Sexual; Reproductive Health Needs and Rights of Young People with Perinatally Acquired HIV in Uganda

Background: Numbers of young people with perinatally acquired HIV is growing significantly. With antiretroviral drugs; children who get infected at birth with HIV have an opportunity to graduate into adolescence and adulthood. This achievement notwithstanding; new challenges have emerged in their care and support needs. The most dynamic being; their sexual and reproductive health needs and rights (SRHR). Objectives: This paper aimed at establishing the gaps at policy; program and health systems level as far as addressing sexual and reproductive health needs of young people who have lived with HIV since infancy is concerned. Methods: This paper is based on a desk review of existing literature on sexual and reproductive health needs and rights of young positives. Results: The results indicate young positives are sexually active and are engaging in risky sexual encounters. Yet; existing policies; programs and services are inadequate in responding to their sexual and reproductive health needs and rights. Conclusion: Against these findings; it is important; that policies specifically targeting this subgroup are formulated and to make sure that such policies result in programs and services that are youth friendly. It is also important that integration of Sexual Reproductive Health (SRH) and HIV services is prioritized

Promoting and prioritising reproductive health commodities: understanding the emergency contraception value chain in South Africa

Use of emergency contraception is low in South Africa despite high rates of unplanned and unwanted pregnancies. Existing studies have demonstrated that women access emergency contraception from commercial pharmacies rather than from public health facilities at no charge. Research has also demonstrated that awareness of emergency contraception is a key barrier to improving uptake, especially in the public health sector. This study investigates the low use of emergency contraception in South Africa and employs a qualitative value chain analysis to explore the role of market and regulatory structures in creating an enabling environment for the supply and promotion of emergency contraception. The results suggest that there are several 'market imperfections' and information barriers impacting on the effective supply of emergency contraception to women who are dependent on the public health sector for their health care. Balancing commercial interests with reproductive health needs, it is argued, may form a crucial part of the solution to the low uptake of emergency contraception in South Africa (Afr J Reprod Health 2010; 14[1]:9-20)

Cultural and ethical challenges of assisted reproductive technologies in the management of infertility among the yoruba of southwestern Nigeria

This paper discusses the cultural and ethical issues arising from the use of Assisted Reproductive Health Technologies. Twenty-five In-depth interviews were conducted with 5 couples of reproductive age who have never conceived or brought pregnancy to term after one year of unprotected intercourse, 4 adult males, 4 adult females, a gyneacologist, a nurse, a herbalist and 2 religious leaders in Ibadan, Nigeria. Content analysis was used for data analysis. Legitimacy of children born through ART, religious obligation, patriarchy, polygamy and value of children are cultural issues surrounding ARTs while decision making about it, discrimination against children born through ART, psychological problems and loss of self esteem, side effects of the technologies and the cost of accessing them are the ethical challenges. The findings have methodological implications for conducting infertility research in non-western societies. (Afr. J. Reprod. Health 2010; 14[2]: 115-127)

The society of gynaecology and obstetrics of Nigeria (SOGON) plan for sustainable reduction in maternal mortality: a review

In the year 2000, SOGON formulated a strategic plan on women's health based on the reproductive health approach with the aim of reducing maternal mortality by 50% by the year 2010. In 2005, the Nigerian Road Map for accelerating the attainment of Millennium Development Goals 4 and 5 was launched. One of the key guiding principles of the Road Map was promoting partnerships and joint programming among stakeholders including professional associations. In response, SOGON decided to align her strategic plan with the Road Map by refocusing the plan to the key objectives of the Road Map. The new SOGON Plan involves interventions with a focal objective of reducing the case-fatality of emergency obstetric conditions. The plan is anchored on interventions where SOGON has comparative advantage such as providing human resources and promoting capacity building for emergency obstetric care and skilled attendance at delivery, and advocacy and information dissemination on maternal health (Afr. J. Reprod. Health 2010; 14[2]: 139-147)

Menstruation and menstrual hygiene amongst adolescent school girls in Kano, Northwestern Nigeria

This study examined the knowledge and practices of adolescent school girls in Kano, Nigeria around menstruation and menstrual hygiene. Data was collected quantitatively and analyzed using Epi info version 3.2.05. The mean age of the students was 14.4 ± 1.2 years; majority was in their mid adolescence. The students attained menarche at 12.9 ± 0.8 years. Majority had fair knowledge of menstruation, although deficient in specific knowledge areas. Most of them used sanitary pads as absorbent during their last menses; changed menstrual dressings about 1-5 times per day; and three-quarter increased the frequency of bathing. Institutionalizing sexuality education in Nigerian schools; developing and disseminating sensitive adolescent reproductive health massages targeted at both parents and their adolescent children; and improving access of the adolescents to youth friendly services are veritable means of meeting the adolescent reproductive health needs in Nigeria (Afr. J. Reprod. Health 2010; 14[3]: 201-207)

Factors that influence male involvement in sexual and reproductive health in Western Kenya: a qualitative study

This study explored factors that influence male involvement in reproductive health in western Kenya. Qualitative study design was used. From December 2008 to February 2009, data were collected via in-depth interviews and focus group discussions (FGDs) at three provinces of western Kenya. Twelve in-depth interviews and eight FGDs were conducted. Five participants in in-depth interviews were female, seven were male. Four of the FGDs had all-male participants, four all-female. The factors that influence male involvement in reproductive health emerged in two themes, namely gender norms and the traditional approaches used to implement reproductive health and family planning programs. Any strategy taken to involve men in reproductive health must therefore consider addressing these two factors. A review of the traditional approaches of implementing reproductive health is necessary to make them more male-friendly (Afr J Reprod Health 2010; 14[4]: 33-43)

Influence of independent and proximate variables on condom use in selected states in Nigeria

The study examined the influence of individual and proximate factors in determining condom use. Current use of condom and condom use during last sex were used as proxies for consistent condom use. Data on 3,797 sexually active respondents of reproductive age was analyzed from the 2007 USAID-COMPASS midline evaluation on basic family planning and reproductive health outcomes in five Nigerian states. About 9% of respondents were current users, while 11% used a condom during last sex. Younger and more educated respondents were more likely to report condom use. Of the 23 variables, four were statistically significant (p<0.05) in predicting current use for females, and five for males; six were statistically significant in predicting condom use during last sex for females and seven for males. The paper concluded that understanding the determinants and predictors of condom use is critical to improving family planning and reproductive health indicators in Nigeria (Afr J Reprod Health 2010; 14[4]: 53-62)

Assessing the importance of gender roles in couples' home-based sexual health services in Malawi

To more effectively address individuals' and couples' sexual and reproductive health needs, innovative service delivery strategies are being explored. These strategies are logistically and ethically complicated, considering prevailing gender inequalities in many contexts. We conducted an exploratory study to assess the acceptability of couples' home-based sexual health services in Malawi. We collected qualitative data from six focus group discussions and 10 husband-wife indepth interviews to gain a more thorough understanding of how gender norms influence acceptability of couples' sexual health services. Findings reveal that women are expected to defer to their husbands and may avoid conflict through covert contraceptive use and non-disclosure of HIV status. Many men felt that accessing sexual health services is stigmatizing, causing some to avoid services or to rely on informal information sources. Gender norms and attitudes toward existing services differentially impact men and women in this setting, influencing the perceived benefits of couples' sexual health services (Afr J Reprod Health 2010; 14[4]: 63-73)

Family planning, abortion, and HIV in ghanaian print media: a 15-month content analysis of a national ghanaian newspaper

This study assessed coverage of Reproductive Health (RH) issues­family planning (FP), abortion, and HIV­in the Ghanaian Daily Graphic newspaper. Using the composite week sampling technique, the researcher analyzed the contents of 62 editions of the paper. Prominence was measured using various attributes, and differences in mean coverage over time were assessed using analysis of variance. This review shows that coverage of RH issues was extraordinarily poor, less than 1 percent each for FP, abortion, and HIV. RH news that was covered was given little prominence. These findings support the popular impression that the Daily Graphic does not give priority to reproductive health issues in its coverage. RH advocates need to develop innovative means of integrating RH content into existing media outlets. (Afr J Reprod Health 2010; 14[4]: 83-89)

Population and reproductive health in national adaptation programmes of action (NAPAs) for climate change in Africa

This paper reviews 44 National Adaptation Programmes of Action (NAPAs) to assess the NAPA process and identify the range of interventions included in countries' priority adaptation actions and highlight how population issues and reproductive health/family planning (RH/FP) are addressed as part of the adaptation agenda. A majority of the 44 NAPAs identify rapid population growth as a key component of vulnerability to climate change impacts. However, few chose to prioritise NAPA funds for family planning/reproductive health programmes. The paper emphasizes the need to translate the recognition of population pressure as a factor related to countries' ability to adapt to climate change into relevant project activities. Such projects should include access to RH/FP, in addition to other strategies such as girls education and women's empowerment that lead to lower fertility. Attention to population and integrated strategies should be central and aligned to longer-term national adaptation plans and strategies (Afr J Reprod Health 2010; 14[4]: 133-145)

Utilization of antenatal care services among teenagers in Ethiopia: a cross sectional study

Background: Teenaged women suffer from a disproportionate share of reproductive health problem. The purpose of this study was to estimate the utilization of antenatal care (ANC) services among teenagers (13-19 years) during delivery in Ethiopia. Methodology: Raw data collected from all part of the country on child bearing aged women using stratified cluster sampling method by the Ethiopian Demographic Health Survey 2005 was used. From the large dataset of women; a total of 994 teenage women at the time of their most recent childbirth five years prior to the survey was selected and analyzed. Both bivariate and multivariate analyses were performed to determine the differentials of ANC by explanatory variables. Result: Most (60) of the subjects were in the age group between 18 and 19 years. The vast majority (90) was from the rural settings and most (87) were in marital union. Almost three out of four (72.4) of those who had given birth has no any form of formal education. Over a quarter (27.3) of most recent childbirths had at least one ANC service; of this; 21had started their first antenatal visit in the first trimester of pregnancy. The majority (80.4) of the women who attended ANC delivered at home without being assisted. The major deriving factors for the utilization of ANC service were education level of women and their male partners; better wealth index and urban residence. Conclusion: Education of partners; rich wealth index and urban residence seemed to encourage teenagers to utilize ANC. Appropriate interventions targeting teenaged women with poor socioeconomic status is recommended with more emphasis on the rural underserved segment of population. [Ethiop. J. Health Dev. 2010;24(3):221-225]

Family Life and HIV/AIDS Education (FLHE) in schools in Enugu State: baseline study of reproductive health issues among in-school adolescents in Enugu State

We studied the sexual and reproductive health (SRH) knowledge and practices among junior secondary school grades 1 and 3 students Enugu State; preparatory to incorporating family life and HIV/AIDS education (FLHE) into the school curricula in the state. Results show that over 90of the respondents were regularly involved in sexual activities. More than seventeen per cent (17.5) indicated that they would definitely have sex in the next two years while 19.2may have sex in the next two years. The students lacked proper knowledge of protection and knowledge scores on SRH issues was low especially among the urban dwellers (p0.001). Some respondents (64.4) did not know if condoms prevent pregnancy. Some indicated that charms and herbs are effective ways of preventing pregnancy. Against this background; the opinion leaders and community members welcome the FLHE for improving youth knowledge on SRH issues and pledge their support for the programme

Reproductive Health Knowledge and Attitude among Adolescents: a Community Based Study in Jimma Town; Southwest Ethiopia

Background: Adolescents often lack basic reproductive health RH information; knowledge; and access to health services for RH. Many have less than favorable attitudes and do not feel comfortable to discuss RH with parents or other key adults. Objectives: To assess RH knowledge; attitude and provider preference among adolescents of age 15 to 19 years. Methods: A community-based cross-sectional study was conducted in Jimma Town; Southwest Ethiopia from February to March 2004. A structured questionnaire was utilized to collect data from the sampled population. Adolescents aged between 15 to 19 years old were interviewed about their knowledge and attitudes regarding health services for RH. The data were entered into two different computers using SPSS for windows version 12.0.1 and analyzed using STATA 9.1. Descriptive and bivariate analyses using t-test were employed to depict results. Results: The majority of adolescents knew major health services for RH and the main health service providers of RH. The major sources of information for RH were radio for 80.4and television for 73and school teachers for 71.8of respondents. The overall mean score indices of knowledge for health services of RH; health services providers and source of information were 3.44; 3.78 and 4.68 respectively. The average index score of attitude for health services of RH was also moderately favorable (2.98). Conclusion: The level of knowledge and attitude about health services for RH; source of information for these services and service provider centers is encouraging. However; the role of health professionals and families as the source of information for the adolescents seems to be low. This should be improved using a more integrated all stakeholders particularly adolescents' families and health professionals who have a vital role to ensure adequate knowledge and favorable attitudes for utilization of the RH in the locality.http://indexmedicus.afro.who.int/iah/fulltext/EJHD/vol 22 n3/Reproductive health 243-251.pdf

The Quality and use of Maternal Health Care in Oyam District; Uganda: a Baseline Survey for an Intervention

Despite the availability of technically sound approaches; maternal mortality and other reproductive health problems persist in Uganda and other developing countries. Utilisation of maternal health services remains very low; especially delivery attended by skilled birth attendants. In Oyam and other Ugandan districts smarting out of prolonged insurgency; reproductive health services are generally poorly utilised. Doctors with Africa-CUAMM; an Italian NGO; together with other partners and with funding from the EU; initiated a programme intended to improve the uptake and quality of repro- ductive health services in Oyam District. A baseline study was conducted in 2008 to document the initial pattern of use and quality of the existing maternal healthcare services in order to generate baseline data against which the performance of the programme will be evaluated. Its objectives were to establish the level of utilisation of maternal healthcare; the factors underlying mothers' health-seeking behaviour; the quality of maternal healthcare services; and to describe the outcome of pregnancies carried within the previous 5 years. The study had three major components: a household survey (1472 households); a survey of community resource persons (30 TBAs; and 9 senior women leaders); and a health facilities survey (1 hospital; 1 HC IV; and 5 HC IIIs). Government-owned facilities were the most prevalent and most utilised (by 84.7). The median age of the mothers at the last pregnancy was 24 years and by that age; most mothers had had 3 pregnancies. At the first onset of labour; most women consulted an untrained friend or relative; and TBAs due to proximity. Overall; 41of the deliveries in the district take place in health facilities; and 44at the TBAs but 3.2are not attended to. PNC services are not well utilised despite high levels of awareness of the presence and utility of the services (by 73). Most mothers utilize injectable hormonal contraceptives and natural methods. Resistance from spouses and perceived negative effects of FP methods are major hindrances to FP utilisation. Over 90of the pregnancies had a positive outcome for the mother and child. The study recommends focusing on quality improvement through implementation of the standard package of reproductive health services and support supervision

Immigrants' and Refugees' Unmet Reproductive Health Demands in Botswana: Perceptions of Public Health Providers

Background: The health care of Botswana (citizens of Botswana) as indicated in the country's VISION 2016 is uppermost in the priorities of Government of Botswana; yet Botswana's National Health Policy; the Immigration Policy; and the National Sexual and Reproductive Health Programme Framework all are silent on the obligations of the government for providing health services for the immigrant and refugees population. In view of the high prevalence of HIV/AIDS in Botswana; South Africa and other sub-Saharan countries; it is critical that reproductive health services be as affordable and accessible for this population as they are for others in Botswana. This study; therefore; has measured the views of the primary health care providers in Botswana on the perceived reproductive health needs of immigrants and refugees; the availability and accessibility of reproductive health care services to the immigrant and refugee population in the country. This information will be necessary for policy makers; Government of Botswana and the private sector to shape interventions measures to assist immigrants and refugees seek and access their desired reproductive health services. Methods: The study targeted all the 4; 667 medical doctors and nurses who were serving in various hospitals and clinics in 23 health districts of Botswana at the time of this study. Using NCS Pearson statistical software; the sample size for the study was determined to be 851. This estimated sample size was allocated to the 23 health districts (strata) using probability proportional to size (PPS). Having obtained the sample size for each district; the health providers to be interviewed from each health district were selected randomly and in proportion to the number of doctors and nurses in each district. Questionnaires were administered to these health providers by research assistants; who explained the purpose of the study and obtained informed consent. The questionnaires were coded to ensure anonymity of the respondents. The questionnaire contained questions about the health care providers' demographic characteristics; their opinions on the reproductive health needs of immigrants and refugees; and their views on factors that influence accessibility of these services to immigrants and refugees. The fieldwork ended collecting data from 678 doctors and nurses (about 80of the targeted sample). Results: Majority of the health providers indicated that the most important reproductive health needs of the immigrants and refugees; namely; pregnancy related (Prenatal; Obstetrics; Postnatal conditions); STI treatment; HIV/AIDS treatment and counseling; and family planning were not different from those of the locals. However; some major differences noted between the local population and the foreigners were (i) that ARV treatments and PMTCT were never accessible to the non-citizens; (ii) that while treatments and other health services were free to Batswana (citizens of Botswana); a fee was charged to non-citizens. Although 86of the 21 studied reproductive health services were available in the health care system more than 50of the time; only 62of them could be accessible to the immigrants and refugees 50of the times. The major reasons for inability to access these services were: (i) The immigrants and refugees have to pay higher fees to access the reproductive health services (ii) Once an immigrant or refugee is identified as HIV positive; there are no further follow-ups on the patient such as detecting the immune status using CD4 count or testing the viral load (iii) The immigrants and refugees do not have referral rights to referral clinics/ hospitals for follow- ups in case of certain health conditions (iv) The immigrants and refugees are required to enlist in the Medical Aids scheme which can help offset part of the costs for the desired services. Conclusions: The study recommended an improved availability of reproductive health services to the immigrants and refugees and the expunging of laws and practices which made it difficult for immigrants and refugees to access the available reproductive health services

From HIV Prevention to Reproductive Health Choices: HIV/AIDS Treatment Guidelines for Women of Reproductive Age

In South Africa; the private sector has responded to the HIV epidemic by providing treatment in the form of highly active antiretroviral therapy (HAART). The private sector has paved the way for policy and treatment regimens; while the public sector has reviewed health-systems capacity and the political will to provide treatment. The paradigm of prevention of mother-to-child transmission of HIV (PMTCT) has led the way as a clear evidenced-based method of treatment and prevention in South Africa. In sub-Saharan Africa; the HIV epidemic is feminised as a growing proportion of infections occurs among women or affects women. While access to HIV treatment has been contested in South Africa; women's sexual and reproductive health has been neglected. This paper is a reflection and critical review of current practice. Many HIV-positive women desire to choose to have a child; while the best choice of contraception for women on HAART is not well understood. In some areas there are reports of women being forced to accept injectable contraceptives. Some women who learn of their HIV-positive status during pregnancy may want to choose to terminate their pregnancy. There is a clear absence of HIV/AIDS-treatment guidelines for women of reproductive age; including options for HAART and options regarding fertility intentions. A range of other sexual and reproductive health areas (relevant to both the public and private health sectors) are neglected; these include depression and anxiety; violence against women; HIV-testing practices; screening for cervical cancer; and vaccination. Given the narrow focus of HAART; it is important to expand HIV treatment conceptually; by applying a broader view of the needs of working women (and men); and so contribute to better HIV prevention and treatment practices. There is a need to move from an HIV/AIDS-care maternal-health paradigm to one that embraces women's sexual and reproductive health and rights

Reproductive Health Knowledge and Practices among Junior Secondary School Grade one Students in Enugu State: Threat to Achieving Millennium Development Goals in Nigeria

Objective: This was designed to provide background information for the implementation of family life and HIV/AIDS education in post primary schools in the Enugu State. Methods: A cross sectional survey of the reproductive health knowledge and practices of 412 junior secondary school pupils from 12 schools in Enugu State; Nigeria was undertaken using a uniform set of structured self-administered questionnaire. Results: The results revealed that while the pupils demonstrated fair knowledge of human biology; they lacked knowledge of selfprotective mechanisms as it related to sexual health. About (50) of the participants reported that they have had sex; at the age of less than 11 years when they must have been in the primary school and most (89.3) at age 11-14 years. Half (50.9) of the respondents hold the belief that a girl would not get pregnant in her first sexual encounter. Statistically more of those who have ever had sex were betrayed this ignorance (p=0.004). The boys were less certain about what constitutes the wrong ideas about reproductive health systems than the girls (p=0.042). In the same vein; there was a difference (p0.0001) in the proportion of the rural residents; vis-a-vis their urban counterparts that could correctly identify the wrong ideas about human reproduction. Conclusion: This situation urgently calls for concerted efforts at addressing the poor reproductive health knowledge of these sexually active young people; for the millennium development goals (MDGs) target to be realized in Nigeria

Qualite de la prevention du paludisme au cours des consultations prenatales a Niakhar (Senegal)

Introduction : Pour evaluer la qualite de la prevention du paludisme lors des consultations prenatales; cette etude a ete effectuee a Niakhar; une sous-prefecture de la region de Fatick. Methode : Il s'agissait d'une etude transversale descriptive; basee sur l'ecoute et l'observation de 60 consultations prenatales (CPN) effectuees dans trois postes de sante. Les variables d'etude portaient sur les criteres d'une bonne qualite de prophylaxie a trois niveaux : interrogatoire; examen; et conduite a tenir. Resultats : L'interro- gatoire etait axee; par ordre de frequence; sur : les antecedents de grossesses (65); la prise de la chloroquine (34;3); la notion de fievre (6); et les effets secondaires de la chloroquine (3). Lors de l'examen physique; tous les prestataires ont recherche l'anemie; la tension arterielle; et les odemes des membres inferieurs ; mais seuls 8;6d'entre eux ont pris la temperature. Apres la consultation; la prescription de chimio prophylaxie et la date de la prochaine consultation ont ete systematiques ; la duree de la prise rappelee dans 57et la gravite du paludisme pendant la grossesse dans 3des cas ; aucun prestataire n'a evoque les modalites de la prise; ni la conduite a tenir en cas de fievre. Conclusion : La prevention du paludisme gravidique a travers les CPN necessite une formation appropriee et une supervision reguliere des postes de sante

Sexual Behaviour and Reproductive Health Among Female Senior Secondary School Students in Abakaliki LGA; Ebonyi State

Objective: To investigate the sexual behaviour and reproductive health amongst female senior secondary school students. Methods: Using cross-sectional descriptive study 374 students were studied. Information was collected on their sexual behaviours; knowledge of sexually transmitted infections (STIs); prevalence of induced abortion and knowledge of health consequences of these practices. Results: Of the 81 (21.7) sexually active students; pressure from friends in 24.7; and desire for sex in 23.5were the commonest reasons for having sex. The modal age at debut sexual encounter was 15 - 19 years. Condom use was reported in 58: this was neither associated with age; class nor knowledge of STIs. Knowledge of sexually transmitted infections; including HIV was reported by 43.9: this was not influenced by age or class. There was also no association between ever having had sex and knowledge of STIs. However; there was a statistically significant association between knowledge of STIs and both mother's (p

Female Genital Mutilation : Psychological and Reproductive Health Consequences. The Case of Kayoro Traditional Area in Ghana

The study examined the reproductive health and psychological effects of female genital mutilation; in one traditional area in the Upper East region (i.e. Kayoro Traditional Area) of Ghana. The results of the study revealed that; the practice of FGM actually affects the physical (deforming the female genitalia); psychological (the mental torture due to pain experienced during the circumcision and also the fear of the unknown which includes medical examination which will involve touching of the genitalia as well as sexual intercourse); and the reproductive health consequences ranging from various forms; including immediate complications such as bleeding; sepsis; and to later complications such as child birth complications and even death. Recommendations were made to the public; policy makers and NGOs with the aim of reducing and if possible eradicate the practice