Early removal of etonogestrel subcutaneous contraceptive implant at a community health centre in Pretoria

The etonogestrel subcutaneous contraceptive implant offers efficacy for three years, but some women remove it earlier than prescribed. This study discusses factors associated with the early removal of these implants at a Pretoria community health centre between 01January 2020 to 30 June 2020.Methods: A cross-sectional study using a piloted and researcher assistant-administered questionnaire.Results: Of the 124 participants who removed their etonogestrel subcutaneous contraceptive implant earlier than prescribed, most were single, unemployed, in the age group 30­39 years, Christian, with secondary level education and with parity one or more. Etonogestrel subcutaneous contraceptive implant pre-insertion counselling was given to all participants, most of whom had not previously used contraceptives. Those participants with previous contraceptive use had used injectables. Long-term contraception was the main reason for getting the etonogestrel subcutaneous contraceptive implant. Most participants did not attend post-insertion counselling. Heavy bleeding was the most common side effect and reason for early removal. Fifty-one participants kept the etonogestrel subcutaneous contraceptive implant in for a longer period of 12­23 months. From participants' responses, it seems that Etonogestrel implants may be offered from as early as 15­20 years of age. Conclusion: Women having etonogestrel subcutaneous contraceptive implants removed early at a Pretoria community health centre tended to be young, single, unemployed, Christian, with a secondary level education and with parity one or more. All participants attended the etonogestrel subcutaneous contraceptive implant pre-insertion counselling services but not the post-counselling services. Heavy bleeding was the main reason for the early removal of the etonogestrel subcutaneous contraceptive implant.Keywords: early removal; etonogestrel; subcutaneous contraceptive; implant; Pretoria; community health centre; weight gain; vaginal bleeding.

Survey on attitude to sexually transmitted disease testing among physicians in community health service centers of 20 cities in China / 中华全科医师杂志

Objective To survey the attitude to sexually transmitted disease(STD)testing among physicians in community health service centers(CHC)of 20 cities in China.Methods A cross-sectional survey using stratified random sample was conducted in September to December 2015, among 1 734 physicians from 158 CHCs in 20 cities of 6 provinces and 2 municipalities.Results The average age of participants was(39.7 ±10.6)years, the time for present position was(15.8 ±11.5)years, and 47.0%(799/1 700)were general practitioners(GPs).The survey showed that in the last month,8.1%(138/1 699)of the physicians contacted with the specific population of STD(sex worker,MSM,drug user, etc), and 18.3%(313/1 706)of them managed STD patients or provided services to suspected STD patients;62.0%(1 048/1 689)of them received the STD-related training previously;46.5%(784/1 686) thought the lack of training in STD testing as the biggest barrier for carrying out STD testing in CHC.As for the specific populations, 73.4%(1 241/1 692)of physicians thought that it was meaningful, 62.0%(1 043/1 683)of them worried about"have difficulty to deal with their STD clinically", and only 5.8%(97/1 683)of them expressed their"dislike of specific population".Conclusions Most physicians in CHCs believe that STD testing should be included in the routine tests, and it is feasible to carry out STD testing in CHCs.Lack of training is the main barrier for STD testing, so it is necessary to conduct STD testing related trainings in CHCs.

Challenges to the implementation of the integrated management of childhood illness (IMCI) at community health centres in West Java province, Indonesia.

Background: The integrated management of childhood illness (IMCI) is a comprehensive approach to child health, which has been adopted in Indonesia since 1997. This study aims to provide an overview of IMCI implementation at community health centres (puskesmas) in West Java province, Indonesia. Methods: Data were derived from a cross-sectional study conducted in 10 districts of West Java province, from November to December 2012. Semi-structured interviews were used to obtain information from staff at 80 puskesmas, including the heads (80 informants), pharmacy staff (79 informants) and midwives/nurses trained in IMCI (148 informants), using semi-structured interviews. Quantitative data were analysed using frequency tabulations and qualitative data were analysed by identifying themes that emerged in informants’ responses. Results: Almost all (N = 79) puskesmas implemented the IMCI strategy; however, only 64% applied it to all visiting children. Several barriers to IMCI implementation were identified, including shortage of health workers trained in IMCI (only 43% of puskesmas had all health workers in the child care unit trained in IMCI and 40% of puskesmas conducted on-the-job training). Only 19% of puskesmas had all the essential drugs and equipment for IMCI. Nearly all health workers acknowledged the importance of IMCI in their routine services and very few did not perceive its benefits. Lack of supervision from district health office staff and low community awareness regarding the importance of IMCI were reported. Complaints received from patients’ families were generally related to the long duration of treatment and no administration of medication after physical examination. Conclusion: Interventions aiming to create local regulations endorsing IMCI implementation; promoting monitoring and supervision; encouraging on-the-job training for health workers; and strengthening training programmes, counselling and other promotional activities are important for promoting IMCI implementation in West Java province, and are also likely to be useful elsewhere in the country.