ABSTRACT
OBJECTIVE: In 2003-2004 and 2007-2008, an initiative was implemented to improve client and provider knowledge and acceptance of no-scalpel vasectomy (NSV) in Ghana. METHODS: At eight facilities, physicians were trained in NSV and staff received training in the provision of "male-friendly" services. Health promotion activities provided NSV information to prospective clients. Client-provider communication was assessed via a mystery client study (n=6). Knowledge and acceptance of NSV among potential clients were assessed with baseline and follow-up surveys (each n=200) in 2003-2004 and three follow-up panel surveys in 2008 (each n=240). RESULTS: Trained health staff exhibited improved attitudes and knowledge regarding NSV. Mystery clients reported receiving accurate, nonjudgmental NSV counseling. Awareness of NSV among panel respondents doubled from 31% to 59% in 2003-2004 and remained high (44%) in 2008. The proportion of men who would consider NSV increased from 10% to 19% in 2007-2008. NSV procedures increased three-fold from 2003 (n=26) to 2004 (n=83) and 2007 (n=18) to 2008 (n=53). CONCLUSION: Provider training in client-centered services, coupled with targeted health promotion, improved client and provider knowledge and acceptance of NSV in an African context. PRACTICE IMPLICATIONS: Complementary, sustained provider training and health promotion are needed to maintain NSV service quality and acceptance.
Subject(s)
Health Knowledge, Attitudes, Practice , Patient Acceptance of Health Care , Physician-Patient Relations , Vasectomy/methods , Communication , Follow-Up Studies , Ghana , Health Care Surveys , Health Personnel/education , Humans , Male , Reproductive Health Services/organization & administrationABSTRACT
Vasectomy is safer, simpler, less expensive, and equally as effective as female sterilization--yet it remains one of the least known and least used methods of contraception. Worldwide, an estimated 33 million of married women ages 15 to 49 (less than 3%) rely on their partner's vasectomy for contraception.
Subject(s)
Vasectomy/statistics & numerical data , Vasectomy/trends , Canada , Developing Countries , Forecasting , Humans , Male , Prevalence , United StatesSubject(s)
Family Planning Services/organization & administration , Sexual Behavior , Africa South of the Sahara , Child , Child Health Services/organization & administration , Contraceptive Agents/supply & distribution , Contraceptive Devices/supply & distribution , Family Planning Services/economics , Fertility , HIV Infections/epidemiology , Humans , Maternal Health Services/organization & administration , Population Growth , PovertyABSTRACT
BACKGROUND: Simple ligation of the vas with suture material and excision of a small vas segment is believed to be the most common vasectomy occlusion technique performed in low-resource settings. Ligation and excision (LE) is associated with a risk of occlusion and contraceptive failure which can be reduced by performing fascial interposition (FI) along with LE. Combining FI with intra luminal thermal cautery could be even more effective. The objective of this study was to determine the surgical vasectomy techniques currently used in five Asian countries and to evaluate the facilitating and limiting factors to introduction and assessment of FI and thermal cautery in these countries. METHODS: Between December 2003 and February 2004, 3 to 6 major vasectomy centers from Cambodia, Thailand, India, Nepal, and Bangladesh were visited and interviews with 5 to 11 key informants in each country were conducted. Vasectomy techniques performed in each center were observed. Vasectomy techniques using hand-held, battery-driven cautery devices and FI were demonstrated and performed under supervision by local providers. Information about interest and open-mindedness regarding the use of thermal cautery and/or FI was gathered. RESULTS: The use of vasectomy was marginal in Thailand and Cambodia. In India, Nepal, and Bangladesh, vasectomy was supported by national reproductive health programs. Most vasectomies were performed using the No-Scalpel Vasectomy (NSV) technique and simple LE. The addition of FI to LE, although largely known, was seldom performed. The main reasons reported were: 1) insufficient surgical skills, 2) time needed to perform the technique, and 3) technique not being mandatory according to country standards. Thermal cautery devices for vasectomy were not available in any selected countries. Pilot hands-on assessment showed that the technique could be safely and effectively performed by Asian providers. However, in addition to provision of supplies, introducing cautery with FI could be associated with the same barriers encountered when introducing FI in combination with LE. CONCLUSION: Further studies assessing the effectiveness, safety, and feasibility of implementation are needed before thermal cautery combined with FI is introduced in Asia on a large scale. Until thermal cautery is introduced in a country, vasectomy providers should practice LE with FI to maximize effectiveness of vasectomy procedure.
