Research capacity building through North-South-South networking: towards true partnership? An exploratory study of a network for scientific support in the field of sexual and reproductive health.

BACKGROUND: We explored the perceptions of members of the Network for Scientific Support in the field of Sexual and Reproductive Health (NetSRH) on North-South-South networking and on constraints and perspectives for South-led research. METHODS: An exploratory qualitative study was conducted 18 months after the network was launched. In-depth interviews were carried out with NetSRH members (n = 15) affiliated to southern research institutions. A thematic analysis was done and N-Vivo 10 software used. RESULTS: A number of barriers to South-led research were identified, the most important being a lack of time, resources and research skills, and donor influence for the choice of research topics. Although the level of technical skills, such as writing proposals and scientific papers, differed among NetSRH members, all welcomed additional research capacity building. All members have deplored the lack of research management skills such as project cycle management as well as how to communicate with and get funds from donor agencies. International (local or regional) donor agencies had their own agenda with a budget already reserved for other purposes, thus priorities identified by national researchers were less taken into consideration. Systemic dependencies on external funds lead southern research partners to respond to calls for proposals mostly initiated by partners from northern institutions, leaving limited leeway for local initiatives. Southern NetSRH members perceived coaching done by the northern partners in scientific writing positively. South-South collaboration was minimal within NetSRH at this stage of the project, mainly due to time and resources constraints. CONCLUSION: NetSRH members unanimously concluded that sustainable financing of southern research centres is a necessary condition for them to initiate their own research projects. We recommend reserving funds within the international donor agencies for South-led research in order to break the vicious circle of running behind money provided by northern donors, thereby missing out on time and resources for reviewing research gaps and/or conducting needs evaluations required to initiate relevant own research.

Covert contraceptive use among women attending a reproductive health clinic in a municipality in Ghana.

BACKGROUND: Covert contraceptive use (CCU) in sub-Saharan Africa is an indication of women's inability to exercise autonomy in their reproductive choices. The aim of this study was to assess the prevalence and determinants of CCU among a sample of FP clients in a municipality of Ghana. METHODS: We conducted a mixed method study among women attending a public reproductive health clinic in Sunyani, a city of over 250,000 inhabitants in Ghana. An initial survey inquired into sociodemographic characteristics, use of family planning (FP) methods and partner awareness of contraceptive use. The predictors of CCU were explored using logistic regressions. We used the findings to develop a guide which we applied in-depth interviews and focus group discussions with attendants at the same facility. Qualitative data analysis was conducted using a framework approach. RESULTS: We interviewed 300 women, 48 % of whom were aged between 26-33 years. The injectable was the most widely used method (56 %). The prevalence of CCU was 34 %. In multivariate analysis, single women were more likely to practice CCU than married or co-habiting women (Adjusted OR = 12.12, 95 % C.I. 4.73-31.1). Muslim and traditionalist women were similarly more likely to practice CCU than non-Muslim, non-traditionalist (Adjusted OR = 4.56, 2.29-9.06). Women who preferred to have their first or next child in 4 or more years from the time of the interview were more likely to be in CCU than women who intended to have children within 4 years of the interview (2.57; 1.37-4.83). Single women saw in covert use a statement of their social autonomy. To succeed in CCU, women wished that clinic attendance cards would not be given to them to keep at home. Though many participants saw in CCU a source of anxiety, they expected health workers to consider it and uphold confidentiality in the provision of services. CONCLUSIONS: Covert contraceptive use was high in this municipality and being single was the strongest predictor of the practice. Providers of FP services should reflect on how to adequately address the challenges faced by women who practice CCU.

Induced abortion among women attending antenatal clinics in Yaounde, Cameroon.

OBJECTIVES: Unsafe abortion is a public health concern because of its impact on maternal morbidity and mortality. The objective of this study was to document on induced abortion in Yaounde, Cameroon. DESIGN: Cross-sectional study. SETTING: Six antenatal clinics in Yaounde, Cameroon. METHODS: Women attending antenatal clinics between October and December 1998 were included in the study and interviewed. Nulliparous were women with no previous delivery and multiparous were defined as women who had at least one previous delivery. RESULTS: Out of the 1532 women, five hundred seventy-two were nulliparous and 960 were multiparous. Of the nulliparous women 17% reported a previous abortion ever; this proportion exceeded 35% in those over 24 years. For multiparous women, the proportion who reported an abortion (between the last birth and present pregnancy) was 22%. In multivariate analysis on the group of nulliparous women, older age, having used modern contraception and having spent more than two years in the city were significantly associated with induced abortion. In the multiparous group, older age, having a full time job and antenatal clinic were significantly associated with induced abortion. CONCLUSIONS: This study shows that induced abortion is a common practice in urban Cameroon. Because of restrictive laws, a substantial proportion of these abortions are likely to be unsafe, with the risk of associated complications. There is a need for expanded comprehensive sexual and reproductive health services.

Barriers to prenatal care in Europe.

BACKGROUND: In Europe, it is sometimes assumed that few barriers to prenatal care exist because extensive programs of health insurance and initiatives to promote participation in prenatal care have been established for many decades. METHODS: A case-control study was performed in ten European countries (Austria, Denmark, Germany, Greece, Hungary, Ireland, Italy, Portugal, Spain, and Sweden). Postpartum interviews were conducted between 1995 and 1996. A total of 1283 women with inadequate prenatal care (i.e., with 0, 1, or 2 prenatal care visits or a first prenatal care visit after 15 completed weeks of pregnancy) and 1280 controls with adequate prenatal care were included in the analysis combining data from the ten countries. RESULTS: Based on combined data of the ten countries, lack of health insurance was found to be an important risk factor for inadequate prenatal care (crude odds ratio [OR] at 95% confidence interval [CI]: 30.1 [20.1-47.1]). Women with inadequate prenatal care were more likely to be aged < 20 years (16.4% vs 4.8%) and with higher parity (number of children previously borne) than controls. They were more likely to be foreign nationals, unmarried, and with an unplanned pregnancy. Women with inadequate care were also more likely to have less education and no regular income. They had more difficulties dealing with health services organization and child care. Cultural and financial barriers were present, but after adjusting for confounders by logistic regression, perceived financial difficulty was not a significant factor for inadequate prenatal care (adjusted OR [95% CI]: 0.7 [0.4-1.3]). CONCLUSIONS: Personal, socioeconomic, organizational, and cultural barriers to prenatal care exist in Europe.

Disparity in prenatal care in Europe. Study group on barriers and incentives to prenatal care in Europe.

OBJECTIVE: The purpose of the study was to compare prenatal care attendance in European Union countries, Hungary and Norway. STUDY DESIGN: We analysed live births or deliveries from national registers in five countries, national surveys in five countries, and regional register or surveys in three countries. RESULTS: The frequency of no prenatal care was lower than 0.5% in 10 countries, 0.9% in Hungary, 2.1% in Greece and 2.6% in Portugal. Late prenatal care varied from 3.1% in Finland to 29.2% in Ireland. Late care among women with parity 4 and more varied from 7.7% in Finland to 41.5% in Hungary. Among women under 20 years old, late care varied from 11.8% in Finland to 39.5% in Portugal. The median number of prenatal visits varied from seven in Greece to 14 in Finland. CONCLUSION: Prenatal care attendance varies widely among European countries. Late attendance is frequent in many countries.

Prenatal care incentives in Europe. Study Group on Barriers and Incentives to Prenatal Care in Europe.

The purpose of the study was to identify prenatal care incentives and benefits in 17 European countries. All participating countries completed a questionnaire on their prenatal care delivery system, incentives and benefits. Results were analyzed according to their direct or indirect relationship with prenatal care attendance. Direct incentives require a prenatal care visit to be eligible for the benefit. Indirect incentives support the pregnant woman but do not require a prenatal care visit to be eligible for the benefit. All 17 countries offer direct incentives, such as paid maternity leave. In 9 countries, pregnant women receive direct financial incentives. Eleven countries offer indirect incentives, such as transportation benefits. Prenatal care incentives such as financial benefits and social supports are widespread in Europe. The combination of incentives superimposed upon an inclusive health care system create a supportive environment which encourages prenatal care attendance.

High birthweights among infants of north African immigrants in Belgium.

OBJECTIVES: This study examined birthweights of North African immigrants in Belgium. METHODS: Analyses focused on Belgian single live birth certificates from 1981 to 1988. RESULTS: Low-birthweight (< 2500 g) rates were 3.1% among 34,686 newborns of North African origin and 4.8% among 804,286 newborns of Belgian origin. The entire North African birthweight distribution was shifted toward higher birthweights than the Belgian distribution. Low frequencies of low birthweights among North Africans were still observed after marital status, occupation of the father, and parity had been taken into account. CONCLUSIONS: Despite their low socioeconomic status, North African immigrants have high birthweights.

Blastomyces dermatitidis and the adult respiratory distress syndrome. Case reports and review of the literature.

The adult respiratory distress syndrome (ARDS) developed in 2 patients with blastomycosis. In one, ARDS apparently followed the rupture of an infected subcarinal lymph node into a bronchus. Extensive involvement of alveoli with Blastomyces dermatitidis was noted at autopsy in both patients. Four additional cases of blastomycosis with definite or presumed ARDS are reviewed. The clinical course of these 6 patients was characterized by a prolonged prodrome (median, 36 days), consistent with pulmonary blastomycosis, and a rapid demise (median, 5 days) associated with ARDS.