Medicine and Health Sciences Commons^™

Health Facilities Preparedness To Deliver Maternal And Newborn Health Care In Kilifi And Kisii Counties, Kenya, James Orwa, Marleen Temmerman, Lucy Nyaga, Kennedy Mulama, Stanley Luchters

Population Health, East Africa

Introduction: Health facility preparedness is essential for delivering quality maternal and newborn care, minimizing morbidity and mortality by addressing delays in seeking skilled care, reaching appropriate facilities, and receiving emergency care. A rapid assessment of 23 government health facilities in Kilifi and Kisii counties identified poor maternal and newborn indicators in 16 facilities. The Access to Quality Care through Extending and Strengthening Health Systems (AQCESS) project supported these facilities with training, equipment, and referral linkages. This study focuses on facility preparedness of the 16 facilities to deliver maternal and newborn health services, specifically delays two and three at the end …

Trends And Factors Associated With Declining Lifetime Fertility Among Married Women In Kenya Between 2003 And 2014: An Analysis Of Kenya Demographic Health Surveys, James Orwa, Samwel Maina Gatimu, Paulino Ariho, Marleen Temmerman, Stanley Luchters

Population Health, East Africa

Background Globally, fertility has declined in the last three decades. In sub-Saharan Africa Including Kenya, this decline started more recent and at a slower pace compared to other regions. Despite a significant fertility decline in Kenya, there are disparities in intra- and interregional fertility. Reduction in lifetime fertility has health benefits for both the mother and child, thus it is important to improve women and children health outcomes associated with high fertility. The study, therefore evaluated the factors associate with change in lifetime fertility among married women of reproductive age in Kenya between 2003 and 2014.

Methods The study used …

Physiological Mechanisms Of The Impact Of Heat During Pregnancy And The Clinical Implications: Review Of The Evidence From An Expert Group Meeting, Louisa Samuels, Britt Nakstad, Nathalie Roos, Ana Bonell, Matthew Chersich, George Havenith, Stanley Luchters, Louise-Tina Day, Jane E. Hirst, Tanya Singh

Population Health, East Africa

Many populations experience high seasonal temperatures. Pregnant women are considered vulnerable to extreme heat because ambient heat exposure has been linked to pregnancy complications including preterm birth and low birthweight. The physiological mechanisms that underpin these associations are poorly understood. We reviewed the existing research evidence to clarify the mechanisms that lead to adverse pregnancy outcomes in order to inform public health actions. A multi-disciplinary expert group met to review the existing evidence base and formulate a consensus regarding the physiological mechanisms that mediate the efect of high ambient temperature on pregnancy. A literature search was conducted in advance of …

Point-Of-Care Testing And Treatment Of Sexually Transmitted And Genital Infections During Pregnancy In Papua New Guinea (Wantaim Trial): Protocol For An Economic Evaluation Alongside A Cluster-Randomised Trial, Neha Batura, Olga Pm Saweri, William Pomat, Caroline Homer, Rebecca Guy, Stanley Luchters, Glen Mola, Lisa M. Vallely, Christopher Morgan, Grace Kariwiga

Population Health, East Africa

Introduction: Left untreated, sexually transmitted and genital infections (henceforth STIs) in pregnancy can lead to serious adverse outcomes for mother and child. Papua New Guinea (PNG) has among the highest prevalence of curable STIs including syphilis, chlamydia, gonorrhoea, trichomoniasis and bacterial vaginosis, and high neonatal mortality rates. Diagnosis and treatment of these STIs in PNG rely on syndromic management. Advances in STI diagnostics through point-of-care (PoC) testing using GeneXpert technology hold promise for resource-constrained countries such as PNG. This paper describes the planned economic evaluation of a cluster-randomised cross-over trial comparing antenatal PoC testing and immediate treatment of curable STIs …

A Qualitative Endline Evaluation Study Of Male Engagement In Promoting Reproductive, Maternal, Newborn, And Child Health Services In Rural Kenya, Adelaide Lusambili, Stefania Wisofschi, Constance Shumba, Peter Muriuki, Jerim Obure, Michaela Mantel, Lindsay Mossman, Rachel Pell, Lucy Nyaga, Anthony Ngugi, James Orwa, Stanley Luchters, Kennedy Mulama, Terrance J. Wade, Marleen Temmerman

Population Health, East Africa

Background: Globally, male involvement in reproductive, maternal, newborn, and child health (RMNCH) is associated with increased benefits for women, their children, and their communities. Between 2016 and 2020, the Aga Khan University implemented the Access to Quality of Care through Extending and Strengthening Health Systems (AQCESS), project funded by the Government of Canada and Aga Khan Foundation Canada (AKFC). A key component of the project was to encourage greater male engagement in RMNCH in rural Kisii and Kilifi, two predominantly patriarchal communities in Kenya, through a wide range of interventions. Toward the end of the project, we conducted a …

Family Planning And Afghan Refugee Women And Men Living In Melbourne, Australia: New Opportunities And Transcultural Tensions, Alana Russo, Belinda Lewis, Razia Ali, Atiq Abed, Grant Russel, Stanley Luchters

Population Health, East Africa

This research aimed to explore the family planning perspectives and experiences of Afghan women and men living in Melbourne. A total of 57 Afghan women and men participated in six focus groups and 20 semi-structured interviews. The majority of participants indicated a preference for two or three children and were open to using modern contraception. However, many women described experiencing negative side effects when using hormone-based contraception and expressed difficulty negotiating condom use with their husbands as an alternative. Some women described how these difficulties resulted in inconsistent contraceptive practices and, at times, unintended pregnancy. Participants recognised that health professionals …

Ethical Considerations For Conducting Sexual And Reproductive Health Research With Female Adolescents Engaged In High-Risk Behaviours In China, Xu-Dong Zhang, Sabrina Ching Yuen Luk, Yue-Hong Han, Gui-Rong Chen, Bao-Sheng Zhu, Stanley Luchters

Population Health, East Africa

Background: Chinese female adolescents engaged in sex trade and substance use are often criminalized and stigmatized. As a result of these cultural, legal and political constraints, ethical concerns can discourage investigators from engaging these adolescents in research. This paper aims to address the ethical tensions between protection and inclusion in conducting sexual and reproductive health (SRH) research with adolescents engaged in high-risk behaviours. Processes of moral reasoning, and examples and practical mechanisms in managing such ethical challenges were presented in the hope of advancing the research ethics policies and practice with adolescents.

Methods: We extracted ethical issues from three previously …

Assessing The Operational Feasibility And Acceptability Of An Inhalable Formulation Of Oxytocin For Improving Community-Based Prevention Of Postpartum Haemorrhage In Myanmar: A Qualitative Inquiry, Kyu Kyu Than, Victoria Oliver, Yasmin Mohamed, Thazin La, Pete Lambert, Michelle Mcintosh, Stanley Luchters

Population Health, East Africa

Objective: This study assessed the potential operational feasibility and acceptability of a heat-stable, inhaled oxytocin (IOT) product for community-based prevention of postpartum haemorrhage in Myanmar.

Methods: A qualitative inquiry was conducted between June 2015 and February 2016 through focus group discussions and in-depth interviews. Research was conducted in South Dagon township (urban setting) and in Ngape and Thanlyin townships (rural settings) in Myanmar. Eleven focus group discussions and 16 in-depth interviews were conducted with mothers, healthcare providers and other key informants. All audio recordings were transcribed verbatim in Myanmar language and were translated into English. Thematic content analysis was done …

Incidence Of Unintended Pregnancy Among Female Sex Workers In Low-Income And Middle-Income Countries: A Systematic Review And Meta-Analysis, Frances H. Ampt, Lisa Willenberg, Paul A. Agius, Matthew Chersich, Stanley Luchters, Megan S. C. Lim

Population Health, East Africa

Objectives: To determine the incidence of unintended pregnancy among female sex workers (FSWs) in lowincome and middle-income countries (LMICs).

Design: We searched MEDLINE, PsychInfo, Embase and Popline for papers published in English between January 2000 and January 2016, and Web of Science and Proquest for conference abstracts. Meta-analysis was performed on the primary outcomes using random effects models, with subgroup analysis used to explore heterogeneity.

Participants: Eligible studies targeted FSWs aged 15–49 years living or working in an LMIC.

Outcome measures: Studies were eligible if they provided data on one of two primary outcomes: incidence of unintended pregnancy and incidence …

Expectant Fathers’ Participation In Antenatal Care Services In Papua New Guinea: A Qualitative Inquiry, Jessica Davis, Cathy Vaughan, Justine Nankinga, Lisa Davidson, Hellen Kigodi, Eileen Alalo, Liz Comrie-Thomson, Stanley Luchters

Population Health, East Africa

Background: The importance of engaging men in maternal and child health programs is well recognised internationally. In Papua New Guinea (PNG), men’s involvement in maternal and child health services remains limited and barriers and enablers to involving fathers in antenatal care have not been well studied. The purpose of this paper is to explore attitudes to expectant fathers participating in antenatal care, and to identify barriers and enablers to men‘s participation in antenatal care with their pregnant partner in PNG.

Methods: Twenty-eight focus group discussions were conducted with purposively selected pregnant women, expectant fathers, older men and older women across …

Women And Substance Use: A Qualitative Study On Sexual And Reproductive Health Of Women Who Use Drugs In Delhi, India, Vartika Sharma, Avina Sarna, Waimar Tun, Lopamudra Ray Saraswati, Ibou Thior, Ira Madan, Stanley Luchters

Population Health, East Africa

Objectives: To explore contextual factors that increase vulnerabilities to negative sexual and reproductive health (SRH) outcomes and possible differences in SRH-related behaviours and the needs of women who use drugs (WUD) through non-injecting and injecting routes.

Design: Qualitative study design using semi-structured in-depth interviews.

Participants: Twenty women who injected drugs in the past 3months and 28 women who reported using drugs through non-injecting routes in the past 1month.

Setting: Interviews were conducted at community-based, drop-in centres in Delhi, India.

Results: Study findings illustrate that WUD were sexually active and had multiple sex partners including clients of sex work. Transient relationships …

Determinants Of Knowledge Of Critical Danger Signs, Safe Childbirth And Immediate Newborn Care Practices Among Auxiliary Midwives: A Cross Sectional Survey In Myanmar, Kyu Kyu Than, Alison Morgan, Minh Duc Pham, James G. Beeson, Stanley Luchters

Population Health, East Africa

Objectives The re-emergence of community-based health workers such as the auxiliary midwives (AMWs) in Myanmar, who are local female volunteers, has been an important strategy to address global health workforce shortages. The Myanmar government recommends one AMW for every village. The aim of this study is to investigate the current knowledge of critical danger signs and practices for safe childbirth and immediate newborn care of AMWs to inform potential task shifting of additional healthcare responsibilities.

Methods A cross-sectional survey was conducted from July 2015 to June 2016 in three hard-to-reach areas in Myanmar. Face-to-face interviews were conducted using a pretested …

Whisper Or Shout Study: Protocol Of A Cluster-Randomised Controlled Trial Assessing Mhealth Sexual Reproductive Health And Nutrition Interventions Among Female Sex Workers In Mombasa, Kenya, Frances H. Ampt, Collins Mudogo, Peter Gichangi, Megan S. C. Lim, Griffins Manguro, Matthew Chersich, Walter Jaoko, Marleen Temmerman, Marilyn Laini, Stanley Luchters

Population Health, East Africa

Introduction New interventions are required to reduce unintended pregnancies among female sex workers (FSWs) in low- and middle-income countries and to improve their nutritional health. Given sex workers’ high mobile phone usage, repeated exposure to short messaging service (SMS) messages could address individual and interpersonal barriers to contraceptive uptake and better nutrition.

Methods In this two-arm cluster randomised trial, each arm constitutes an equal-attention control group for the other. SMS messages were developed systematically, participatory and theory-driven and cover either sexual and reproductive health (WHISPER) or nutrition (SHOUT). Messages are sent to participants 2–3 times/week for 12 months and include …

Prevention Of Postpartum Haemorrhage By Community-Based Auxiliary Midwives In Hard-To-Reach Areas Of Myanmar: A Qualitative Inquiry Into Acceptability And Feasibility Of Task Shifting, Kyu Kyu Than, Yasmin Mohamed, Victoria Oliver, Theingi Myint, Thazin La, James G. Beeson, Stanley Luchters

Population Health, East Africa

Background: In Myanmar, postpartum haemorrhage is the leading cause of maternal mortality and contributes to around 30% of all maternal deaths. The World Health Organization recommends training and supporting auxiliary midwives to administer oral misoprostol for prevention of postpartum haemorrhage in resource-limited settings. However, use of misoprostol by auxiliary midwives has not formally been approved in Myanmar. Our study aimed to explore community and provider perspectives on the roles of auxiliary midwives and community-level provision of oral misoprostol by auxiliary midwives.

Methods: A qualitative inquiry was conducted in Ngape Township, Myanmar. A total of 15 focus group discussions with midwives, …

A Novel Point-Of-Care Testing Strategy For Sexually Transmitted Infections Among Pregnant Women In High-Burden Settings: Results Of A Feasibility Study In Papua New Guinea, Steven G. Badman, Lisa M. Vallely, Pamela Toliman, Grace Kariwiga, Bomesina Lote, William Pomat, Caroline Holmer, Rebecca Guy, Stanley Luchters, Chris Morgan

Population Health, East Africa

Background: Sexually transmitted and genital infections in pregnancy are associated with an increased risk of adverse maternal and neonatal health outcomes. High prevalences of sexually transmitted infections have been identified among antenatal attenders in Papua New Guinea. Papua New Guinea has amongst the highest neonatal mortality rates worldwide, with preterm birth and low birth weight major contributors to neonatal mortality. The overall aim of our study was to determine if a novel point-of-care testing and treatment strategy for the sexually transmitted and genital infections Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Bacterial vaginosis (BV) in pregnancy is …

A Qualitative Exploration Of The Emotional Wellbeing And Support Needs Of New Mothers From Afghanistan Living In Melbourne, Australia, Alana Russo, Belinda Lewis, Andrew Joyce, Belinda Crockett, Stanley Luchters

Population Health, East Africa

Background: The Afghan community is a priority population for many health and social services within the southeast region of Melbourne, which is home to the largest population of Afghanistan-born people within the state of Victoria. The majority of Afghan women arriving in Australia are of childbearing age, and evidence suggests that they are at increased risk of emotional challenges following birth as a result of the refugee and migration experience. This research aimed to explored the experiences of Afghan women living in Melbourne throughout pregnancy, birth, and early motherhood, and gain insight into the aspects of their experiences that they …

Systematic Review Of Facility-Based Sexual And Reproductive Health Services For Female Sex Workers In Africa, Ashar Dhana, Stanley Luchters, Lizzie Moore, Yves Lafort, Anuradha Roy, Fiona Scorgie, Matthew Chersich

Population Health, East Africa

Background: Several biological, behavioural, and structural risk factors place female sex workers (FSWs) at heightened risk of HIV, sexually transmitted infections (STIs), and other adverse sexual and reproductive health (SRH) outcomes. FSW projects in many settings have demonstrated effective ways of altering this risk, improving the health and wellbeing of these women. Yet the optimum delivery model of FSW projects in Africa is unclear. This systematic review describes intervention packages, service-delivery models, and extent of government involvement in these services in Africa.

Methods: On 22 November 2012, we searched Web of Science and MEDLINE, without date restrictions, for …

'There Are A Lot Of New People In Town: But They Are Here For Soccer, Not For Business' A Qualitative Inquiry Into The Impact Of The 2010 Soccer World Cup On Sex Work In South Africa, Marlise L. Richter, Fiona Scorgie, Matthew F. Chersich, Stanley Luchters

Population Health, East Africa

Background: Sports mega-events have expanded in size, popularity and cost. Fuelled by media speculation and moral panics, myths proliferate about the increase in trafficking into forced prostitution as well as sex work in the run-up to such events. This qualitative enquiry explores the perceptions of male, female and transgender sex workers of the 2010 Soccer World Cup held in South Africa, and the impact it had on their work and private lives.

Methods: A multi-method study design was employed. Data consisted of 14 Focus Group Discussions, 53 sex worker diaries, and responses to two questions in surveys with …

The Case For Investing In Family Planning In The Pacific: Costs And Benefits Of Reducing Unmet Need For Contraception In Vanuatu And The Solomon Islands, Elissa C. Kennedy, Sean Mackesy-Buckley, Sumi Subramaniam, Andreas Demmke, Rufina Latu, Annette Sachs Robertson, Kabwea Tiban, Apisai Tokon, Stanley Luchters

Population Health, East Africa

Background: Unmet need for family planning in the Pacific is among the highest in the world. Better understanding of required investments and associated benefits of increased access to family planning in the Pacific may assist prioritisation and funding.

Methods: We modelled the costs and associated health, demographic and economic impacts of reducing unmet need for family planning between 2010-2025 in Vanuatu and the Solomon Islands. Baseline data were obtained from census reports, Demographic and Health Surveys, and UN agency reports. Using a demographic modelling program we compared a scenario of "no change in unmet need" with two distinct scenarios: 1) …

Family Planning Knowledge, Attitude And Practice Among Married Couples In Jimma Zone, Ethiopia, Tizta Tilahun, Gily Coene, Stanley Luchters, Wondwosen Kassahun, Els Leye, Marleen Temmerman, Olivier Degomme

Population Health, East Africa

Background: Understanding why people do not use family planning is critical to address unmet needs and to increase contraceptive use. According to the Ethiopian Demographic and Health Survey 2011, most women and men had knowledge on some family planning methods but only about 29% of married women were using contraceptives. 20% women had an unmet need for family planning. We examined knowledge, attitudes and contraceptive practice as well as factors related to contraceptive use in Jimma zone, Ethiopia.

Methods: Data were collected from March to May 2010 among 854 married couples using a multi-stage sampling design. Quantitative data based on …

Maternal Morbidity In The First Year After Childbirth In Mombasa Kenya; A Needs Assessment, Matthew F. Chersich, Nicole Kley, Stanley Luchters, Carol Njeru, Elodie Yard, Mary J. Othigo, Marleen Temmerman

Population Health, East Africa

Background: In sub-Saharan Africa, few services specifically address the needs of women in the first year after childbirth. By assessing the health status of women in this period, key interventions to improve maternal health could be identified. There is an underutilised opportunity to include these interventions within the package of services provided for woman-child pairs attending child-health clinics.

Methods: This needs assessment entailed a cross-sectional survey with 500 women attending a child-health clinic at the provincial hospital in Mombasa, Kenya. A structured questionnaire, clinical examination, and collection of blood, urine, cervical swabs and Pap smear were done. Women's health care …