Medicine and Health Sciences Commons^™

E-Learning For Research Capacity Strengthening In Sexual And Reproductive Health: The Experience Of The Geneva Foundation For Medical Education And Research And The Department Of Reproductive Health And Research, World Health Organization, Karim Abawi, Venkatraman Chandra-Mouli, Igor Toskin, Mario Philip Festin, Lynn Gertiser, Raqibat Idris, Hanan Hamamy, Moazzam Ali, Ameyo Masakhwe Bonventure, Marleen Temmerman, Aldo Campana

Obstetrics and Gynaecology, East Africa

Abstract: Technological advancement has resulted in the increasing use of e-learning and online education, initially in high-income countries and increasingly in low- and middle-income countries.

Background: In 2010, the Geneva Foundation for Medical Education and Research, in collaboration with the World Health Organization and partner institutions, developed an online postgraduate course “From Research to Practice: Training Course in Sexual and Reproductive Health Research”. This course takes advantage of the advancing Internet technology to provide training opportunities to health professionals mostly from low- and middle-income countries whose access to quality education is constrained by time, financial resources, or both.

Case presentation: …

Addressing The Intersection Between Alcohol Consumption And Antiretroviral Treatment: Needs Assessment And Design Of Interventions For Primary Healthcare Workers, The Western Cape, South Africa, M. Schneider, M. Chersich, Marleen Temmerman, C. D. Parry

Obstetrics and Gynaecology, East Africa

Background: At the points where an infectious disease and risk factors for poor health intersect, while health problems may be compounded, there is also an opportunity to provide health services. Where human immunodeficiency virus (HIV) infection and alcohol consumption intersect include infection with HIV, onward transmission of HIV, impact on HIV and acquired immunodeficiency syndrome (AIDS) disease progression, and premature death. The levels of knowledge and attitudes relating to the health and treatment outcomes of HIV and AIDS and the concurrent consumption of alcohol need to be determined. This study aimed to ascertain the knowledge, attitudes and practices of primary …

Lessons Learnt From The Cerca Project, A Multicomponent Intervention To Promote Adolescent Sexual And Reproductive Health In Three Latin America Countries: A Qualitative Post-Hoc Evaluation., Olena Ivanova, Kathya Cordova Pozo, Zoyla Esmeralda Segura, Bernardo Vega, Venkatraman Chandra-Mouli, Michelle J. Hindin, Marleen Temmerman, Peter Decat, Sara De Meyer, Kristien Michielsen

Obstetrics and Gynaecology, East Africa

The Community-Embedded Reproductive Health Care for Adolescents (CERCA) Project was implemented in Bolivia, Ecuador and Nicaragua (2011–2014) to test the effectiveness of interventions preventing teenage pregnancies. As the outcome evaluation showed limited impact, a post-hoc process evaluation was carried out to determine if and how CERCA’s design, implementation, monitoring and evaluation affected the results. We did a document analysis and conducted 18 in-depth interviews and 21 focus group discussions with stakeholders and beneficiaries. Transcripts were analyzed using directed content analysis.

Data showed that CERCA sensitized stakeholders and encouraged the discussion on this sensitive issue. In terms of design, a strong …

Progestogen-Only Contraceptive Use Among Breastfeeding Women: A Systematic Review., Sharon J. Phillips, Naomi K. Tepper, Nathalie Kapp, Kavita Nanda, Marleen Temmerman, Kathryn M. Curtis

Obstetrics and Gynaecology, East Africa

Background: Postpartum women need effective contraception. Concerns have been raised that use of progestogen-only contraceptives (POCs) may affect breastfeeding performance and infant health outcomes.

Objectives: We investigated the clinical outcomes of breastfeeding duration, initiation of supplemental feeding and weaning, as well as infant outcomes including infant growth, health and development among breastfeeding women using POCs compared with breastfeeding women not using POCs.

Search strategy: We searched the PubMed database for all articles published from database inception through December 2014.

Selection criteria: We included primary research studies of breastfeeding women of any age or parity who received POCs, including progestogen-only pills, …

Global Burden Of Maternal And Congenital Syphilis In 2008 And 2012: A Health Systems Modelling Study, N. Saman Wijesooriya, Roger W. Rochat, Mary L. Kamb, Prasad Turlapati, Marleen Temmerman, Nathalie Broutet, Lori M. Newman

Obstetrics and Gynaecology, East Africa

Background: In 2007, WHO launched a global initiative for the elimination of mother-to-child transmission of syphilis (congenital syphilis). An important aspect of the initiative is strengthening surveillance to monitor progress towards elimination. In 2008, using a health systems model with country data inputs, WHO estimated that 1·4 million maternal syphilis infections caused 520 000 adverse pregnancy outcomes. To assess progress, we updated the 2008 estimates and estimated the 2012 global prevalence and cases of maternal and congenital syphilis.

Methods: We used a health systems model approved by the Child Health Epidemiology Reference Group. WHO and UN databases provided inputs on …

Participatory Approaches Involving Community And Healthcare Providers In Family Planning/Contraceptive Information And Service Provision: A Scoping Review., Petrus S. Steyn, Joanna Paula, Peter Gichangi, Jennifer A. Smit, Theresa Nkole, James Kiarie, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

As efforts to address unmet need for family planning and contraception (FP/C) accelerate, voluntary use, informed choice and quality must remain at the fore. Active involvement of affected populations has been recognized as one of the key principles in ensuring human rights in the provision of FP/C and in improving quality of care. However, community participation continues to be inadequately addressed in large-scale FP/C programmes. Community and healthcare providers’ unequal relationship can be a barrier to successful participation. This scoping review identifies participatory approaches involving both community and healthcare providers for FP/C services and analyzes relevant evidence. The detailed analysis …

Caesarean Section Surgical Techniques: All Equally Safe, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Since 1985, a caesarean section rate of 10–15% has been deemed optimum by the international health-care community.1 When caesarean section rates rise towards 10% across a population, maternal and newborn deaths decrease; when they are higher than 15%, there is no evidence of reduced mortality.1 Complications of caesarean sections can be substantial and sometimes permanent for both mothers and babies, and can result in disability or death, especially in settings with inadequate facilities or capacity to undertake safe surgery and treat surgical complications.

Modern Contraceptive Use Among Migrant And Non-Migrant Women In Kenya, Rhoune Ochako, Ian Askew, Jerry Okal, John Oucho, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Manifest socio-economic differences are a trigger for internal migration in many sub-Saharan settings including Kenya. An interplay of the social, political and economic factors often lead to internal migration. Internal migration potentially has significant consequences on an individual’s economic growth and on access to health services, however, there has been little research on these dynamics. In Kenya, where regional differentials in population growth and poverty reduction continue to be priorities in the post MDG development agenda, understanding the relationships between contraceptive use and internal migration is highly relevant.

Methods: Using data from the 2008–09 Kenya Demographic and Health Survey …

Factors Associated With Uptake Of Visual Inspection With Acetic Acid (Via) For Cervical Cancer Screening In Western Kenya, Elkanah Omenge, Juddy Wachira, Fredrick Chite Asirwa, Naftali Busakhala, Violet Naanyu, Job Kisuya, Grieven Otieno, Alfred Keter, Ann Mwangi, Thomas Inui

Obstetrics and Gynaecology, East Africa

Purpose: Cervical cancer screening has been successful in reducing the rates of cervical cancer in developed countries, but this disease remains the leading cause of cancer deaths among women in sub-Saharan Africa. We sought to understand factors associated with limited uptake of screening services in our cervical cancer-screening program in Western Kenya.

Participants and Methods: Using items from a previously validated cancer awareness questionnaire repurposed for use in cervical cancer and culturally adapted for use in Kenya, we interviewed 2,505 women aged 18–55 years receiving care in gynecology clinics or seeking other services in 4 health facilities in Western Kenya …

The Global Strategy For Women's, Children's And Adolescents' Health (2016-2030): A Roadmap Based On Evidence And Country Experience., Shyama Kuruvilla, Flavia Bustreo, Taona Kuo, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

The Global strategy for women’s, children’s and adolescents’ health (2016–2030) provides a roadmap for ending preventable deaths of women, children and adolescents by 2030 and helping them achieve their potential for and rights to health and well-being in all settings.1 The global strategy has three objectives: survive (end preventable deaths); thrive (ensure health and well-being); and transform (expand enabling environments). These objectives are aligned with 17 targets within nine of the sustainable development goals (SDGs),2 including SDG 3 on health and other SDGs related to the political, social, economic and environmental determinants of health and sustainable development.

Like the SDGs, …

Intimate Partner Violence In Early Adolescence: The Role Of Gender, Socioeconomic Factors And The School, A. J. Mason-Jones, P De Koker, S. M. Eggers, Marleen Temmerman, E. Leye, P. J De Vries, H De Vries

Obstetrics and Gynaecology, East Africa

Background: Intimate partner violence (IPV) among adolescents is common worldwide, but our understanding of perpetration, gender differences and the role of social-ecological factors remains limited.

Objectives: To explore the prevalence of physical and sexual IPV perpetration and victimisation by gender, and associated risk and protective factors.

Methods: Young adolescents (N=2 839) from 41 randomly selected public high schools in the Western Cape region of South Africa (SA), participating in the PREPARE study, completed a self-administered questionnaire.

Results: The participants’ mean age was 13.65 years (standard deviation 1.01), with 19.1% (541/2 839) reporting being victims/survivors of IPV and 13.0% (370/2 839) …

Engaging With Community-Based Public And Private Mid-Level Providers For Promoting The Use Of Modern Contraceptive Methods In Rural Pakistan: Results From Two Innovative Birth Spacing Interventions, Syed Khurram Azmat, Waqas Hameed, Hasan Bin Hamza, Ghulam Mustafa, Muhammad Ishaque, Ghazunfer Abbas, Omar Farooq Khan, Jamshaid Asghar, Erik Munroe, Safdar Ali, Wajahat Hussain, Sajid Ali, Aftab Ahmed, Moazzam Ali, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Family planning (FP) interventions aimed at reducing population growth have negligible during the last two decades in Pakistan. Innovative FP interventions that help reduce the growing population burden are the need of the hour. Marie Stopes Society - Pakistan implemented an operational research project - ‘Evidence for Innovating to Save Lives’, to explore effective and viable intervention models that can promote healthy timing and spacing of pregnancy in rural and under-served communities of Sindh, Punjab and Khyber Pakhtunkhwa provinces of Pakistan.

Methods: We conducted a quasi-experimental (pre - and post-intervention with control arm) study to assess the effectiveness of …

Evidence And Knowledge Gaps On The Disease Burden In Sexual And Gender Minorities: A Review Of Systematic Reviews, Karel Blondeel, Lale Say, Doris Chou, Igor Toskin, Rajat Khosla, Elisa Scolaro, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Sexual and gender minorities (SGM) include individuals with a wide range of sexual orientations, physical characteristics, and gender identities and expressions. Data suggest that people in this group face a significant and poorly understood set of additional health risks and bear a higher burden of some diseases compared to the general population. A large amount of data is available on HIV/AIDS, but far less on other health problems. In this review we aimed to synthesize the knowledge on the burden of communicable and non-communicable diseases, mental health conditions and violence experienced by SGM, based on available systematic reviews. We conducted …

Eregistries: Electronic Registries For Maternal And Child Health, J. Frederik Frøen, Sonja L. Myhre, Michael J. Frost, Doris Chou, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: The Global Roadmap for Health Measurement and Accountability sees integrated systems for health information as key to obtaining seamless, sustainable, and secure information exchanges at all levels of health systems. The Global Strategy for Women’s, Children’s and Adolescent’s Health aims to achieve a continuum of quality of care with effective coverage of interventions. The WHO and World Bank recommend that countries focus on intervention coverage to monitor programs and progress for universal health coverage. Electronic health registries - eRegistries - represent integrated systems that secure a triple return on investments: First, effective single data collection for health workers to …

Effects Of The Copper Intrauterine Device Versus Injectable Progestin Contraception On Pregnancy Rates And Method Discontinuation Among Women Attending Termination Of Pregnancy Services In South Africa: A Pragmatic Randomized Controlled Trial, G. Justus Hofmeyr, Mandisa Singata-Madliki, Theresa A. Lawrie, Eduardo Bergel, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: The copper intrauterine device (IUD) is under-utilised in South Africa, where injectable progestin contraception (IPC) dominates contraception usage. There is a lack of robust comparative data on these contraceptive options to inform policy, programs, clinical counseling, and women’s choices.

Methods: Within the context of a South African program to increase women’s access to the IUD, we conducted a pragmatic, open-label, parallel-arm, randomised controlled trial of the IUD versus IPC at two South African hospitals. The target sample size was 7,000 women and the randomisation ratio was 1:1. The random sequence was computer-generated and group allocation was concealed in sealed, …

Endometrial Tuberculosis Compounding Polycystic Ovary Syndrome In A Subfertile Woman: A Case Report, Charles Mariara, Angela Koech, P. Waweru, Alfred Murage

Obstetrics and Gynaecology, East Africa

Background: Asymptomatic female genital tuberculosis can impair tubal and endometrial function and later present as subfertility. A majority of the patients with genital tuberculosis in endemic regions present with subfertility and the delay in presentation, coupled with the potential the disease has in mimicking other gynecological conditions, renders it elusive. In addition to the challenge of diagnosing genital tuberculosis, fertility outcomes after treatment are not impressive. This is particularly so in the background of another confounding subfertility factor to which interventional efforts may initially be directed, at the expense of undiagnosed genital tuberculosis. We therefore present a case of subfertility …

Evidence And Evidence Gaps In Adolescent Health, George Patton, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

The momentum to bring adolescents and young adults to center stage in global health and international development is palpable. Adolescents are increasingly seen as a crucial group for the success of the newly adopted Agenda for Sustainable Development [1]. Sitting within the Agenda for Sustainable Development framework, the 2030 Global Strategy for Women's, Children's and Adolescents' Health has extended the Every Woman, Every Child agenda to adolescence [2]. The strategy articulates the need for adolescent responsive health systems as well as social determinants, a focus that extends to legal and policy environments [3]. Countries seeking to adopt this more holistic …

Contraceptive Method Choice Among Women In Slum And Non-Slum Communities In Nairobi, Kenya, Rhoune Ochako, Chimaraoke Izugbara, Jerry Okal, Ian Askew, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Understanding women’s contraceptive method choices is key to enhancing family planning services provision and programming. Currently however, very little research has addressed inter and intra-regional disparities in women’s contraceptive method choice. Using data from slum and non-slum contexts in Nairobi, Kenya, the current study investigates the prevalence of and factors associated with contraceptive method choice among women.

Methods: Data were from a cross-sectional quantitative study conducted among a random sample of 1,873 women (aged 15–49 years) in two non-slum and two slum settlement areas in Nairobi, Kenya. The study locations were purposively sampled by virtue of being part of …

Assessing Women's Satisfaction With Family Planning Services In Mozambique, Leonardo Chavane, Martinho Dgedge, Patricia Bailey, Osvaldo Loquiha, Marc Aerts, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: The contraceptive prevalence rate in Mozambique was estimated as 11.3% in the last Demographic and Health Survey. The impact of family planning (FP) on women’s health and on the reduction of maternal mortality is well known.

Methods: Acknowledging the importance of user satisfaction in the utilisation of health services, exit interviews were used to assess women’s satisfaction with FP services in Mozambique. The survey, conducted in 174 health facilities, was representative at the national level, covered all provinces, and both urban and rural areas.

Results: Overall, 86% of respondents were satisfied with FP services, but issues such as insufficient …

Scientific Basis For Standardization Of Fetal Head Measurements By Ultrasound: A Reproducibility Study, R. Napolitano, V. Donadono, E. O. Ohuma, C. L. Knight, Sikolia Wanyonyi, B. Kemp, T. Norris, A. T. Papageorghiou

Obstetrics and Gynaecology, East Africa

Objective: To compare the standard methods for ultrasound measurement of fetal head circumference (HC) and biparietal diameter (BPD) (outer-to-outer (BPDoo) vs outer-to-inner (BPDoi) caliper placement), and compare acquisition of these measurements in transthalamic (TT) vs transventricular (TV) planes.

Methods: This study utilized ultrasound images acquired from women participating in the Oxford arm of the INTERGROWTH-21st Project. In the first phase of the study, BPDoo and BPDoi were measured on stored images. In the second phase, real-time measurements of BPD, occipitofrontal diameter (OFD) and HC in TT and TV planes were obtained by pairs of sonographers. Reproducibility of measurements made by …

Moving Towards The Goals Of Fp2020 — Classifying Contraceptives, Mario Philip R. Festin, James Kiarie, Julie Solo, Jeffrey Spieler, Shawn Malarcher, Paul F.A. Van Look, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

With the renewed focus on family planning, a clear and transparent understanding is needed for the consistent classification of contraceptives, especially in the commonly used modern/traditional system. The World Health Organization Department of Reproductive Health and Research and the United States Agency for International Development (USAID) therefore convened a technical consultation in January 2015 to address issues related to classifying contraceptives. The consultation defined modern contraceptive methods as having a sound basis in reproductive biology, a precise protocol for correct use and evidence of efficacy under various conditions based on appropriately designed studies. Methods in country programs like Fertility Awareness …

Who Statement On Caesarean Section Rates, A. P. Betran, M. R. Torloni, J. J. Zhang, A. M. Gulmezoglu, Marleen Temmerman, Who Working Group On Caesarean Section

Obstetrics and Gynaecology, East Africa

In 1985 when a group of experts convened by the World Health Organization in Fortaleza, Brazil, met to discuss the appropriate technology for birth, they echoed what at that moment was considered an unjustified and remarkable increase of caesarean section (CS) rates worldwide.1 Based on the evidence available at that time, the experts in Fortaleza concluded: ‘there is no justification for any region to have a caesarean section rate higher than 10–15%’.1 Over the years, this quote has become ubiquitous in scientific literature, being interpreted as the ideal CS rate. Although this reference range was intended for ‘populations’, which are …

A Global Reference For Caesarean Section Rates (C‐Model): A Multicountry Cross‐Sectional Study, J. P. Souza, A. P. Betran, A. Dumont, B De Mucio, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objective: To generate a global reference for caesarean section (CS) rates at health facilities. Design Cross-sectional study.

Setting: Health facilities from 43 countries. Population/Sample Thirty eight thousand three hundred and twenty-four women giving birth from 22 countries for model building and 10 045 875 women giving birth from 43 countries for model testing.

Methods: We hypothesised that mathematical models could determine the relationship between clinical-obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three-step approach to generate the global benchmark of CS rates at health facilities: …