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PubMed2001

Coping with changing conditions: alternative strategies for the delivery of maternal and child health and family planning services in Dhaka, Bangladesh.

The door-to-door distribution of contraceptives and information on maternal and child health and family planning (MCH-FP) services, through bimonthly visits to eligible couples by trained fieldworkers, has been instrumental in increasing the contraceptive prevalence rate and immunization coverage in Bangladesh. The doorstep delivery strategy, however, is labour-intensive and costly. More cost-effective service delivery strategies are needed, not only for family planning services but also for a broader package of reproductive and other essential health services. Against this backdrop, operations research was conducted by the Centre for Health and Population Research at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) from January 1996 to May 1997, in collaboration with government agencies and a leading national nongovernmental organization, with a view to developing and field-testing alternative approaches to the delivery of MCH-FP services in urban areas. Two alternative strategies featuring the withdrawal of home-based distribution and the delivery of basic health care from fixed-site facilities were tested in two areas of Dhaka. The clinic-based service delivery strategy was found to be a feasible alternative to the resource-intensive doorstep system in urban Dhaka. It did not adversely affect programme performance and it allowed the needs of clients to be addressed holistically through a package of essential health and family planning services.

Adult↗
PubMed2000

Measuring reproductive health: review of community-based approaches to assessing morbidity.

This article begins by reviewing selected past approaches to estimating the prevalence of a range of morbidities through the use of household or community-based interview surveys in developed and developing countries. Subsequently, it reviews epidemiological studies that have used a range of methods to estimate the prevalence of reproductive morbidities. A detailed review of recent community or hospital based health interview validation studies that compare self-reported, clinical and laboratory measures is presented. Studies from Bangladesh, Bolivia, China, Egypt, India, Indonesia, Nigeria, Philippines and Turkey provide empirical evidence that self-reported morbidity and observed morbidity measure different phenomena and therefore different aspects of reproductive health and illness. Rather than estimating the prevalence of morbidity, interview-based surveys may provide useful information about the disability or burden associated with reproductive health and illness.

Community Health Services↗
PubMed2001

Improving adolescent preventive care in community health centers.

OBJECTIVE: To evaluate implementation of the Guidelines for Adolescent Preventive Services (GAPS) in Community and Migrant Health Centers (CMHCs). DESIGN: Before and after comparison of health center policy, clinician and adolescent self-report, and chart reviews in 5 CMHCs. PARTICIPANTS: Eighty-one preintervention and 80 one-year postintervention providers and 318 preintervention and 331 postintervention 14- to 19- year-old adolescent patients being seen for well visits at 5 CMHCs. INTERVENTION: Health center staff were trained to implement GAPS and were provided resource materials, patient questionnaires, and clinician manuals. MAIN OUTCOME MEASURES: Delivery of and receipt of preventive services and perceived access to care. RESULTS: CMHC systems changes were related to stronger leadership commitment to adolescent care. Providers reported high levels of preventive services delivery before and after guideline implementation. After guideline implementation, adolescents reported increases in having discussed prevention content with providers in 19 of 31 content areas, including increased discussion of physical or sexual abuse (10% before to 22% after), sexual orientation (13% to 27%), fighting (6% to 21%), peer relations (37% to 52%), suicide (7% to 22%), eating disorders (11% to 28%), weapons (5% to 22%), depression (16% to 34%), smokeless tobacco (10% to 29%), and immunizations (19% to 48%). Adolescents were also more likely to report knowing where to get reproductive or mental health services and were more likely to have received health education materials. Implementation also increased documentation of recommended screening and counseling in 51 of 79 specific content areas assessed in chart reviews. CONCLUSION: Implementing GAPS increased the receipt of preventive services at these health centers. Adolescents received more comprehensive screening and counseling, more health education materials, and had greater access to care after implementation. GAPS implementation may help improve the quality of care for adolescents.

Adolescent↗
PubMed1991

Screening for carriers of cystic fibrosis through primary health care services.

OBJECTIVE: To evaluate the uptake of cystic fibrosis carrier testing offered through primary health care services. DESIGN: Carrier testing for cystic fibrosis was offered to patients of reproductive age through primary health care services. SETTING: Three general practice surgeries and four family planning clinics in South West Hertfordshire District Health Authority. SUBJECTS: Over 1000 patients aged 16-44 attending two general practices and four family planning clinics and a stratified random sample of patients aged 16-44 from one general practice's age-sex register. RESULTS: When screening was offered opportunistically the uptake was 66% in general practice and 87% in family planning clinics. Ten per cent of those offered a screening appointment by letter took up the invitation. Of the screened population, 76% had previously heard of cystic fibrosis, 35% realised it is inherited, and 18% realised that carriers need not have any family history. If they found themselves in an "at risk" partnership 39% would consider not having children and 26% would consider terminating an affected pregnancy, but in each case most people were unsure how they would react. CONCLUSIONS: Most people offered a cystic fibrosis test opportunistically wish to be tested, and the responses of those tested indicate that knowledge of carrier state would be considered in future reproductive decisions.

Attitude to Health↗
PubMed1995

Surveillance of family planning services at Title X clinics and characteristics of women receiving these services, 1991.

PROBLEM/CONDITION: Public health surveillance data describing family planning services at Title X clinics and characteristics of women receiving these services during 1991 are contained in this report. These data update previously published information concerning characteristics of women and services at such clinics during 1981. REPORTING PERIOD COVERED: 1991. DESCRIPTION OF SYSTEM: Data characterizing patients and services were reported by family planning clinics to Title X grantees. These data for 1991 were provided by all 75 grantees to CDC's Family Planning Services Surveillance (FPSS) project. RESULTS: In 1991, 4.2 million women received services at Title X clinics. Overall, 69.5% of family planning patients had chosen oral contraceptives as their method of contraception, and 64.7% of patients were at or below the federal poverty level. In addition to information characterizing patients and services at Title X clinics, this report also evaluated current data-collection methods used by Title X grantees. Complexities in the analysis reflected variations in the quality and availability of data, including differences in definitions, data-collection instruments at the clinic level, and data categories. INTERPRETATION: The number and characteristics of family planning patients receiving services at Title X clinics during 1991 were similar to the number and characteristics during 1981. Furthermore, these results underscore the need to improve the quality and timeliness of family planning data and to facilitate program planning and operations at the grantee level. ACTIONS TAKEN: These surveillance findings have been communicated to state family planning administrators and to national Title X program administrators. This information will be used to assess how publicly funded family planning clinics currently contribute to health-care delivery and how these clinics might contribute to a national system of reproductive health-care services in the future.

Adolescent↗
PubMed1998

The school-linked health center: a promising model of community-based care for adolescents.

PURPOSE: To examine the nature of the linkages between school-linked health centers (SLHCs) and schools; the centers' services, staffing, financing, and other operational details; and the advantages of this model of care. METHOD: Twenty-one SLHCs completed a written survey on a range of operational issues, including types of services provided, staffing patterns, budgets, and populations served in 1995. The researchers conducted on-site interviews with six centers and telephone interviews with 14 centers to obtain more detailed information. RESULTS: Although each SLHC has a unique program design, the study identified characteristics common to all sites. In general, SLHCs provide comprehensive medical, reproductive health, mental health, and health education services designed for adolescents. Staffed with a minimum of an administrator, a primary care provider, a nurse, and an administrative assistant, SLHCs serve students from more than one school as well as out-of-school youth. SLHCs develop formal and/or informal linkages with schools to improve outreach and follow-up services. CONCLUSIONS: The report describes a community-based model of care that is designed to provide affordable, age-appropriate, confidential, convenient care to adolescents, a population that traditionally has been very hard to reach. The SLHCs ability to provide reproductive health care makes it an attractive option for communities trying to prevent pregnancy and sexually transmitted diseases among adolescents. To firmly conclude that the SLHC is an effective model for improving adolescent access to services, more research is needed on adolescents' use and nonuse of SLHCs and other models of care; the cost of SLHCs compared to other models of care; and how SLHCs can sustain themselves financially, particularly in a managed care environment.

Adolescent↗
PubMed2000

Monitoring std prevalence and reproductive health care among high-risk adolescent women

Background: Urban adolescent women, particularly those in socially disadvantaged situations are at high risk for infections with Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (GC) and their sequelae. Non-invasive screening technologies, including ligase chain reaction (LCR) and polymerase chain reaction (PCR) urine tests for CT and GC allow for provision of screening services in settings frequented by high-risk adolescents where such services have not been traditionally provided. In 1999, the CDC lead a multi-site project monitoring STD prevalence and reproductive health service, collecting a standard set of variables in women <20 yrs in juvenile justice system, drug treatment centers, and school-based clinics. This report provides preliminary data from Alabama and Colorado. Methods: Adolescent women who present for intake/services at selected facilities are enrolled in the project. In collaboration with CDC, sites developed a set of standard variables to be collected, including demographics, risk behaviors, symptoms, test performed, and test results. Dependent on services already performed, sites added CT and/or GC urine PCR/LCR and pregnancy testing to existing screening protocols.Results: In first 3-months, 533 adolescent women were enrolled in this on-going study; 379 in juvenile institutions, 38 in drug treatment centers, and 116 in school-based clinics. Mean age was 16 yrs, over 90% were sexually experienced, nearly 50% did not use condom with the last sex, less than 40% reported "current" birth control use, over 2/3 had sexual intercourse in past 3 months, many with multiple partners. Prevalence rates for CT and GC are summarized in the table. Conclusions: Non-invasive (urine) LCR/PCR tests allow for easy monitoring of selected STDs among adolescent women in high-risk settings. These findings may contribute to a sentinel surveillance system among high-risk populations and, in turn, may provide the rationale for the development of health care/intervention priorities at policy level.

Journal Article↗
PubMed1993

Training in family planning.

In spite of extensive programmes for training in family planning and extensive services in contraception in the UK, the number of unplanned pregnancies has not decreased. On the contrary it is increasing. Medical graduates are now educated in methods of contraception. There is an extensive programme for postgraduates, regulated by the Joint Committee on Contraception (JCC), which is well integrated and co-ordinated. The provision of good training opportunities at a local level will be enhanced by the establishment of consultant posts in Reproductive Health/community Gynaecology and the development of higher training programmes to meet the projected expansion of these posts. They can play a role in education in reproductive health with respect to sexuality and personal relationships, as well as in the provision of family planning services and training to all reproductive health care professionals and teachers.

Education, Medical, Graduate↗
PubMed1995

Factors associated with adolescent pregnancy in rural Nigeria.

A community-based case-control study to determine the risk factors associated with adolescent pregnancy was conducted in the rural community of Gbongan in southwestern Nigeria. 132 pregnant girls aged 20 years or less were compared with 131 nonpregnant girls of similar age. Information on their sociodemographic characteristics and those of their parents, their knowledge of reproductive health, and practice of contraception were obtained by household confidential interviews and by focus group discussions with parents and adolescents. Univariate analyses revealed a large number of potential risk factors, but after adjustment by logistic regression, only two factors remained significantly associated with pregnancy. These were being married (OR=9.8) and doing an income job as opposed to being an apprentice (OR=4.7). In turn, doing an income job was the only significant factor that predicted marriage in the logistic regression model (OR=1.5). Both pregnant and nonpregnant adolescents had poor knowledge of, and negative attitude toward, contraception, and only a small percentage of them had ever used contraceptives. The authors conclude that pregnancy among adolescents in this community is mostly associated with completion of formal education at an early age by the girls and to their lack of knowledge of reproductive health. Measures that could reduce the high rate of pregnancies among adolescents in rural Nigeria include 1) a program to encourage adolescents to continue formal and informal education, 2) reproductive health education and services for adolescents, and 3) appropriate legislation to discourage early marriage and pregnancy in the community.

Africa↗
PubMed2005

Experiences of pregnant adolescents--voices from Wakiso district, Uganda.

BACKGROUND: In Uganda, morbidity and mortality among adolescent mothers and their children are high. Social factors behind this problem need to be better understood. OBJECTIVE: To explore problems that pregnant adolescents face in order to design appropriate policies and interventions. METHODS: This was a descriptive study that utilized qualitative methods for data collection. The study population comprised of pregnant adolescents, adolescent mothers, opinion leaders, In-charge of health unit, and Traditional Birth Attendants (TBAs) in Wakiso district, Uganda. Six Focus Group Discussions (FGDs) with adolescent mothers and pregnant adolescents, and six key informant interviews were conducted with leaders in-charge of health units and TBAs. A moderator and a note taker facilitated the FGDs, which were tape recorded with consent from participants. Qualitative content analysis was done. RESULTS: Discussions revealed that pregnant adolescents faced domestic physical violence. Furthermore, they were psychologically violated by parents and partners, and the community within which they lived. Pregnant adolescents were treated inhumanely and overworked with household chores and had inadequate food to eat. Adolescents experienced stigma and as a result some had carried out unsafe abortions. Key informant interviews and FGDs revealed that health workers were rude and unsympathetic to pregnant adolescents. This significantly contributed to delayed health care seeking when adolescents were ill. CONCLUSION: Pregnant adolescents lack basic needs like shelter, food and security. They also face relational problems with families, partners and the community. There is, therefore, a need to sensitize the community and school personnel about adolescent reproductive health issues. In addition, adolescent friendly services need to be established/strengthened. Continuous in-service training for health workers with emphasis on counseling skills for young people is urgently needed.

Adolescent↗
PubMed2003

Parents' attitudes to adolescent sexual behaviour in Lesotho.

This study investigated the knowledge, attitudes and opinions of parents on various aspects of adolescents' sexual and reproductive health in Lesotho. The study used a qualitative methodology. Findings reveal that parents are aware that male and female adolescents engage in sexual relationships. Some parents believe that adolescents are too young to initiate sexual activities while others said they don't mind older unmarried adolescents having sex. In addition, parents felt that adolescents do not face discrimination in obtaining family planning services. In relation to passing sexual and reproductive health knowledge to adolescents, there seems to be a dilemma on who should take the responsibility. A number of policy implications have emerged from this study. There should be awareness campaign for parents who are not aware that adolescents engage in sexual relationships. Parents should be encouraged to communicate with their adolescent children on sex-related matters. Government should carry on with the dialogue on introducing sex education in schools curriculum.

Adolescent↗
PubMedDate not supplied

An economic appraisal of alternative strategies for the delivery of MCH-FP services in urban Dhaka, Bangladesh.

The strategy of distributing maternal and child health and family planning (MCH-FP) services at the doorsteps of the clients--through routine visits to the eligible couples by trained fieldworkers--has been instrumental in increasing the contraceptive prevalence rate (CPR), reducing fertility and attaining a considerably high immunization coverage of children and women in Bangladesh. The doorstep strategy, however, appeared to be labour-intensive and costly. With the maturity of the programme, priorities of the national MCH-FP programme have shifted to a stage that calls for more cost-effective service-delivery strategies, capable of offering a broader package of reproductive and other essential health services. The main objective of the present study was to examine the cost and effectiveness implications of the alternative strategies of delivering services from fixed sites--field-tested within an ICDDR,B operations research--in comparison to the conventional (existing) doorstep strategy. The key findings of the economic appraisal indicated that, at the end of the operations research intervention, both cost per birth averted and cost per QALY gained were lowest for the option of delivering services from static (fixed-site) clinics: US$13 and US$17 compared with the corresponding values of US$18 and US$42 for the doorstep strategy. Provision of health and family planning services from clinics--complemented with a reduced system of outreach workers to inform and target the hard-to-reach clients--was found to be the most cost-effective service-delivery alternative.

Adolescent↗