCR.Conclusion In summary,pre and post-nCRT CEA levels≤5 ng/mL were favorable predictors of pCR in LACR patients,and the“watch and wait”strategy is not recommended for patients with post-nCRT CEA levels>10 ng/mL.展开更多
文摘Background: Long-acting and reversible contraceptive methods hold great potential as solutions to address the unmet need for contraception and the significant discontinuation rates, especially in sub-Saharan Africa. Among these methods, the Implant has gained popularity in sub-Saharan Africa, whereas the utilization of Intrauterine Devices (IUDs) has remained comparatively low, particularly in Burkina Faso. This study aims to evaluate the shifts in IUD and Implant usage from 2010 to 2020 and to pinpoint the factors influencing the choice of IUDs among LARCs users in Burkina Faso. Data and Methods: We conducted an analysis using data from Burkina Faso, drawn from the 2010 Demographic and Health Survey (DHS) and the 2020 PMA Phase 1 data. The 2010 DHS garnered responses from 17,087 women aged 15 - 49, achieving a response rate of 98.4%. The 2020 PMA data collected responses from 6590 women aged 15 - 49, with a response rate of 95.8%. The final sample of Long-Acting Reversible Contraceptives (LARCs) users consisted of 1502 women, including 576 women from the 2010 survey and 926 women from the 2020 survey. Results: The study demonstrates an expansion of IUD usage to include socioeconomically disadvantaged segments among LARC users. However, higher levels of education, older age, and decisions influenced by healthcare providers are correlated with the preference for IUDs over Implants. The choice of IUDs is also connected to a comprehensive understanding of contraceptive methods, suggesting potential biases in the counseling process. Conclusion: Facilitating the broader adoption of IUDs among disadvantaged groups could be achieved by improving the accessibility of IUD products and services in rural areas. Nevertheless, there should be focused initiatives to enhance access to removal services, as this factor could dissuade specific users. Further efforts are required to train healthcare providers, aiming to mitigate biases in delivering Long-Acting Reversible Contraceptives (LARCs). Providers should provide impartial counseling, irrespective of the selected type of LARC.
文摘Objectives: To determine the percentage of women who accepted a LARC after abortion, specify the interval time for the insertion of the LARC and compare such interval time with that of injectable and oral contraceptives. Patients and Methods: This is a prospective, descriptive and comparative study conducted in Libreville (Gabon), from February 1, 2013 to August 31, 2013. After receiving post-abortion care (PAC), all patients with stable general states were counseled about three types of contraceptive methods: combined oral contraceptive pills, LARCs (Jadelle? implants, Copper IUDs) and injectable Medroxyprogesterone Acetate (DMPA). Results: 231 women received PAC and among them 215 (93%) wanted to use one of the three proposed contraceptive methods. At the end of the study, only 193 women (89.7%) used contraception and 22 others (10.3%) abandoned their intentions. LARCs were used by 31 (16.0%) women. The average period for the insertion of LARCs was 15.4 ± 15.5 days with extremes of 1 to 53 days. This period for the insertion of LARCS was significantly longer than that of other methods (p < 0.001). LARCs were inserted more often after the 2nd day than immediately (same day) with a highly significant difference (p < 0.0001). Conclusion: LARCs could constitute an appropriate approach to reducing unintended pregnancies in Gabon. However, in order to increase their rates of use, it is necessary to improve women awareness.
文摘Objective: The aim of the current study was to assess the impact of operative interventions for misplaced device among women who opted for PPIIUCD and the evaluation of reasons for PPIUCD removal within the follow up period of two years. Design: A descriptive exploratory study was conducted over three months among fourteen PPIUCD acceptors at a tertiary care health facility in Delhi, India. Face-to-face & telephonic in-depth interviews were conducted with a selected sample of PPIUCD acceptors who had later opted for its removal. Results: Participants (n = 14) aged 24 – 40 exhibited generally positive attitudes towards PPIUCDs indicating an indicate an understanding of the importance of PPIUCD in preventing unintended pregnancies. Menstrual disturbance and misplaced IUCD were major reasons for removal. despite their own experience necessitating the removal of IUCD, positive experience by other family members (mothers in law) in this study helped to keep the confidence on the contraceptive. Themes included (a) general experience of PPIUCD use (b) Health Facility accessed for removal of IUCD (c) Would she recommend it to others? (d) preferred contraceptive after removal of IUCD. Conclusion: Misplaced IUCD, missing thread, menstrual irregularities, and pain are all associated with PPIUCD and are important reasons for dissatisfaction. Appropriate, timely and supportive individualized care that address knowledge gaps, societal perceptions, and healthcare system challenges would certainly help in reducing dissatisfaction due to PPIUCD and thereby the removal rates.
文摘Background: About one-third of all pregnancies that occur in low income countries are unintended. An estimated 1.2 million unwanted pregnancies occur in Uganda annually. The majority of the unwanted pregnancies end in unsafe abortion which is one of the five direct causes of maternal mortality. Abortion related complications are responsible for 26% of all maternal deaths in Uganda. Abortion complications can be avoided if women appropriately use contraception to avoid unwanted pregnancy. However, in Uganda the contraceptive prevalence is low at 30% and less than 4% of women rely on long acting reversible contraceptives. Aim: We aimed to explore post-abortion women’s perceptions of using of long acting reversible contraception (LARC). Methods: A qualitative research design was used for data collection and analysis. Thirty in-depth interviews with post abortion women in Mulago hospital were carried out using an interview guide. Interviews were transcribed and coded using nodes and subsequently through query, we derived themes. Results: Emergent themes regarding women perceptions of using LARC methods were myths and misinformation, fear of side effects, women’s lived experiences, relatives’ influence, health providers’ perceptions, lack of knowledge and women desire for spacing children for a long time. Conclusion and recommendations: The majority of women were skeptical about using LARC. There is a need to educate women to dispel myths, misinformation and quality counseling to address the benefits and side effects of LARC. There is also a need to revamp the knowledge and skills of the healthcare providers regarding LARC methods.
基金Supported by a grant from the Scientific research project of Nantong Municipal Health Commission(No.QA2019049)。
文摘Objective The aim of this study was to evaluate the impact of serum carcinoembryonic antigen(CEA)in the prediction of pathological complete response(pCR)in locally advanced rectal cancer(LARC)patients treated with neoadjuvant chemoradiotherapy(nCRT).Methods A total of 925 LARC patients who underwent nCRT followed by TME between March 2006 and February 2018 were enrolled at Fudan University Shanghai Cancer Center.Using logistic regression models,we investigated the associations between serum CEA levels and pathological complete remission(pCR).Further stratified analyses were performed according to different CEA thresholds.Results We found that pre-nCRT CEA and post-nCRT CEA were negatively correlated with pCR(P<0.001).Stratified analyses revealed that when the CEA cutoff value was set to 5 ng/mL,10.6%of patients with post-nCRT CEA levels>5 ng/mL achieved pCR.Meanwhile,when the CEA cutoff value was set to 10 ng/mL,only 6.8%of the patients with post-nCRT CEA levels>10 ng/mL achieved pCR.Conclusion In summary,pre and post-nCRT CEA levels≤5 ng/mL were favorable predictors of pCR in LACR patients,and the“watch and wait”strategy is not recommended for patients with post-nCRT CEA levels>10 ng/mL.
