RESUMO
INTRODUCTION: In Uganda, the proportion of women having another live birth before age 20 years (repeat adolescent birth) has not declined in 30 years. More women want to delay the next birth. We determined the prevalence and factors associated with postpartum contraceptive use among teenage mothers in Mbale City. PATIENTS AND METHODS: We conducted a cross-sectional study in all the six government-supported health facilities within Mbale City. Over a period of 3 months, 511 teenage mothers in the postpartum period were consecutively enrolled by midwives/nurses. Data were collected using a pretested interviewer-administered questionnaire. We used logistic regression in STATA version 14, to determine the association between various sociodemographic characteristics and utilization of contraception. We set the level of significance at 5% and report odds ratios and the corresponding 95% confidence intervals. RESULTS: Most of the respondents - 314/511 [61.5%, 95% CI= 57.1-65.6%] - were using contraceptives. More than three-fourth (238/314) of the respondents opted for short-term methods of contraception. In the adjusted analyses, intention to resume school [AOR 1.79 (1.16-2.74)], and utilization of maternal Child Heath services such as postnatal care services [AOR 0.40 (0.25-0.63)] were significantly associated with utilisation of postpartum contraception. CONCLUSION: We found a high prevalence of postpartum contraceptives use - over 6 in 10 women - although they were using mainly short-term methods. Those with intentions of resuming schooling and utilised postnatal care services were most likely to use contraceptives. This is encouraging and calls for inquiry into why their use is higher than the national averages. Further, the results call for renewed efforts to maintain adolescent mothers in school.
RESUMO
AIM: The aim of the present study was to assess the trajectories of glomerular filtration rate (GFR) and determinants of change during a 3-year period in free-living mixed-ancestry South Africans. METHODS: In all 320 (78.1% women) adults, aged 56.2 years, from Cape Town were examined in 2008 and 2011. Estimated glomerular filtration rate (eGFR) was based on the Modification of Diet in Renal Disease model; and staging of eGFR used the National Kidney Foundation's classification. RESULTS: Mean eGFR (mL/min per 1.73 m2) was 68.6 at baseline and eGFR stages were: > 90 (9.4%), 60-90 (58.7%), 30-60 (28.1%) and < 30 (0.9%). eGFR increased by 8 mL/min during follow-up, reflecting variable trajectories by baseline eGFR stages, sex, hypertension and glucose tolerance (all P-interaction ≤ 0.012). Movements across eGFR stages during follow-up favoured improvement in 113 participants (35.3%), and worsened in 23 (7.2%). In adjusted multinomial logistic regressions, men had a 72% (43-86%) lower chance of improvement, while each mmHg higher systolic blood pressure conferred a 7% (3-11%) risk of deterioration. Equivalent for each 1% HbA1c was 30% (8-56%). Participants with glucose intolerance had 102% (3-297%) higher chances of improvement than diabetics. CONCLUSION: Variable trajectories of eGFR with time were observed in this cohort, reflecting the effects of modifiable risk factors such as hypertension and dysglycaemia.
