Unsafe abortion - A Risk factor for maternal mortality in Liberia - An analysis of the characteristics of unsafe abortion clients and risk factors for maternal morbidity and mortality.

Worldwide, an estimated 68,000 women die yearly due to unsafe abortion practices. In Liberia, the maternal mortality ratio is 1072 deaths per 100,000 live births. However, there has not been a study conducted to understand the relationship between unsafe abortion and maternal mortality. We conducted a retrospective cohort study at three county hospitals and assessed obstetric data gathered using a defined questionnaire in 2016 - 2018, from maternal-child health units. The results of the study suggest a strong association between unsafe abortion and maternal morbidity and mortality and also provide insight into the characteristics and factors that put women and girls who have unsafe abortions at risk. The results can inform programs and policies on age disaggregation of women and girls who choose abortion. The variation in the association between unsafe abortion and the risk factors, have implications for maternal morbidity and mortality.

Are modern contraceptives acceptable to people and where do they source them from across Nigeria?

BACKGROUND: Understanding the extent that different modern contraceptives are acceptable to different populations groups and where they get the commodities from will help in developing specific interventions that will help to scale-up the availability of the contraceptives. METHODS: The study took place in urban and rural sites in six states across Nigeria. Data on acceptability and sources of the contraceptives was collected from at least 770 randomly selected mostly female householders from each state respectively using a questionnaire. Acceptability of the different contraceptives was scored by the respondents on a scale of 1 (lowest) to 10 (highest). The relationships between acceptability and sources of the contraceptives with socio-economic status and geographic location of the respondents were examined. RESULTS: The use of modern contraceptives in general was acceptable to 87% of the respondents. Male condom was the most acceptable means of contraceptive with an average score of 5.0. It was followed by implants with and oral contraceptive pill with average scores of 4.0, whilst IUD was the least acceptable with an average score of 2.9. The private sector was the major source of contraceptives to different population groups. Both male and female condoms were mostly procured from patent medicine dealers (PMD) and pharmacy shops. Intra Uterine Devices (IUDs) and implants were mostly sourced from public and private hospitals in the urban areas, whilst injectibles were mostly sourced from private hospitals. Oral contraceptives were mostly sourced from pharmacy shops and patent medicine dealers. There were SES and geographic differences for both acceptability and sources of the contraceptives. Also, the sources of different contraceptives depended on the type of the contraceptive. CONCLUSION: The different contraceptives were acceptable to the respondents and the major source of the contraceptives was the private sector. Hence, public-private partnership arrangements should be explored so that universal coverage with contraceptives could be easily achieved. Interventions should be developed to eliminate the inequities in both acceptability and sources of different contraceptives. The acceptability of all the contraceptives should be enhanced with relevant behaviour change communication interventions especially in areas with the lowest levels of acceptability.

Increasing access to modern contraceptives: the potential role of community solidarity through altruistic contributions.

BACKGROUND: There is an urgent need for universal access to modern contraceptives in Nigeria, to facilitate the achievement of the Millennium Development Goals and other national goals. This study provides information on the potential role of community solidarity in increasing access to contraceptives for the most-poor people through exploration of the role of altruism by determining level of altruistic willingness to pay (WTP) for modern contraceptives across different geographic contexts in Nigeria. METHODS: It was a cross-sectional national survey which took place in six states spread across the six-geopolitical zones of the country. In each state, an urban and a rural area were selected for the study, giving a total of 6 urban and 6 rural sites. A pre-tested interviewer-administered questionnaire was used to collect information from at least 720 randomly selected householders from each state. The targeted respondent in a household was a female primary care giver of child bearing age (usually the wives), or in her absence, another female household member of child bearing age. A scenario on altruistic WTP was presented before the value was elicited using a binary with open-ended follow-up question format. Test of validity of elicited altruistic WTP was undertaken using Tobit regression. FINDINGS: More than 50 % of the respondents across all the states were willing to contribute some money so that the very poor would be provided with modern contraceptives. The average amount of money that people were willing to contribute annually was 650 Naira (US$4.5). Mean altruistic WTP differed across SES quintiles and urban-rural divide (p < .01). Multiple regression analysis showed that age was negatively related to altruistic WTP (p < 0.05). However, years of schooling, being employed by government or being a big business person, prior experience of paying for contraceptives and socioeconomic status had statistically significant effects on altruistic WTP (p < 0.05). CONCLUSION: There is room for community solidarity to ensure that the very poor benefit from modern contraceptives and assure universal coverage with modern contraceptives. The factors that determine altruistic WTP should be harnessed to ensure that altruistic contributions are actually made. The challenge will be how to collect and pool the altruistic contributions for purchasing and delivering modern contraceptives to the most-poor, within the context of community financing.

Trends in HIV infection: prevention-related attitudes and behaviors among secondary school students in western Uganda.

OBJECTIVE: To monitor trends in the attitudes and behaviors of youth in western Uganda with respect to prevention of HIV/AIDS. DESIGN: Annual data collection in a group of sentinel secondary schools in 3 districts using a short, self-administered, and anonymous questionnaire. METHODS: Fifteen secondary schools were randomly selected, and a cross-sectional survey of students was carried out each year between 1995 and 2001. All students from S (senior level) 2 to S4 were invited to complete the questionnaire. For data analysis, all completed questionnaires of students between the ages of 12 and 20 years were considered. RESULTS: In total, 6 surveys were carried out yielding 6231 valid questionnaires. Ever use of condoms among sexually active youth increased significantly from 48.8% in 1995 to 1996 to 72.8% in 2000 to 2001. Male students were more likely to report increased sexual abstinence during the time period than female students. Conversely, female students over the same time period reported having fewer sexual partners than male students. The number of sexually active students reporting sexual intercourse in the past 3 months remained the same. CONCLUSIONS: These data show that significant positive changes in the sexual behavior of secondary school students in western Uganda have occurred. This could explain, in part, the decline of HIV prevalence rates among young people observed in this region.

Reproductive health behaviour among in-school and out-of-school youth in Kabarole District, Uganda.

This study was conducted to elucidate whether in-school adolescents have sexual behavioural patterns that differ from those of out-of-school adolescents. A total of 300 in-school and 256 out-of-school adolescents were interviewed. Condom use was significantly higher among in-school than out-of-school adolescents. In-school adolescents had fewer sexual partners in the previous year and had started sexual activities at a later age than out-of-school adolescents. In-school adolescents were more likely to have used modern contraceptive in the past than out-of-school adolescents. We conclude that out-of-school adolescents are less likely to practice safe sex and to use modern family planning methods than in-school adolescents. This indicates the need to provide more information to this group of adolescents. They are traditionally neglected in favour of in-school adolescents, who have greater access to information.