Planning for child and adolescent mental health interventions in a rural district of South Africa: a situational analysis

Objective: The aim of this study was to conduct a situational analysis as part of formative work to inform the development of community-based mental health services for children and adolescents at a district level. The purpose of the situational analysis was to determine the current state of child and adolescent mental health (CAMH), the available resources for CAMH, the range of services provided, and the existing pathways to CAMH care in a low-resource district with a view to developing a district mental health plan to improve access to CAMH services.Methods: Data for this situational analysis was collected from a rural district in the KwaZulu-Natal province using mixed methods. The qualitative component explored various stakeholders' (n = 26) perspectives using semi-structured interviews. The quantitative data for the study was collected using an adaptation of the situation analysis tool developed by the PRIME consortium.Results: The findings revealed the need to strengthen all the basic building blocks of the health system due to the weaknesses identified in the current CAMH care system in the district. The result of the situational analysis revealed that the provision of CAMH services in the district is sparse, uncoordinated, and not prioritised.Discussion: The findings of the study highlighted a severe shortage of specialised CAMH services in the district, poor integration of CAMH services into primary health care, and at the community platform there are deficits in the integrated school health programme. Further, the lack of a coordinated intersectoral collaborative system and well-defined referral pathways were revealed.Conclusion: The study highlights various challenges facing CAMH services at the Amajuba district. While these are not new, the study contributes to our understanding of the district level factors that may hinder the development of a district CAMH plan

A twenty year experience with the use of intrauterine contraceptive device (IUCD) in a university teaching hospital in South- south Nigeria

Context: Contraceptive prevalence in Nigeria is low at 17%. Amongst Nigerian women and couples who accept to use contraception, the IUCD is the most commonly used contraceptive method with variation in rates of use between geographical areas and among Health Institutions. Factors that determine decision making on IUCD use are not well understood. Aims: To study the use, effectiveness, complications and discontinuation rates for intrauterine contraceptive device received at the University of Benin Teaching Hospital from 1997 to 2016 and analyzed in January, 2019. Study Design: This was a retrospective cross sectional study. Methodology: The case notes of all 3326 new clients who accepted Copper T intrauterine contraceptive device at the UBTH Family Planning Clinic during the review period were retrieved and analyzed. Data regarding acceptors socio-demographic characteristics, side effects, effectiveness, complications, duration of use and reasons for discontinuation were extracted and entered into SPSS for windows version 22.0 and analyzed. Results: Out of the 8203 clients that accepted to commence a family planning method, 3326 (40.55%) accepted to use IUCD. The mean age of IUCD acceptors at commencement was 33.4±5.60 and the mean age of their husbands was 39.85±6.91. The mean parity was 3.73±1.87 (range 0-12), while the mean number of living children was 3.56±1.66 (range 0-10). The mean duration of use (in months) was 40.43±40.13. Women with 5 or more children (P Value 0.000) and at least a minimum of secondary education (P Value 0.000), were significantly associated with IUCD use duration of > or more than 2 years. Also, women who reported satisfaction with IUCD (P Value 0.000) and no complications (P Value 0.000) were also associated with longer duration of use. Conclusion: IUCD is a common family planning method used by women at UBTH. Its duration of use is higher among clients with more children, at least a minimum of secondary school education and no complications from its use. This information is relevant for family planning service providers to increase contraceptive uptake by women in Nigeria

Barriers to Utilisation of Maternal Health Services in a Semi-urban Community in Northern Nigeria: The Clients' Perspective

Low level of utilisation of maternal health services is a major factor responsible for high maternal mortality in northwestern region of Nigeria. This study was aimed at determining the barriers to utilisation of maternal health services from the perspective of mothers in northwestern Nigeria. Materials and Methods: A cross-sectional study of 150 mothers; selected through multistage technique; was conducted. Data were collected using a structured interviewer-administered questionnaire; and analysed using SPSS statistics 17.0. Results: Only 2.7 utilised preconception service; 98.7 antenatal care service (ANC); 24.0 delivery; 35.3 postnatal care and 14.0 utilised family planning service. Major reasons for non-utilisation of delivery service were not having a delivery complication in the past (57 (CI = 47.4-66.1)) and negative provider attitude (23.7(CI = 16.4-32.7)). For non-utilisation of postnatal care; the major reasons were also not having a postnatal complication in the past (60.8 (CI = 50.4-70.4)) and negative provider attitude (27.8 (CI = 19.4-38.0)). As for non-utilisation of family planning service; the major reason was desire to have more children (32.6 (CI = 24.7-41.4)). Reasons for non-use of preconception care and ANC were not computed because respondents to these questions were not enough; only 6 (4.0) were aware of preconception care in the first place and only 2 (1.3) were aware of preconception care in the first place and only 2 (1.3) were not using ANC. Conclusion: Despite living near a health facility; most of the mothers were not using maternal health services. It is recommended that while there is the need to raise awareness on the utilisation of maternal health services; bring it closer to the mothers and make it more affordable; there is a more pressing need to improve its quality; especially through the alleviation of negative attitude of health care providers

Factors Affecting Unmet Need for Family Planning in Southern Nations; Nationalities and Peoples Region; Ethiopia

BACKGROUND: High fertility and low contraceptive prevalence characterize Southern Nations; Nationalities and Peoples Region. In such populations; unmet needs for contraception have a tendency to be high; mainly due to the effect of socio-economic and demographic variables. However; there has not been any study examining the relationship between these variables and unmet need in the region. This study; therefore; identifies the key socio- demographic determinants of unmet need for family planning in the region. METHODS: The study used data from the 2000 and 2005 Ethiopian Demographic and Health Surveys. A total of 2;133 currently married women age 15-49 from the 2000 survey and 1;988 from the 2005 survey were included in the study. Unmet need for spacing; unmet need for limiting and total unmet need were used as dependent variables. Socio- demographic variables (respondent's age; age at marriage; number of living children; sex composition of living children; child mortality experience; place of residence; respondent's and partner's education; religion and work status) were treated as explanatory variables and their relative importance was examined on each of the dependent variables using multinomial and binary logistic regression models. RESULTS: Unmet need for contraception increased from 35.1in 2000 to 37.4in 2005. Unmet need for spacing remained constant at about 25; while unmet need for limiting increased by 20between 2000 and 2005. Age; age at marriage; number of living children; place of residence; respondent's education; knowledge of family planning; respondent's work status; being visited by a family planning worker and survey year emerged as significant factors affecting unmet need. On the other hand; number of living children; education; age and age at marriage were the only explanatory variables affecting unmet need for limiting. Number of living children; place of residence; age and age at marriage were also identified as factors affecting total unmet need for contraception. CONCLUSION: unmet need for spacing is more prevalent than unmet need for limiting. Women with unmet need for both spacing and limiting are more likely to be living in rural areas; have lower level of education; lower level of knowledge about family planning methods; have no work other than household chores; and have never been visited by a family planning worker. In order to address unmet need for family planning in the region; policy should set mechanisms to enforce the law on minimum age for marriage; improve child survival and increase educational access to females. In addition; the policy should promote awareness creation about family planning in rural areas

Strategy for the Zimbabwe National Family Planning Programme for the five years from 1991 to 1996

The strategy outlined in this document has been developed at a propitious moment. The major donors (the World Bank; USAID; and UNFPA) are beginning new major projects aimed at strengthening the national family planning programme. The Ministry of Health is developing a Five-Year Plan that includes the provision of integrated family planning services. This strategy document provides a framework for these and other inputs; which comprise that the national programme; and which will help ensure that all efforts contribute in an efficient and complementary manner to the achievement of programme goals. Above all; the strategy charts a course into the future directed towards challenging yet achievable goals and objectives. It also serves as a guide for decision-makers; planners and implementors as they strive to make full use of the resources available to develop an expanded; sustainable national family planning programme. The national family planning strategy has been developed in consultation with health and family planning workers from the Ministry of Health (MOH) and the Zimbabwe National Family Planning Council (ZNFPC) at all levels of the system; from community-level workers to district; provincial and national service providers; managers and leaders