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PubMed2005

Reproductive disorders of crossbred dairy cows in the central highlands of Ethiopia and their effect on reproductive performance.

The study was conducted to estimate the proportion of reproductive disorders and to determine factors affecting reproductive performance of crossbred dairy cows under four different production systems in the central highlands of Ethiopia. The principal postpartum reproductive disorders were retained fetal membranes (14.7%) and uterine infection (15.5%). Anoestrus was the major postpartum reproductive problem in the mixed crop-livestock production system (38.6%) and was significantly associated with this production system. Apart from anoestrus, the occurrence of reproductive disorders was not significantly associated with a production system. Most of the reproductive disorders occurred as a complex rather than as a single abnormality. Two or more abnormal conditions were seen in 11.4% of the cases. Each reproductive trait measured was affected adversely by reproductive disorders. Cows with reproductive disorders in each production system, lactation group and suckling and non-suckling group had longer intervals from calving to first service and to conception (p < 0.001) and required more services per conception (p < 0.001). Pregnancy rate and conception to first service were 84.7% and 51.7%, respectively, for cows without reproductive health problems; and 64.2%, and 15.1%, respectively, for cows with reproductive disorders (p < 0.001). Overall, intervals from calving to first service were shorter (p < 0.05) than in younger cows. Intervals from calving to first service and to conception were longer in suckling than in non-suckling cows (p > 0.05). Cows with a good body condition score (> 3.5) at calving had shorter calving to first service and conception intervals than cows in poor condition (p < 0.001). The results showed that reproductive abnormalities, coupled with poor body condition, are important factors that contributed to reproductive inefficiency. An appropriate reproductive health management, a reliable artificial insemination service and supplementary feeding could be the management options to reduce or alleviate some of the problems.

Anestrus↗
PubMed2000

Men's sexual health matters: promoting reproductive health in an international context.

Recent concern regarding the control of sexually transmitted infections (STIs) has resulted in an increased interest in the sexual health of men. This interest has primarily focused on strategies to 'encourage and enable men to take responsibility for their sexual and reproductive behaviour and their social and family roles' (United Nations 1994). Whilst men are deemed to have 'responsibilities', women are said to have 'rights' with regard to making choices about reproductive health and accessing appropriate and effective services. Here it is argued that, whilst provision of services and interventions against STIs in men should never be at the expense of those for women, it is often clinically easier and more effective to diagnose and treat men with STIs compared to women in resource-poor settings. Indeed, this may prove to be an effective strategy in controlling the spread of STIs, and hence reducing the disproportionate burden of their complications suffered by women. The paper reviews key issues in relation to improved service delivery for sexual and reproductive health in men, notably: the heterogeneity of male populations; current knowledge regarding men's sexual behaviour; the role of sexuality; methods of studying sexual behaviour in resource poor countries; men's own concerns in relation to sexual and reproductive health; and where and how they access treatment. It is argued that the time has now come to determine and address men's sexual health needs if we are to expect them to participate fully as responsible partners in improving and protecting their own and others' sexual and reproductive health.

Delivery of Health Care↗
PubMed2005

A survey of sexual and reproductive health in men with cystic fibrosis: new challenges for adolescent and adult services.

BACKGROUND: Improved survival dramatically alters the consequences of adult co-morbidities in men with cystic fibrosis (CF) such as male infertility. Few studies have systematically addressed the impact of sexual and reproductive health issues in these men or considered the implications for healthcare delivery. METHOD: A descriptive cohort study was undertaken using a sexual and reproductive health survey of men from a large adult CF centre, including men with lung transplantation. RESULTS: The mean (SD) age of the 94 men (response rate 75%) was 30.5 (7.6) years. 94% knew that men with CF had reduced fertility. Men first heard about infertility later than desired (p<0.001) and only 53% heard from their preferred source. Men who were told about infertility when older were more likely to be upset than those told earlier (p<0.01). 53% of men had undergone semen analysis: 68% of men who had not been tested wanted semen analysis. 73% believed semen analysis should occur before 18, but the youngest age of testing was 24 years. In adolescence, one in three men had assumed they did not need to use condoms and one in 10 had confused infertility with impotence. 66% of men wanted more information on reproductive options and 84% wanted children. Seventeen men were parents by natural conception (n = 1), micro-epididymal sperm aspiration (n = 6), donor sperm (n = 9), and through step children (n = 1). CONCLUSIONS: Men with CF desire more sexual and reproductive health information. Earlier discussion of sexual and reproductive health is indicated in paediatric settings, and semen analysis should be routinely offered. In adult services greater discussion of reproductive health options is indicated.

Adolescent↗
PubMed1988

Statutory prohibition on use of appropriated funds in programs where abortion is a method of family planning; standard of compliance for family planning services projects--PHS. Final rules.

The Public Health Service (PHS) amends the regulations governing the use of funds for family planning services under Title X of the Public Health Service Act in order to set specific standards for compliance with the statutory requirement that none of the funds appropriated under Title X may be used in programs where abortion is a method of family planning. It is expected that the amendments will improve compliance by grantees with the statute and facilitate monitoring of compliance by PHS.

Abortion, Induced↗
PubMed2004

Client satisfaction with reproductive health-care quality: integrating business approaches to modeling and measurement.

Health-care managers are increasingly interested in client perceptions of clinic service quality and satisfaction. While tremendous progress has occurred, additional perspectives on the conceptualization, modeling and measurement of these constructs may further assist health-care managers seeking to provide high-quality care. To that end, this study draws on theories from business and health to develop an integrated model featuring antecedents to and consequences of reproductive health-care client satisfaction. In addition to developing a new model, this study contributes by testing how well Western-based theories of client satisfaction hold in a developing, Asian country. Applied to urban, reproductive health clinic users in Hanoi, Vietnam, test results suggest that hypothesized antecedents such as pre-visit expectations, perceived clinic performance and how much performance exceeds expectations impact client satisfaction. However, the relative importance of these predictors appears to vary depending on a client's level of service-related experience. Finally, higher levels of client satisfaction are positively related to future clinic use intentions. This study demonstrates the value of: (1) incorporating theoretical perspectives from multiple disciplines to model processes underlying health-care satisfaction and (2) field testing those models before implementation. It also furthers research designed to provide health-care managers with actionable measures of the complex processes related to their clients' satisfaction.

Female↗
PubMedDate not supplied

An evaluation of community-based HIV services for women in New York State.

The proportion of women in New York State diagnosed with acquired immune deficiency syndrome (AIDS) is increasing dramatically. In 1987, only 12% of cumulative AIDS cases in New York were among women; by 1993, 26% of new cases of AIDS were. This evaluation describes community-based HIV programs that provide services to women in New York State and are funded by the State Department of Health's AIDS Institute. The evaluation assesses the success different programs have had in reaching and engaging women. It also describes the problems organizations face in serving their target populations. Four sets of data were collected and analyzed to assess the care being received by female clients. Programs appear to be reaching women who are human immunodeficiency virus (HIV) positive or at high risk of HIV infection, and once engaged, female clients find the services helpful. However, agencies report difficulties in finding and using the strategies that are most effective with women. Agencies appear to do a better job of addressing their female clients' economic needs than those related to gender, such as reproductive health care, family services, and access to clinical trials.

Adolescent↗
PubMed2006

Reproductive care and rates of pregnancy in teenagers with negative pregnancy test results.

PURPOSE: The purpose of this study was to follow-up adolescent girls with negative pregnancy tests (NPTs) through an 18-month follow-up analysis of health services received, patterns of contraception use, and pregnancy outcomes. METHOD: This study involved a retrospective review of medical records of 129 adolescent patients who had a NPT result from clinical sites in an urban medical center during a 3-month period in 1997. A stratified random sample of participants was selected from adolescents who received care at 2 school-based health centers, a women's health center, and an adolescent health clinic associated with a large academic medical center. FINDINGS: Analysis of the 129 cases indicated that the cohort of adolescents with NPTs appears to be a higher risk group of girls than suggested by previous studies. Of the multi-ethnic sample with a mean age of 16.2 +/- 1.4 years at the time of the NPT, 47% had already had 1 or more pregnancies and 25% had 1 child. Thirty percent of the subjects were offered condoms, and 50% were offered hormonal contraception at the time of the NPT; only 46% were given a return appointment. By 18 months after the index pregnancy test, 36% of the subjects had 1 or more pregnancies, and the majority of the subjects had used no form of contraception or had used contraception inconsistently. CONCLUSIONS: Comprehensive reproductive health services often are not offered to adolescents who receive NPT results. Sexually active teenagers need thorough reproductive care and consistent follow-up evaluation to avoid sexually transmitted infections (STIs) and unintended pregnancies.

Adolescent↗
PubMed2006

Perspectives of midwives and doctors on adolescent sexuality and abortion care in Vietnam.

BACKGROUND: Vietnam has one of the highest abortion rates in the world and adolescent abortions are thought to constitute at least one-third of all cases. Lack of balanced reproductive health information and services to adolescents and negative social attitudes towards adolescent sexuality are contributing factors to the high abortion rates. Health providers are important in guiding and counselling adolescents on how to protect their reproductive health. There is a lack of studies on health providers' perspectives on their work in adolescent reproductive health care. AIM: To explore the perspectives of midwives and doctors on adolescent sexuality and abortion, and what they considered to be quality abortion care for adolescents and the barriers to it, as well as to their own training needs. METHODS: Observations of care in abortion clinics and focus-group discussions (FGD) were used to collect data. Doctors and midwives from three healthcare facilities in Quang Ninh province in Northern Vietnam participated in a total of eight FGDs. Data were analysed using latent content analysis. FINDINGS: Major barriers identified for quality abortion care were of technical and managerial nature. Participants considered that counselling unmarried clients in connection with abortion should focus on warning against the risks and dangers of abortion and pre-marital sexual relations, which they strongly disapproved of. However, they also expressed a pragmatic and caring attitude towards the unmarried girls and couples coming for abortion. Adolescent sexuality and abortion are morally sensitive issues in the Vietnamese culture. The contradictions between cultural norms and the reality facing health providers while counselling unmarried adolescents need to be addressed in education and training programmes.

Abortion, Induced↗
PubMed2003

Unplanned teenage pregnancy.

This chapter addresses unplanned teenage pregnancy from a human-rights-based perspective. Many programmes focus only on the negative aspects of young people's sexual and reproductive health; putting rights at the centre of teenage sexual health avoids treating adolescents as a homogeneous collection of discrete problems. Taking a rights-based approach to adolescent sexual and reproductive health encompasses the inter-relationships and complexity of factors influencing choices and decisions. In this chapter we explore the meaning of a rights-based approach and examine its implementation in the provision of sexuality, education and health services. We provide examples of international strategies for ensuring the participation of diverse young people and generating youth-friendly services to meet their sexual and reproductive needs and rights.

Adolescent↗
PubMed2000

Syndromic management of vaginal discharge among women in a reproductive health clinic in India.

OBJECTIVES: To examine the performance of the syndromic approach in the management of vaginal discharge among women attending a reproductive health clinic in New Delhi, India. METHODS: Women who sought services from the clinic and who had a complaint of vaginal discharge were interviewed, underwent a pelvic examination, and provided samples for laboratory investigations of bacterial vaginosis, candidiasis, syphilis, trichomoniasis, and Chlamydia trachomatis and Neisseria gonorrhoeae infections. Data analysis focused on the prevalence of infection and on the performance of the algorithm recommended by the national authorities for the management of vaginal discharge. RESULTS: The most common infection among 319 women was bacterial vaginosis (26%). At least one sexually transmitted infection was detected in 21.9% of women. The prevalence of C trachomatis infection was 12.2%; trichomoniasis 10%; syphilis 2.2%; N gonorrhoeae was not isolated. An algorithm based on risk assessment and speculum assisted clinical evaluation was not helpful in predicting cervical infections associated with C trachomatis (sensitivity 5% and PPV 9%). This algorithm was sensitive (95%) though not specific (22%) in selecting women for metronidazole therapy effective against bacterial vaginosis or trichomoniasis, and overtreatment was a problem (PPV 38%). The sensitivity, specificity, and PPV of this algorithm for the treatment of candidiasis were 46%, 98%, and 88% respectively. The cost per case assessed using the algorithm was $2 and the cost per infection correctly treated was $4.25. CONCLUSIONS: The prevalence of cervical infection associated with C trachomatis was high among these "low risk" women. The syndromic approach is not an efficient tool for detecting this condition, and alternative approaches to evaluation and intervention are required. The syndromic management of vaginal discharge among women seeking family planning and other reproductive health services should focus on vaginal infections, thus enhancing quality of care and addressing women's concerns about their health.

Algorithms↗