001 – Modern contraceptive utilization and associated factors among epileptic women of reproductive age at public hospitals in Ethiopia
Matiyas Shiferaw1, Mekitie Wondafrash2, Hanna Demissie3, Abel Teshome1, Balkachew Negatu1, Lemi Tolu1.
1St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. 2Saint Paul’s Institute for Reproductive Health and Rights, Addis Ababa, Ethiopia. 3Addis Ababa University, Addis Ababa, Ethiopia
Background: Epilepsy is the most common neurologic disorder globally. Women with epilepsy have a special need for contraception and careful pregnancy planning. They are at risk for potential teratogenicity of antiepileptic drugs. Optimal seizure control before conception and a well-planned pregnancy is crucial for good maternal and fetal outcomes. Objectives: To assess utilization of modern contraceptive methods and associated factors among women with epilepsy at neurology clinics in Addis Ababa, Ethiopia. Methods: A cross-sectional study was conducted among 428 women of reproductive age attending neurology clinics for an epilepsy diagnosis at three referral hospitals in Addis Ababa, Ethiopia from June to December, 2020. Data was collected using a structured and pretested questionnaire administered by a trained interviewer. Multivariable logistic regression was used to identify factors associated with the utilization of contraception. Results: Only 29.7% of the women were using a modern contraceptive method. The contraceptive implants were the most popular method used. Counseling on family planning methods was provided to 36.2% of the participants during their follow up at the clinics. Being married was associated with higher utilization of modern contraceptive methods [adjusted odds ratio (95%, confidence interval) 3.91 (1.80, 8.50)]. Women who were from an urban area [AOR (95% CI) 0.29 (0.11, 0.78)], who had never been pregnant [AOR (95% CI) 0.34 (0.17, 0.68)], and who had never been counseled on contraception [AOR (95% CI) 0.47 (0.28, 0.78)] had lower odds of modern contraceptive method utilization compared to the respective counterparts. Conclusion: In this study, most women with epilepsy were not using a modern contraceptive method. Marital status, place of residence, previous history of pregnancy, and history of family planning counseling were independent predictors of modern contraceptive utilization. Counseling and education about modern contraceptive methods for women with epilepsy at the neurology clinics should be strengthened. Keywords: Epilepsy, teratogenicity of antiepileptic drugs, Contraception, Counselling, Addis Ababa, Ethiopia.
002 – Contraceptive utilization and associated factors among women with diabetes and hypertension in Ethiopia: a cross sectional study
Matiyas Shiferaw1, Alferid Abrar2
1Saint Paul’s Hospital Millenium Medical College, Addis Ababa, Ethiopia. 2Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia.
Background: Medical conditions like diabetes and hypertension put women at higher risk of pregnancy related morbidity and mortality when compared with women without medical conditions. Pregnancy, therefore, should be well planned for women with chronic medical conditions. Effective contraceptive methods should be used to avoid unplanned pregnancy among the women who do not intend to get pregnant. Objectives: To asses the magnitude of modern contraceptive utilization and associated factors among women with diabetes and hypertension. Methods: A facility based cross sectional study was conducted from March 1, 2021 to May 30, 2021 at diabetic and hypertension clinics of Saint Paul’s Hospital Millennium Medical College. Data was collected using a structured and pretested questionnaire administered by a trained interviewers. Descriptive, bivariable and multivariable methods were used to analyze the level of contraceptive use and associated factors. Results: More than two-third (71.4%) of women had ever used contraceptive methods. Among the contraceptive methods, injectables (28.9%) and implants (28.3%) were the most commonly used methods. Almost all (98.4%) used modern contraceptive methods. One-third of the study participants used long-acting reversible contraceptives (LARC). One-third of women were using contraceptive methods at the time of interview. The most common reasons for use and non-use were spacing and desire of having a baby, respectively. Age, education level, relationship status, previous delivery and partner support were identified as significant predictors of contraceptive use in multivariable regression analysis. Conclusion: The overall contraceptive utilization of women with diabetes and hypertension was low. This put them at high risk for unintended pregnancy as their healthy counterparts, but at a greater pregnancy related complications. Hence, strengthening family planning counseling and integrating family planning service with medical care of women with chronic medical illnesses is paramount important. Keywords:Chronic Illness, Diabetes, Hypertension, FP, Counseling, Uptake.
004 – Respectful maternity care during labor and delivery and associated factors among women gave birth in North Showa zone public health institutions, North Showa, Ethiopia, 2020.
Nakachew Sewnet1, Abebayehu Melesew, Getaye Worku, Yeshinat Lakew
1Debre Berhan University, Debre Berhan, Ethiopia.
Background: Respectful maternity care is one of the most important sexual and reproductive health rights of women and facilitating factors to increase access to skilled maternity care. Disrespect and abuse are a violation of human rights and are the main hindering factor preventing skilled birth utilization versus other more commonly recognized deterrents such as financial and geographical obstacles. Objectives: This study aimed to assess respectful maternity care during labor and delivery and associated factors among women who gave birth in North Showa zone public health institutions, North Showa zone, Ethiopia, 2020. Methods: An institutional-based cross-sectional study was conducted among women who got birth in North Showa public health institution from October 20 to November 20, 2020. Bivariable and multivariable logistic regressions were performed to identify statistically significant variables using a cut- off p< 0.2 in the bivariable analysis to identify candidate variables for multivariable logistic regression. Adjusted odds ratio with 95% uncertainty interval was used to declare statistically significant variables based on p<0.05 in the multivariable logistic regression model. Results: The overall prevalence of respectful maternity care during labor and delivery was 48.6 % (95% CI: 44.6%-52.3%). Urban residence AOR=2.6 (95% CI: 1.8, 3.6), being multiparous AOR=1.6 (95% CI: 1.1, 2.3), having planned pregnancy AOR=2.4 (95% CI: 1.3, 4.3) and giving birth in health center AOR=1.6 (95% CI: 1.2, 2.8) were statistically significant factors with respectful maternity care during labor and delivery. Conclusion: This study showed that low prevalence of respectful maternity care during labor and delivery in the North Showa Zone. Therefore, to improve the level of respectful maternity care interventions on specified associated factors need to be implemented. Keywords: Childbirth, Labor and delivery, Respectful Maternity care, Shoa, Ethiopia.
006 – Fertility desire and associated factors among people on antiretroviral therapy users at south Gondar zone public hospitals, 2022
1Debre tabor University, Debre tabor, Ethiopia.
Background: There were approximately 38 million people across the globe with human immune deficiency virus/acquired immune deficiency virus syndrome in 2019. Of these, 36.2 million were adults and a total of this 25.4 million person with human immune virus (67%) were accessing antiretroviral therapy globally. The desire to have children among human immune virus-infected people has signiﬁcant implications for the transmission of human immune virus. In many developing countries like Ethiopia, where the prevalence of human immune virus is high, the risk of human immune virus transmission to the baby is inevitable.Therefore, the aim of the study is to assess the prevalence of fertility desire and factors affecting among people on anti-retrovirus therapy. Objectives: The aim of this study is to assess fertility desire and associated factors among people who have antiretroviral therapy users at South Gondar zone public hospitals, 2022. Methods: Institution based cross sectional study will be conducted from June1- September 30/2022. Four hundred eleven participants will be included in the study.Simple random sampling techniques will be used for hospitals. Systematic random sampling technique will be employed for participants. The data will be collected through face to face interview using pretested structured questionnaire. Binary and multivariable logistic regression model will be used to identify factors associated with fertility desire among people who have antiretroviral therapy follow up. Work plan and budget: The duration of the project will be from June1/2022 to September 30/2022 and the total estimated budget is 31,025.85 Ethiopian birr. Keywords: South Gondar, Fertility desire, Anti retrovirus Therapy, Ethiopia.
007 – Utilization of sexual and reproductive health services and determining factors among women with disability in northwest Ethiopia; A community-based study
Bayew Kelkay Rade, Animut Tagele Tamiru, Getie Lake Aynalem, Eden Bishaw Taye, Mengstu Melkamu Asaye, Endeshaw Admassu Cherkos, Mamaru Melkie
1University of Gondar, Gondar, Ethiopia
Background: International Convention on the Right of Person with Disabilities (CRPD) states that governments must recognize Sexual and Reproductive Health (SRH) as human rights and needs of disabled people as well. Disable women are highly prone to SRH problems like; HIV/AIDS, unintended pregnancy and unsafe abortion. However, the authors did not identify studies that showed real problems/gaps about SRH service uptake and factors influencing the utilization of the service/s. Methods: Community based cross-sectional study was conducted from January 1-30, 2021 in central Gondar zone selected districts. A total of 535 reproductive-age (18-49 years) women with disabilities had been interviewed through face-to-face, and using structured questionnaire. Multistage cluster sampling technique was applied to select study participants. A multivariable binary logistic regression was employed to identify predictors and p-value < 0.05 was a cut-off point to declare statistical significance. Results: The study has found that 33.27% (178/535) women with disabilities utilized at least one SRH services in the last 12 months preceding to the survey. The high odds of utilization were observed among those who had three and more children [AOR=4.85; 95% CI (1.24-9.71)], autonomy to visit health facilities [AOR=3.30; 95% CI (1.45-6.92)], lived with sexual partner [AOR=9.2; 95% CI (2.84-13.60)], exposed to radio/television every day [AOR=5.9; 95% CI (1.26-13.04)], autonomy to visit friends and relatives [AOR=3.95; 95% CI (1.28-12.17)], had a discussion with family members about sexual and reproductive health [AOR=9.36; 95% CI (3.44-17.47)], and started sexual intercourse after the age of 18 years [AOR=7.2; 95% CI (2.51-14.45)]. Conclusion: The uptake of SRH service among reproductive age disabled women was low. Therefore, the concerned governmental and non-governmental organizations need to work at community level to address the above factors to create an inclusive community. Keywords: Disability, FP Uptake, SRH, Gondar, Ethiopia
008 – Concomitant Use of Medicinal Plants and Pharmaceutical Drugs among Pregnant Women in Southern Ethiopia; Prevalence and Associated Factors
Gemechu Gelan Bekele
1Ambo University, Ambo, Ethiopia.
Background: Improving maternal and child health is one of the public health priorities in several African countries including Ethiopia. However, research on the concomitant use of medicinal plants and pharmaceutical drugs among pregnant in Ethiopia is scarce. This study aimed to assess the concomitant use of medicinal plants and pharmaceutical drugs among pregnant women in Southern Ethiopia, 2021. Methods: A community based cross sectional study was conducted among systematically selected 400 pregnant women in Shashamane town, Southern Ethiopia from July 1-30/2021. The data was collected using interviewer-administered structured questionnaire. Binary logistic regression was performed to examine the association between a dependent and independent variables. Results: This study showed that 68 (17%) of the pregnant used both medicinal plants and pharmaceutical drug concomitantly. No formal education (AOR=4.2, 95% CI: 1.3-13.4), Secondary education (AOR=0.1, 95% CI: 0.01-0.99), having medical illness during pregnancy (AOR=5.6, 95% CI: 2.7-11.6), not having ANC follow up (AOR=2.9, 95% CI: 1.3-6.2) and gestational age (AOR=4.2, 95% CI: 1.6-10.7) were significantly associated with concomitant use of medicinal plants and pharmaceutical drugs during pregnancy. Conclusion: This study showed that nearly one in five pregnant women used medicinal plants concomitantly with pharmaceutical drugs. Mother’s educational status, medical illness during pregnancy, having ANC follow up and gestational period were significantly associated with concomitant use of medicinal plants and pharmaceutical drugs. Therefore it is necessary to provide adequate counseling for all pregnant women attending antenatal care regarding the risks associated with drug use during pregnancy on mother and foetus. Keywords: Concomitant use, Medicinal plants, Pharmaceutical drugs, Pregnant Women
009 – Skilled birthing care uptake among women from socially marginalized minorities in the Kambata-Tembaro Zone, Southern Ethiopia
Abebe Alemu1, Biruk Assefa1, Ritbano Ahmed1, Hasen Mossa1, Negesso Gebeyehu2
1Wachemo University, Hossana, Ethiopia. 2Madda Wolabu University, Madda Wolabu, Ethiopia
Background: Globally in 2019, it was reported that 295,000 women die during pregnancy and childbirth every year. In Ethiopia, skilled birthing care service uptake was low. Thus, the study aimed to assess the uptake of birthing care uptake, and associated factors among women from socially marginalized minorities in Kambata-Tembaro Zone, Southern Ethiopia. Methods:A multistage sampling procedure was employed to enroll 521 study participants. Data were entered using EPI- INFO and SPSS-21 for analysis. Bivariate and multivariate analysis was done and the degree of association was assessed using odds ratios with 95% confidence interval and variables with p values <0.05 were declared statistically significant. Results: The magnitude of skilled birthing care uptake among socially marginalized minorities was 19% in the study area. Maternal education, occupation, and awareness of birthing care, pregnancy plan, and number of births, mothers’ lifestyle, and social discrimination were significantly associated with birthing care service uptake in the study area. Conclusion: The prevalence of skilled birthing care uptake among women from socially marginalized minorities was low [19%]. Thus, awareness creation on skilled birthing, improving access to education for women, increasing employability of women, and conducting community forums to avoid social discrimination of minorities are highly recommended.
010 – Proportion and factors associated with intra-procedural pain among women undergoing Manual Vacuum Aspiration for incomplete abortion at Mbarara Regional Referral hospital
Jimmyy Opee1,2, Stephen Bawakanya1, Musa Kayondo1, Leevan Tibaijuka1, Felix Bongomin2, Christopher Orach3, Joseph Ngonzi1
1Mbarara University of Science and Technology, Mbarara, Uganda. 2Gulu University, Gulu, Uganda. 3Makerere University, Kampala, Uganda
Background: Intra-procedural pain (IPP) is common among women undergoing Manual Vacuum Aspiration (MVA) for incomplete abortion. Globally, the proportion varies between 60% to 90% while in Sub-Saharan Africa including Uganda, the proportion varies between 80% to 98%. IPP management during MVA includes Para-cervical block (using 1% lidocaine) or an opioid (using 100mg of intravenous pethidine). Objectives: This study determined the proportion and factors associated with IPP among women undergoing MVA for incomplete abortion at Mbarara Regional Referral Hospital (MRRH). Methods: We conducted a cross-sectional study among women who underwent MVA for incomplete abortion from 17th December 2020 to 28th May 2021. An interviewer-administered structured questionnaire was used and pain assessment was done using VAS considering an IPP as a pain score of 6 or more. The participant characteristics were summarized. The proportion of women with IPP was calculated. We performed multivariable logistic regression to determine the factors associated with IPP. Results: We consecutively enrolled 207 women with a mean age of 25.8 ±5.8 years. The proportion of women with IPP undergoing MVA at MRRH was 82.6% (95% C.I: 76.8-87.2). The factors significantly associated with IPP were age and cervical dilatation. The odds of IPP increased with decreasing age of the women; compared to older women (aged >30 years), teenagers (age <20 years) (aOR=8.0) (p-value=0.005), while women aged 20-24 years (aOR=3.45) (p-value=0.004), and those aged 25-30 years (aOR=2.84) (p-value=0.018). Women with cervical dilatation of 1-2 cm had the odds of IPP increased (aOR=2.27) (p-value=0.024), compared to a cervical dilation of 3-4 cm. Conclusion: The majority of women undergoing MVA at MRRH experienced IPP. Younger women and those with cervical dilatation 1-2cm are more likely to experience IPP. We recommend appropriate improvement of pain control among women undergoing MVA. Keywords: Intra-procedural pain, Manual vacuum aspiration, Incomplete abortion.
011 – Perceived sexual and reproductive health needs and preferences among internally displaced women in a conflict setting in Ethiopia: A qualitative study
University of Gondar, Gondar, Ethiopia
Background: The current war in northern Ethiopia has already harmed thousands of victims and forced millions of people forced to flee internally. Internally displaced women are vulnerable groups that need special attention and assured access to Sexual and reproductive health rights (SRHR). However, their needs and preferences on SRHR are not well known. Therefore, this study aimed to explore the needs and preferences in a conflict affecting communities in the Amhara region, Ethiopia. Method: A descriptive qualitative study was conducted in December 2021 using a semi-structured interview guide. The interview was conducted among a purposive sample of 20 internally displaced women settled in selected humanitarian camps in the Amhara region. After the interviews were transcribed and coded, a content analysis was done using Atlas ti version 7.5 software packages. Result: Psychosocial support, access to antenatal care, intrapartum care, contraceptive service, and safe abortion were the main identified needs of internally displaced women. Access to safe abortion services is urgent and the preferred service in the humanitarian setting. Conclusion and recommendation: Access to SRH services is the major gap in humanitarian settings. In conflict settings, access to innovative SRH interventions like midwifery-led and person-centered comprehensive abortion care services is highly recommended.
012 – Factors associated with sexual violence among waitresses working in Bahir Dar City, Ethiopia: a mixed-method study
Mulugeta Dile Worke1, Habtamu Enyew1, Lealem Bezabih1, Binalu Bezie1, Fantu Eyoas2
1Debre Tabor university, Debre Tabor, Ethiopia. 2Jhpiego-Ethiopia, Bahir Dar, Ethiopia
Background: Workplace sexual violence (WSV) is an incident in which a person is abused, threatened, or assaulted while at work, posing an explicit or implicit threat to their safety, well-being, or health. However, the magnitude and the associated factors were less addressed in low and middle-income countries. Thus, this study aimed to investigate the magnitude, perceptions, and associated factors of WSV among waitresses in Bahir Dar, Ethiopia. Methods: A facility-based convergent mixed-method study with parallel sampling was conducted. The quantitative phase was employed among 406 waitresses. A multistage sampling technique was used to select study participants. A pre-tested structured interview administered questionnaire was used to collect the data. The collected data was cleaned and entered into Epidata version 7 and exported to STATA version 15 for analysis. Binary logistic regression was used to identify independent predictors using odds ratios with a 95% confidence interval and a P < 0.05. A semi-structured questionnaire was also used to collect qualitative data from ten in-depth interviews and six focus group discussions. After transcription of the recorded audios, thematic analysis was performed using the ATLAS ti version 8.4.25 software package. Results: The overall prevalence of WSV was 45.9% (95%CI: 41, 50.8). Waitresses, who had heard about sexual violence and WSV, had witnessed family violence as a child, had a family who valued their honour over their children’s safety and health, and lacked employment opportunities were more likely to experience WSV. Waitresses who worked in emotionally supportive work environments and were educated were also less likely to experience WSV. Conclusions: Many of the waitresses in this study had experienced WSV. This implies that work organisations, both governmental and non-governmental, civic organisations, and other responsible bodies must pay attention to the identified factors. Hospitality workplaces should also develop policies to protect women from WSV.
013 – Reproductive health needs of street dwellers and contribution of stakeholders in southern Ethiopia: A Mixed study design.
Negash Wakgari Amanta1,2, Terefe Woyo3, Emnet Kebede3, Hirut Gemeda3, Samson Gebremedhin4
1Department of Midwifery, Ambo University, Ambo, Ethiopia. 2Executive Board Member, Ethiopian Midwives Association, Addis Ababa, Ethiopia. 3Departments of Midwifery, Hawassa University, Hawassa, Ethiopia. 4School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
Background: Street-dwellers are economically, socially and nutritionally disadvantaged part of the population with lack of knowledge and access of reproductive health service. Hence, this study intended to assess knowledge, attitude and practice of contraception, maternal health service utilization and contribution of stakeholders among street-dwellers in southern Ethiopia. Methods: A mixed study design was conducted among 845 respondents. Snowball sampling technique was used to identify and fill the required sample size. Pre-tested and structured interviewer administered questionnaires were used to collect data. Moreover, a total of 21 in-depth interviews and ten key informants’ interviewees were carried out. Results: In this study, 334(58.5%) of street dwellers had sexually intercourse in the last three months of the study period. Among those who had sexually intercourse in the last three months; 100(11.9%) of them have been using contraception. Most, 690(81.9%) of the respondents were knowledgeable about contraceptive methods. In addition, 756(89.8%) of the respondents had a favorable attitude towards contraceptive methods. About 31(3.7%) of the female respondents were ever had abortions. Moreover, 47(5.6%) of street dwellers had antenatal care for the recent pregnancy they had in the last 2 years of the study period. Among this 9(1.1%) of them were gave birth with the assistance of their friends. Regarding to the postnatal care only 22(2.6%) of the respondents had postnatal care within first 2 days of delivery. Moreover, lack of integration between different sectors is the barrier reported by qualitative finding to address reproductive health needs of street dwellers. Conclusions: In this study, significant percentages of street dwellers were knowledgeable and had a favorable attitude towards contraception. However, contraception use and maternal health service utilization among street dwellers is found to be low. Inter-sectoral collaboration is remaining critical to address reproductive health needs of street dwellers.
014 – Addressing a missed opportunity for postpartum contraceptive use by integrating with infant immunization services in Sidama, Ethiopia: A quasi- experimental study.
Abebaw Abeje Muluneh, Abel Gedefaw, Misganaw Worku, Ayalew Astatkie
Hawassa University, Hawassa, Ethiopia
Background: Globally, unmet need for postpartum family planning is high, while immunization services are among the most widely utilized health services. Establishing a systematic screening, counseling and referral systems from EPI units may improve family planning uptake. This study was aimed to assess the effect of counseling for family planning at infant immunization units on post-partum contraceptive uptake. Methods: A before-and-after quasi-experimental study was conducted in 8 purposively selected health centers in Sidama region, Ethiopia. All mothers coming to the selected health centers for infant immunization from July 06 to September 07, 2020 were screened, counseled and referred for family planning. Quantitative data were collected from a total of 1,422 randomly selected mothers (718 for the pre intervention and 704 for the post intervention phases). EpiData version 3.1 and SPSS version 22 were used for data entry and analysis respectively. Multivariable logistic regression analysis, adjusting for the effects of potential confounders was computed. P value < 0.05 was considered as statistically significant. Results: Contraceptive utilization rate among mothers presented to health centers for infant immunization was 72.7%, 95% CI (69.5, 75.9) and 91.9%, 95% CI (89.8%, 93.9%), before and after the intervention respectively. Utilization of short-acting and long-acting contraceptive methods was increased from 56.8% to 64.3% and 15.9% to 27.8% respectively after the intervention was initiated. After adjusting for the effect of possible confounding variables, counseling for family planning at infant immunization units significantly increases contraceptive utilization rate among mothers presented for infant immunization services, AOR (95% CI) = 5.83(4.02, 8.46) and P< 0.01. Conclusion: screening, counseling, and referring mothers for family planning services at infant immunization units significantly increases postpartum contraceptive uptake. Integrating family planning messages with infant immunization services was recommended. Keywords: Comprehensive contraceptive, immunization, integration, Ethiopia
015 – Late antenatal care initiation and its associated factors among pregnant mothers attending Hawassa Public Health Facilities, South Ethiopia
Wollega University, Nekemte, Ethiopia
Objective: To assess prevalence of late ANC initiation and its associated factors among pregnant women attending in Hawassa Public Health Facilities, South Ethiopia, 2019. Method and materials: Cross-sectional study was conducted from June 15 to August 15 /2019 among 392 pregnant women’s who visited Hawassa city’s public health facilities, Southern Ethiopia for 1st ANC service. Pregnant mothers were enrolled using systematic technique and data was collected using semi- structured questionnaires. Epi-data version 3.1 used for data entry and SPSS version 24 for data analysis was used. Variables at p-value <0.25 on binary model was taken into multivariable logistic regression and finally significance was declared at a P-value 0f < 0.05. Results: The prevalence of late ANC visit was 57.7% (95% CI=52.74-62.57%). Maternal age group, 31- 35 years (AOR=4.93, 95% CI=1.70-14.27), Husband with no formal education (AOR=2.88,95% CI=1.17- 7.314), no previous ANC (AOR=2.03, 95% CI=1.20-3.43), no history of obstetric complications (AOR=4.05, 95% CI=2.06-7.96), Unplanned pregnancy (AOR=2.40,95%CI=1.23-4.68), and no partner support (AOR=2.47,95%CI=1.16-5.26) were significantly associated with increased odds of late ANC initiation. However, Maternal decision making for service (AOR=0.40, 95%CI=0.18-0.87) were significantly associated with decreased odds of late ANC initiation. Conclusion and recommendation: late ANC initiation was high in the study area. Maternal age, husband level of education, previous ANC and obstetric complications, type of pregnancy, maternal decision making, and partner support were significantly associated with late ANC initiation. The City’s health offices need to provide education about danger sign of pregnancy and its complication, create awareness about the importance of early ANC initiation and its recommended time. Keywords: Late Antenatal Initiation
016 – Immediate postpartum intrauterine device utilization and associated factors among women who gave birth in hospitals of western Ethiopia
Gemechu Kejela1, Melkamu Dereje2, Tilahun Bekele1
1Wollega University, Nekemte, Ethiopia. 2West Wollega program office, Gimbi, Ethiopia.
Background: Immediate postpartum Intrauterine Device (IUD) utilization during the postpartum period helps the women to realize the desire of spacing of births and prevent them from unplanned pregnancy. But, many mothers do not get immediate postpartum contraceptives to extend birth interval, to avoid unintended pregnancy and related complications in developing countries including Ethiopia. So, the main aim of this study was to assess the immediate postpartum intrauterine device utilization and associated factors among women who gave birth in Hospitals of western Ethiopia. Methods: An institution-based cross-sectional study was conducted in Hospitals of western Ethiopia on 290 mothers from April 1-30, 2020. A systematic sampling technique was used to select study subjects. Data was collected by the interviewer-administered structured questionnaire and entered by using Epi- data version 3.1 and then exported to statistical package for social science (SPSS) version 24 for analysis. Descriptive analysis and binary logistic regressions were conducted. Factors associated with immediate postpartum intrauterine device utilization were analyzed using a multivariable logistic regression model. Variables with a p-value <0.05 were considered as statistically significant predictors of the outcome variable. Result: In this study, immediate postpartum intrauterine device utilization was 19.3% (95%CI: 14.6, 24.00). Early initiation of antenatal care [AOR=4.46 (95% CI:1.84-10.78)], Planning of pregnancy [AOR=3.7 (95%CI: 1.43-9.54)], Ever heard of immediate postpartum intrauterine device [AOR=2.67(95%CI: 1.08-6.58)] and Counseling on family planning during Antenatal care [AOR=5.15(95%: 2.00-13.28)] were associated with immediate Postpartum intrauterine device utilization. Conclusions: Immediate Postpartum intrauterine device utilization was lower in the study area. Factors like; early initiation of antenatal care, planned pregnancy and having information about the intrauterine contraceptive device were significantly associated with the outcome variable. So, health program managers need to develop strategies to promote utilization of immediate postpartum intrauterine devices through intervening the identified factors. Keywords: Immediate postpartum intrauterine device, women, Hospitals.
017 – Disrespect and abuse during childbirth: self-reported and observed prevalence and associated factors at a university hospital in Eastern Ethiopia
Tamirat Tesfaye Dasa
Hawassa University, Hawassa, Ethiopia. Haramaya University, Harar, Ethiopia.
Background: The disrespect and abuse of women during maternity care are problems that have been hidden behind closed doors. The truth of this situation is beginning to come to light, with grave implications. Disrespect and abuse are factors that significantly impact women’s willingness to seek life- saving care. Therefore, the objective of this paper is to assess the self-reported and observed prevalence and associated factors of disrespect and abuse during childbirth at a university hospital in Eastern Ethiopia. Methods: A mixed-method cross-sectional study was conducted. The data was triangulated with direct observation of provider-woman interaction. Data were collected using the questionnaires by the maternal and child health integrated program. Disrespect and abuse refer to women who have experienced at least one instance of each of seven types of abuse. P-values of less than 0.05 were considered statistically significant. Result: A total of 592 questionnaires were administered to postnatal women, with a response rate of 99%. Trained investigators also directly observed 82 episodes of provider-woman interaction. Twenty- eight percent of women (95% CI, 24.45-31.85) said that they had faced disrespect and abuse. The common types of disrespect and abuse were neglect (101, 17.06%), non-dignified care (100, 16.89%), and unconsented care (60, 10.01%). Observers found that 24 (30%) of the provider-woman interactions included disrespect and abuse. Disrespect and abuse were more common among those reporting rural residence [AOR = 3.32, 95% CI 1.96- 5.64] and having spontaneous vaginal delivery [AOR, 2.03; 95% CI, 1.34-3.00; p=0.001]. Conclusion: Disrespect and abuse during childbirth were reported by more than one in four women. Women from a rural area and those who delivered vaginally reported twice the abuse compared to their counterparts. Interventions to decrease disrespect and abuse should primarily focus on birth attendants at normal deliveries, as interactions between a woman and her provider are longer.
018 – The burden and determinants of anemia among adolescent girls in Ethiopia: A systematic review and meta-analysis
Wollega University, Nekemte, Ethiopia.
Background: Anemia is a condition by which the number of red blood cells or hemoglobin concentration within the body is decreased below the normal level. During adolescence, the iron requirements increase by greater than two folds and this brings a high occurrence of anemia. Besides, adolescent girls in developing countries are at particular risk of developing anemia due to various factors. Objectives: This systematic review and meta-analysis was intended to determine the pooled magnitude of anemia and associated factors among adolescent girls in Ethiopia. Methods: Both published and unpublished articles were extensively searched using various electronic databases as well as digital libraries. All observational studies reporting the prevalence of anemia among adolescent girls and associated factors in Ethiopia were included. The data were extracted by two independent reviewers using a Microsoft Excel spreadsheet and, analyzed with STATA 14.1 version. The Funnel plots and Egger’s statistical test was used to assess the presence of publication bias. The presence of heterogeneity was checked by inverse variance(I2) and the forest plots were used to estimate the pooled prevalence of anemia among adolescent girls using a random-effect model with a 95% confidence interval (CI). A sub-group analysis was done to reduce the underlying heterogeneity. Findings: The pooled prevalence of anemia among Ethiopian adolescent girls was 20.59% (15.79 – 25.40). This systematic review and meta-analysis has shown that the older age (OR=0.30, 95%, CI: 0.13- 0.66), rural residence (OR=0.41, 95% CI 0.34, 0.49), and history of worm infestation (OR=0.13, 95% CI 0.10, 0.16) as independent determinants of anemia among adolescents girls. Conclusion: The burden of anemia among Ethiopian adolescent girls was remarkably high. Intervention focusing on early treatment of intestinal parasites, school nutritional education and iron supplementation should be a priority concern to lessen the burden of anemia among this group of population
019 – Determinants of preeclampsia in Amhara region, Ethiopia: a multi-center case control study
Almaz Getu1, Gedefawe Fikadu2, Muluken Yenesew1
1Bahir Dar University, Bahirdar, Ethiopia. 2Bahirdar University, Bahirdar, Ethiopia.
Background: Preeclampsia is responsible for 16% of direct maternal deaths in Ethiopia. Although little is known about its etiology, studies in other countries identified risk factors associated with preeclampsia. Identifying risk factors has paramount importance in the prevention and early management of preeclampsia. But there are limited studies in Ethiopia. Therefore, the study aimed to identify risk factors associated with preeclampsia in the Amhara region, Ethiopia. The results of the study will help the efforts of the government to reduce maternal mortality. Methods: A multi-center unmatched case-control study was conducted in selected referral hospitals of the Amhara region. A total of 277 cases and 554 controls were included. All cases presented at the time of data collection were included and controls were selected using a systematic random sampling technique. Data were entered, cleaned, and analyzed using SPSS version 20. Descriptive statistics were used to describe the study participant. Bivariable and multivariable logistic regression analyses were employed to identify determinants of preeclampsia. The odds ratio with 95% confidence intervals (CI) was computed to assess the degree of association between preeclampsia and its determinants. Result: Older women (>35 years) [AOR (95%CI), 3.09(1.80-3.35), primigravidae women [AOR (95%CI), 2.32 (1.61–3.35) women with a family history of hypertension [AOR (95%CI), 4.31 (2.37–7.85)], women with twin pregnancy [AOR 95%CI, 3.53(1.77–7.06)], and Anemic women [AOR (95%CI) = 1.49 ( 1.06– 2.1)] had higher odds of being preeclamptic compared to their counterparts. Conclusions: The study identified advanced maternal age, primigravidae, twin pregnancy, family history of hypertension, and anemia as determinants of preeclampsia. Health care providers should be alerted to these risk factors and prioritize screening and surveillance, especially during the third trimester of pregnancy. Keywords: pregnancy, preeclampsia, risk factor, Amhara region, and case-control.
020 – Policy and practice of school-based Sexuality Education from a gender perspective: The case of selected primary schools in Ethiopia and Uganda.
Addis Ababa University, Addis Ababa, Ethiopia
Abstract: However it persisted as a taboo and controversial subject, Sexuality Education/ SE is important for the social-construction of sexuality and gender expectations. Since the 1980s, following the HIV/AIDS epidemic, emphasis on providing youth with sexual health education is increasing in and out of schools in Ethiopia and Uganda. Although, studies show that sexuality education remains unsuccessful to achieve the intended sexuality behavioral change among the youth. The purpose of this study is to understand the policy and practice of school-based SE from gender perspective in the case of two selected primary schools (students being 12-14 years) in Ethiopia and Uganda. Standing on the constructivist philosophical assumption, this study employed theoretically informed ethnographic research design. The study is informed by feminist, neo-institutional and Southern theoretical frameworks. To meet the purpose of the study, classroom and school observations, in-depth interviews, focus group discussions and document reviews were conducted in the natural setting of the participants. The primary informants of the study were SE learners, teachers, school management, and Ministry of Education experts. This presentation focus is only on one of themes i.e. the content of SE. According the preliminary findings, one can argue that in both Ethiopia and Uganda cases, school-based SE contents are found to be trapped in a dilemma between the double function of instilling the existing sexuality and gender values or transforming them. The contents mainly prescribe SE as the remedy to increase HIV/AIDS awareness, gender equality, and body awareness. However, the contents of SE happens to have a deficiency in what learners yearn to know. The study suggests that there is a critical need to bring the questions and experiences of learners to center of the policies and practices of SE.
021 – Precancerous lesion of the Cervix and Associated Factors among Women of West Wollega, West Ethiopia, 2022
Wollega University, Nekemte, Ethiopia
Background: Cervical cancer is a public health problem that contributes to the death of women worldwide. In line with the high burden of the issue, the Ethiopian government had attempted to expand cervical cancer screening centers and recommendation of services to age-eligible as well high-risk groups of women. Therefore, the study aimed to assess the prevalence of precancerous lesions of cervix cancer among women aged 30-49 years and associated factors in West Wollega. Method: Facility-based cross-sectional study was conducted in selected hospitals of West Wollega from January 1-February 20/2022 among 339 women. A face-to-face interview was conducted and the presence or absence of precancerous cervical lesion was tested by visual inspection with acetic acid. Data were analyzed by SPSS version 25. Variable with p-value < 0.25 on bi-variable analysis were entered into multivariable logistic regression. Adjusted odds ratio and corresponding 95% confidence intervals were used to quantify the degrees of association. Results with a p-value ≤ 0.05 were considered as being statistically significant. Result: The prevalence of Cervical Cancer was 27.4% (95% CI: 22.7%-32.1%). A total of 329 women were interviewed, with a mean standard deviation of 35.22 +6.32 years. More than half (63.4%) and 67.6% of them were regarded as having good knowledge and a favorable attitude towards cervical Cancer respectively. Women with a diagnosis of menstrual irregularity [AOR=2.29 (95%CI: 1.29-4.04], women with Sexually transmitted infection [AOR) = 3.46(95%CI: 1.94-6.18)] parity greater than or equal to five and history of steroids uses, [AOR=2.41(95%CI: 1.23-4.75)] and [AOR=3.5(95%CI: 1.32-9.34) respectively. Conclusion and recommendation: The prevalence of precancerous cervical lesions was high. Therefore, Effective primary (HPV vaccination) and secondary prevention approaches (screening for and treating precancerous lesions) should be performed for all women with risk factors. Keywords: Cervical cancer, Knowledge, attitude, and visual inspection with acetic acid
022 – Assessment of contraception uptake after safe pregnancy termination in government health institutions of Bahir Dar City, North-West Ethiopia: cross sectional study.
Liyew Melaku, Getu Dinku
Bahir Dar University, Bahir Dar, Ethiopia
Background: In 2005, Ethiopia’s parliament amended the penal code to expand the circumstances in which abortion is legal. Abortion is largely a product of unintended pregnancy, which can be prevented through use of modern contraceptive methods. Official data regarding provision of abortion and post-abortion care are incomplete in Ethiopia. Objective: The study was conducted to assess contraception uptake after safe pregnancy termination in government health institutions of Bahir Dar City, North-West Ethiopia. Methods: Facility based cross-sectional study was conducted from May 1, 2019 to August 30, 2019 GC, in Bahir Dar City, Northwest Ethiopia. A total of 138 clients were included by using systematic random sampling technique. Data were entered in to EpiData 3.1 and then transported to SPSS 23 software packages for analysis. Descriptive statistics such as frequencies and percentages were computed. Bivariable and multivariable logistic regression models were used to examine the association between independent and dependent variables. The strength of associations was indicated by OR with 95% confidence interval. Variables with P- values < 0.05 were considered as statistically significant. Results: All the participants got counseling on modern contraceptives and 113(81.9%) accepted to use one of the modern contraceptives. Other participants who decided not to use modern contraceptive method planned to abstain from sexual intercourse. Gestational age at current termination was independently associated with contraception uptake. Clients who had gestational age of 9 – 14 weeks (AOR, 6.3(95% CI: [1.4, 28.7], p-value = 0.01) and 14 – 24 weeks (AOR, 9(95%CI: [1.1, 71.9], P-value = 0.03) had better modern contraceptive acceptance than those with gestational age of less than 9 weeks. Conclusion: In conclusion, the post abortion contraceptive acceptance rate was lower compared with other studies done in Ethiopia.
023 – Post Abortion Care utilization and associated factors among women of reproductive age in Lira city- a cross-sectional study
Anena Eunice1,Anna Grace Auma1+
1Lira University, Faculty of health sciences, department of nursing and midwifery
*Corresponding Author: Anna Grace Auma, Tel +256772354232 Email: firstname.lastname@example.org
Background: Post-abortion care has been identified as a priority intervention to improve women’s well-being and advance Agenda 2030. However, there is a low level of post-abortion care utilization. This study therefore aimed at assessing the level of post-abortion care service utilization and associated factors among women of reproductive age in Lira City. Methods: This was a quantitative cross-sectional study conducted among 335 randomly selected women of reproductive age in Lira city. Data was collected using a pre-tested questionnaire. A binary logistic regression model was fitted to identify factors associated with independent variables and AOR was employed to estimate the strength of association between independent and dependent variables. A p-value of < 0.05 was considered statistically significant. Results: Of the total 395 participants, 31.1% had an abortion and 60% had utilized the post-abortion care services. The predictors of post-abortion care services were; social support, income level, and knowledge about complications and stigma. Conclusion: 40% of women of reproductive age in Lira City did not utilize post-abortion care services which puts these women at risk of morbidity and mortality. This is attributed to slow levels of social support, low-income level, insufficient knowledge about complications, and stigma associated with abortion. Keywords: Abortion, Post Abortion Care, Reproductive Age, Women
024 – Utilization of maternal health care (MHC) services in a rural sub-county of Buyende district, Eastern Uganda
Rogers Isabirye1, Samson Udho2
1Entebbe Regional Referral hospital, Kampala, Uganda. 2Lira University, Lira, Uganda
Background: Despite the government’s efforts to promote maternal health care services, full services uptake remains a burden in many remote settings of Uganda. Maternal mortality in the country also remains high at 336 deaths per 100,000 live birth and Buyende district was reported as one of the worst performing in maternal and child health (AHSPR, 2020). We therefore assessed the utilization of three components of MHC (antenatal care use, facility delivery and post natal care utilization) among mothers in Kidera sub-county of Buyende district. Methods: A community based cross-sectional study that used quantitative methods of data collection among 270 respondents. Multi stage sampling and simple random sampling were used to recruit study participants. It involved women of 15 to 49 years, who had at least a child of < 5 years of age. Results: Mean age was 27.59(SD, 6.951), mean parity was 3.25(SD, 2.136), 73.3% were married, 30.4% of the marriages were polygamous. 51.1% had only primary education, 57.8% were peasant farmers and 89.3% were earning less than 100,000 Ugandan shillings monthly. 98.9% utilized ANC at their last pregnancy. Mean ANC visits was 4.44 (SD=1.734). 86.7% had ANC from a government hospital and 59.3% started ANC in the second trimester. 68.9% delivered from a government hospital while 11.9% had home deliveries. 69.3% received immediate postnatal care (PNC) at the hospital within the first 24 hours while others were discharged home before 24 hours elapsed. 98.1% had at least a PNC visit to a health facility in the first six weeks after delivery Conclusion: Findings showed an improved but still sub-optimal utilization of the MHC components assessed. Studies should be conducted to establish the utilization of other components of MHC like emergency obstetrics and family planning services and their associated factors among women of reproductive age in these settings.
025 – Determinants of adolescents’ contraceptive uptake in Ethiopia: a systematic review and meta-analysis of the literature
Alemayehu Gonie Mekonnen1, Daniel Bogale Odo2, Dabere Nigatu3
1Debre Berhan University, Debre Berhan, Ethiopia. 2Arsi University, Arsi, Ethiopia. 3Bahir Dar University, Bahir Dar, Ethiopia
Background: Various studies have identified different factors that affect adolescent contraceptive uptake in different parts of Ethiopia. However, varying results were reported across primary studies and those results need to be systematically collated to inform policies. Therefore, this systematic review aimed to synthesize the findings of those primary studies to obtain more robust and representative evidence about adolescent contraceptive uptake in Ethiopia. Methods: Five databases (MEDLINE via PubMed, Google Scholar, Scopus, Science Direct and CINAHL) were searched for papers published from January 2000 up to June 2021 in English. Seven studies were included in this systematic review and meta-analysis. Heterogeneity between-study was evaluated by forest plot and inconsistency index (I2). Publication bias was checked by Egger’s test. A random-effects model with a 95% confidence interval was used to calculate the pooled estimates of odds ratios. Results: Determinants of adolescent contraceptive utilisation were focused on four levels: individual, socio-cultural, healthcare service and knowledge related factors. Individual-related factors included being young age, currently attending school and adolescents’ level of income, while socio-economic factors include: discussion with family members, arranged marriage, pressure from a partner, harmful traditional practices, discussion with peer groups and sexual partners. Healthcare service-related factors included lack of information about contraceptives during health facility visits, lack of privacy during service provision and inconvenient service hours at health facilities, and not visiting health facilities, whereas, knowledge related factors included having knowledge of contraceptive methods and being heard about contraceptives from media. The overall pooled proportion of adolescent contraceptive uptake was 39%. Conclusions: In Ethiopia, the total proportion of adolescents who used contraception was low. Individual, socio-cultural, health-care-related, and knowledge-related characteristics have all been identified as influencing adolescent contraceptive uptake. Integrated interventions aimed at overcoming barriers to adolescent contraceptive uptake would be beneficial to improving adolescent contraceptive utilization in Ethiopia.
026 – Educational processes and practices of undergraduate Midwifery clinical teaching
SPHMMC, Addis Ababa, Ethiopia
Background: Pre service clinical practice experience is critically important to achieve the maximum level of clinical competence after obtaining adequate theoretical and practical instructions to improve SRH service midwifes deliver. However, graduates have problems in doing some easy tasks. Most new graduates have adequate theoretical knowledge but lack clinical skill competency. The objective of this study was to study the educational process and practice of clinical teaching of undergraduate BSc. midwifery education at Mekelle university, Ethiopia. Method: Institutional based cross sectional exploratory study design. Mixed method data collection is implemented. Quantitative data is collected using structured questionnaire from students, and qualitative data obtained from focus group discussion of midwifery faculty. Quantitative data is processed using SPSS statistical software. Descriptive analysis is made to explain findings. Result: 72.7% said there are enough number of cases available in affiliate clinical attachment sites; 75.8% of them responded those health facilities are well equipped to practice well. 70% said instructors company during clinical attachment help acquire better skill; 60% said tutors relate clinical teaching with theory and simulated teaching. The qualitative data revealed, more time needs to be dedicated for clinical practice, effective curriculum implementation needs emphasis, tutors needs to accompany during clinical attachment, adequate resource needs to be allocated for the practice, preceptorship will improve the clinical teaching where there is shortage of faculty, using facility with high case load and management support as major points to improve clinical skill teaching. Conclusion: Effective clinical practice of students enhances midwifery practice. Students preferred affiliation sites for practice. Instructors company help acquire better skill. Implement preceptorship where there is shortage of faculty. Inadequate infrastructure, equipment and supplies affect clinical practice. Revise curriculum to give emphasis for skill teaching allocating more time for the skill practice.
027 – Utilization of modern postpartum contraceptive methods and associated factors among postnatal mothers in northern Uganda.
JACKLINE AYIKORU1,2,3 and SAMSON UDHO2
1GULU UNIVERSITY, GULU, Uganda. 2LIRA UNIVERSITY, LIRA, Uganda. 3LIRA REGIONAL REFERRAL HOSPITAL, LIRA, Uganda.
Introduction: Modern postpartum contraceptives use significantly reduces maternal mortality and morbidity and yet the level of uptake of these methods remains low. There is a paucity of literature on the predictors of uptake of modern postpartum contraceptives in the context of Uganda in a manner that undermine the design of scalable interventions to increase the uptake of these methods. We aimed to determine the level of utilization of modern postpartum family planning methods and associated factors among postnatal mothers seeking care at a public health facility in northern Uganda. Methods: A cross-sectional study was conducted among 228 consecutively enrolled postnatal mothers seeking care at Lira Regional Referral Hospital. Data were collected using an interviewer-administered structured questionnaire. Data analysis consisted of descriptive statistics, cross-tabulations, and logistic regression at a 95% level of significance in SPSS version 20. Results: Of the 228 participants, 153(68%) were 20 to 29 years of age,140 (61.9%) had an educational level of less than secondary school, and 99(60%) were multiparous mothers who had birthing intervals of more than two years between the last two children. The uptake of modern postpartum contraceptives was 34%. The most used method was injectable (12.3%). Maternal age (AOR: 3.1, 95% CI: 1.1-6.1, p < 0.005), occupation (AOR: 3.8, 95% CI: 1.7-8.3, p < 0.005), source of information about modern postpartum contraceptives (AOR: 0.3, 95% CI: 0.1-0.8, p < 0.005) and postnatal clinic attendance (AOR: 9.1, 95% CI:4.2-19.5, p < 0.005) were independently associated with uptake of modern postpartum contraceptives. Conclusions: The uptake of modern postpartum contraceptive methods is still low in northern Uganda. There is a need to strengthen provision of information on family planning during antenatal and postnatal periods, encourage postnatal clinic attendance, and increase focus on the provision of immediate postpartum family planning methods Keywords: postpartum, family planning, contraceptive, postnatal, and Uganda
028 – Barriers to Contraceptive Access and Use Among Youth (15-24 years) Living in Informal Urban Settlements of Kigali, Rwanda
Emmanuel Okiror Okello1,2, Alexandre Edgard Murinzi1,2, Colyse Nduwimana1,2
1University of Global Health Equity, Butaro, Rwanda. 2Health Development Initiative, Kigali, Rwanda
Background: Contraceptive use among youth in Rwanda is still very low, as low as 3.7% among those below 19 years yet their level of sexual activity is high. By 2020, 42% and 31% of women and men respectively had initiated sex before the age of 20 years. There is no study that looks at the intersectionality involved been contraceptive use and the youth living in impoverished communities, herein our study described as urban informal settlements/slums. 67% of Rwanda’s population is composed of young people below 25 years. Coincidentally, 67% of Rwanda’s population lives in these informal settlements/slums. Youth living in such settings are at increased risk of unintended pregnancies, sexual violence and sexually transmitted infections. Aim: To identify and quantify the barriers to contraceptive access and use among youth, aged 15-24 years, living in urban informal settlements in Kigali Methodology: This study is employing a cross sectional study design, applying a quantitative method in data collection. Data is being collected using a structured questionnaire installed into Kobocollect tool. The study involves 323 participants who are youth residing in 3 informal settlements of Nyamirambo from Nyarugenge District, Gatsata from Gasabo District and Gatenga from Kicukiro District of Kigali city. Simple random sampling is being used to select participants for the study. Ethical approval: This study was approved by the IRB of University of Global Health Equity. Results: We are apparently collecting data and hope that the results will be ready by end of July 2022. Conclusion: This study will generate results that will add to the body of knowledge of the research community in Rwanda and the world at large. These results will also be used to carry out advocacy for youth contraception and identify areas of improvement as far as youth contraceptive access is concerned.
029 – Alcohol over-use among women associated with soldiers after termination of pregnancies : Analysing long-term impacts of abortion in northern Uganda
Grace Akello, PhD1, Christine Chinkin2
1Associate Professor, Gulu University, Faculty of Medicine, Kampala, Uganda. 2Professor, London School of Economics and Poliitical Scinece, London, United Kingdom
Background: In-built within obstetrics and gynaecological care is a clinician’s mandate to terminate a pregnancy whenever a child or mother are in danger. Gynaecologists assess and perform these procedures informed simultaneously by need to save the mother and child, and it is-on-a-case-by-case basis. However, the routine framework neglects women’s right and decision-making to terminate pregnancies. Policy barriers further influence women’s decision-making to terminate their pregnancies. Methods: This is a four-year ethnographic and analytical study with soldiers and people associated with soldiers. I asked various questions including what women associated with soldiers do with unwanted pregnancies and what happens after terminating it. A purposive sample of 26women and 168soldiers (N=194, n=26 women, n=168 men) who were willing to participate and share their experiences was interviewed multiple times. Results: The 26women who had ever terminated a pregnancy attributed their decision to soldier’ absence and lack of support. Soldiers quickly deployed elsewhere, and women lost contacts. Some soldiers did not want long term relationships and pregnancies. Five women terminated their pregnancies because soldiers’ families did not welcome them. One cross cutting characteristic of the 26women was that they abused alcohol to cope with their everyday problems. They blamed men for their challenges and they regretted decisions to terminate pregnancies of children ‘who would have been their future’. Conclusion: Induced abortion can cause mental trauma and depression, lead to alcohol over-use among women and men alike. Although advocates for women’s reproductive and sexual rights have proposed removal/re-revising existing policy barriers, couching decisions to terminate pregnancies within women sexual and reproductive rights framework, this ethnographic study shows precarious long-term social, moral, existential and mental impacts of such decisions. Recommending an abortion due to social challenges have significant relational, mental, existential adverse impacts on women, including over-use of alcohol .
030 – Let’s stop restrictions on contraceptives for teenagers
KIGALI CITY, NYARUGENGE DISTRICT, RWANDA, KIGALI CITY, NYARUGENGE DISTRICT, RWANDA, Rwanda.
Abstract: Mercy Mbabazi died at the age of 14 from severe infection due to unsafe abortion. Although she attempted to use emergency contraceptives to avoid that pregnancy, Mercy was not given the morning after pills because Rwandan laws say that teenagers need permission from their parents or must be accompanied by their guardians to access reproductive health services. Mercy is just one case in an epidemic of teenage pregnancies sweeping Rwanda. Recent data shows that teenage pregnancies in the country have increased by 200 per cent in the last ten years. In the last four years, 78,000 teenage births were reported in Rwanda. And while there’s been a lot of discussion about the need to improve parent-child communication and overcome our “culture of silence” around teen pregnancies, the reality is that there’s something we can do immediately that could have a dramatic impact on teen pregnancies: Change the law so that girls under 18 years old do not have to involve their parents to access contraceptives. Otherwise, we’ll see a continued rise in teenage pregnancies, poorer health outcomes for mothers and babies, and ultimately hurt our prospects for economic growth. In 2019, some 23 million adolescents around the world said they would like to use contraception but do not, due to restrictive laws and policies to access contraceptives as teens in their countries. Yet, teenagers will continue to have intercourse, often against their will. These policies also discourage teenagers from accessing other important reproductive health services, including getting tested for HIV and STIs, antenatal care visits, legal and safe abortions, legal and psychological support all due to the fear that their information would be disclosed to their parents. By providing contraception for teenagers reducing teenage pregnancies, we can position Rwanda for stronger economic growth.
031 – Facteurs associés à l’avortement clandestin dans la ville de Yaoundé : étude transversale analytique
Fouedjio Jeanne Hortence1, Fouelifack Ymele Florent2
1University of Yaoundé 1, Yaoundé, Cameroon. 2institut supérieur des technologies médicales, Yaoundé, Cameroon
Introduction: L’avortement est une opération visant à mettre un terme à une grossesse avant que le fœtus ne soit suffisamment développé pour survivre, dont la durée admise au Cameroun est de 28 semaines d’aménorrhée. C’est une pratique sociale et sanitaire qui existe dans notre pays sous un prisme masqué par le cadre légal restrictif et punitif qui l’entoure, et sa propension croissante induit d’autres fléaux qui affectent notre société, la santé des femmes et la qualité de gouvernance de notre système de santé. Objectif: L’objectif principal de cette étude était de déterminer les facteurs associés à l’avortement clandestin, plus spécifiquement ; définir la prévalence de l’avortement clandestin, évaluer les connaissances des lois sur l’avortement et le souhait d’une loi plus libérale sur l’avortement au Cameroun, recueillir l’opinion et les principales raisons du recours à l’avortement, ressortir le profil des femmes ayant eu recours à l’avortement clandestin et identifier les facteurs pouvant expliquer le recours à l’avortement clandestin. Méthodologie : Cette étude a été réalisée dans le service de gynécologie et obstétrique de trois FOSAs de la ville de Yaoundé, notamment ; HCY, HDBA et HDE pendant une période de 3mois. Il s’agit d’une étude transversale analytique. L’échantillon était probabiliste, non exhaustif et au total 234 femmes âgées de 15 à 49 ans en hospitalisation ou consultation externe ont été recrutées, parmi lesquelles 51e ont reconnues avoir déjà eu recours à l’avortement clandestin. Au cours de l’enquête des données rétrospectives sur la biographie des femmes au moment de l’avortement clandestin ont été recueillies. Résultats: Au total 81 avortement clandestin ont été déclarés, du fait qu’une femme pouvait recourir plus d’une fois à un avortement clandestin. La prévalence de l’avortement clandestin était de 30.7%. La majorité des femmes avaient de bonnes connaissances des lois sur l’avortement (41.5%), et n’ont pas souhaitées qu’une loi plus libérale sur l’avortement soit votée au Cameroun (88%). La majorité des femmes ont déclarés que l’avortement est un acte immoral et criminel (69,30%). Les raisons principales du recours à l’avortement recueillies étaient ; la crainte des parents (23,5%), refus de paternité (19,8%), manque de moyens financier (17,3), l’issue incertaine de la relation (17,3%) et limiter/espacer les naissances /grossesse (11,1%). Les femmes âgées de 20 à 30ans (62%), célibataires (92%), nullipares (52%), élèves (40%) du niveau secondaire (64%) et n’utilisant pas de méthodes contraceptives (89%) avaient plus eu recours à l’avortement clandestin. Conclusion : Les facteurs significativement associés (p < 0.05) à l’avortement clandestin étaient le statut matrimonial de célibataire [AOR :13.6(5.39-34.4)], la nulliparité [(AOR :5.81(2.41-13.9)] et la profession élève [AOR :3.23(1.06-9.81] pour un IC à 95%. Compte tenu de ces constatations nous suggérons ; des campagnes de sensibilisation sur les méthodes contraceptives, le renforcement de l’éducation sexuelle parmi les jeunes. L’adoption de pratique sexuelle saine et des méthodes modernes de contraception. Mots-clés: Avortement, Clandestin, Déterminants, Facteurs.
032 – Contribution de l’avortement non sécurise dans la mortalité maternelle à Yaoundé : étude cohorte
Fouedjio Jeanne Hortence, Medjom Foka
Université de Yaoundé 1, Yaoundé, Cameroon
Introduction: Environ 22 millions d’avortements à risque sont pratiqués chaque année, entraînant la mort de 47 000 femmes et ayant des conséquences à long terme sur la santé de 5 millions d’autres femmes dans le monde. Le risque de décès causé par un avortement à risque est beaucoup plus élevé en Afrique que dans toute autre région du monde. Objectif L’objectif général de l’étude était d’évaluer la contribution des avortements non sécurisés dans la mortalité maternelle à Yaoundé. Méthodologie: Nous avons mené une étude de cohorte comparative avec collecte prospective dans 10 hôpitaux de Yaoundé : hôpital central, hôpital gynéco-obstétrique et pédiatrique, centre hospitalier et universitaire, hôpitaux de district de Biyemassi, Efoulan, Cité verte, Djoungolo, Nkoldongo, Nkolbisson et Soa, pendant une période allant du 01er juillet 2019 au 31 août 2020. Résultats: nous avons obtenu 278 avortements, dont 154 avortements non sécurisés (55,40%). L’âge des participantes variait entre 14 et 47 ans avec une moyenne de 26,97 6,47 ans. La population d’étude était faite en majorité de femmes âgées de 20 à 25 ans (28,06%), célibataires (66,19%), ménagères (31,65%), de niveau d’instruction secondaire (56,83%), résidant en milieu urbain (85,97%), n’utilisant pas de méthode de contraception (91,01%), avec des grossesses indésirées (66,55%) et nullipares (34,53%). L’avortement était réalisé dans un contexte à risque (55,40%). Les facteurs qui augmentait le risque d’avortement non sécurisé étaient l’âge de moins de 20 ans (RR=4,0 ; IC à 95% = 1,59-10,04, p=0,002), le statut célibataire (RR=3,2 ; IC à 95% = 1,91-5,43 ; p=0,001), les élèves et étudiantes (RR=2,1 ; IC à 95% = 1,19-3,60 ; p=0,009), la nulliparité (RR=1,8 ; IC à 95% = 1,07-2,97 ; p=0,025), le fait de ne pas avoir d’enfant (RR=1,65 ; IC à 95% = 1,01-2,72 ; p=0,047), et le non désir de grossesse (RR=29,2 ; IC à 95% = 13,8-61,2 ; p=0,000). Il y avait 97 décès maternels dans l’ensemble dont 09 dus aux avortements notamment non sécurisés, dans un contexte de complications infectieuses graves (55,56%) lors du décès. Le ratio de mortalité maternelle pendant cette période d’étude était de 643 décès maternels pour 100000 naissances vivantes. Le taux de létalité des avortements était de 3,24%. La contribution de l’avortement dans les décès maternels était de 9,28%. Conclusion: L’avortement non sécurisé contribue à 9,28% dans les décès maternels. Il est pratiqué généralement par des jeunes femmes, ne désirant pas de grossesses et n’utilisant pas une méthode de contraception ; avec des complications graves. Il est important de sensibiliser la population sur les risques liés aux avortements non sécurisés et leurs moyens de prévention notamment la contraception, afin d’éviter des grossesses indésirées motivant le recours à ce fléau. Mots clés: Contribution, avortements, non-sécurisés, mortalité, maternelle.
033 – Effet de l’autonomisation des femmes sur l’utilisation actuelle des méthodes contraceptives modernes dans le district de santé de Foumbot – Cameroun : étude transversale analytique
Fouedjio Jeanne Hortence1, Nchagnouot Mouliom Fatima Mouliom Fatima, Kamgno Joseh
Université de Yaoundé 1, Yaoundé, Cameroon
Introduction: L’influence de l’autonomisation des femmes sur l’utilisation des méthodes contraceptives modernes par les femmes est de plus en plus reconnue par les chercheurs. Cependant, très peu d’études sont disponibles dans le contexte camerounais. Objectif: D’où l’intérêt de cette étude, dont l’objectif était d’examiner l’effet de cinq dimensions de l’autonomisation des femmes aux niveaux individuel et communautaire sur l’utilisation actuelle des méthodes contraceptives modernes chez les femmes en union en âge de procréer dans le District de Santé de Foumbot, Cameroun. Méthodologie: Nous avons conduit une enquête de type transversale analytique, de Juin à Juillet 2019 auprès de 390 femmes en union, âgées de 15 à 49 ans et ayant un besoin de contraception satisfait ou non. Nous avons utilisé des modèles de régression logistique multiniveaux pour évaluer l’influence de cinq dimensions de l’autonomisation sur l’utilisation actuelle des méthodes contraceptives modernes. Les cinq dimensions étaient : la mobilité, la relation entre les conjoints, le pouvoir de décisions dans le ménage, le pouvoir de décisions en matière des soins de santé, et le pouvoir de décisions économiques. Résultats: Des cinq dimensions de l’autonomisation, le pouvoir de décisions en matière des soins de santé a obtenu les scores les plus bas. Seules 8% des femmes pouvaient décider des soins de santé les concernant, 12% des femmes disposaient de l’autonomie décisionnelle concernant le nombre d’enfants désirés du couple et seulement 15% des femmes pouvaient quitter leur domicile sans autorisation. Nos résultats montrent que 44% des femmes de l’échantillon utilisaient au moins une méthode contraceptive moderne, dont 34% pour espacer les naissances, et 10% pour les limiter. Dans les modèles multivariables ajustés, deux dimensions étaient significativement associées à l’utilisation actuelle des méthodes contraceptives modernes, la mobilité au niveau individuel et le pouvoir de décisions dans le ménage au niveau communautaire. La probabilité qu’une femme de notre site d’étude utilise une méthode contraceptive moderne peut-être estimée à 27% si elle a obtenu le score le plus faible (-13,1) pour la mobilité, contre 63% si elle a obtenu le score le plus élevé (11,5). En revanche, concernant le pouvoir de décisions dans le ménage, une femme vivant dans une communauté ayant obtenu le score le plus élevé (10,2) a une probabilité de 40% d’utiliser une méthode contraceptive moderne, contre 66% si elle vit dans une communauté ayant obtenu le score le plus faible (1,3). Conclusion: Les efforts visant à accroître l’utilisation des méthodes contraceptives modernes par la promotion de l’autonomie des femmes devraient être axés sur des interventions ciblant la mobilité des femmes. Les études futures sur l’autonomisation des femmes pourraient tirer profit de l’emploi préalable des méthodes qualitatives visant à explorer les dimensions clés qui mesurent réellement l’autonomisation des femmes dans un contexte socioculturel particulier avant de mener des enquêtes quantitatives. Mots clés: autonomisation des femmes, contraception, planning familial, Cameroun.
034 – Obstacles à l’utilisation de la contraception moderne à Yaoundé
Fouedjio Jeanne Hortence
Université de Yaoundé 1, Yaoundé, Cameroon
Introduction: La problématique est la prévalence contraceptive moderne faible au Cameroun de l’ordre de 16 %. Pourtant, la contraception est l’une des stratégies efficaces de lutte contre la mortalité maternelle car elle peut être réduire de 27% si tous les couples désirant espacer ou limiter leurs grossesses avaient accès aux services de Planification familiale. Objectif: identifier les obstacles à l’utilisation de la contraception moderne Méthodologie: nous avons mené des études transversales descriptives et études CAP Résultats La moyenne d’âge était de 26 ans avec des extrêmes de 15 à 49 ans. La plupart des clientes étaient célibataire, sans emploi, multipares et avaient un niveau d’instruction moyen.. Les clientes étaient recrutées en postpartum (28,3%), post abortum (24,2%) et dans le service de planification familiale (47,4%). Elles bénéficiaient d’un councelling selon l’approche REDI pour le choix des différentes méthodes contraceptives. Le condom masculin était la méthode la plus utilisée de manière générale (70%) tandis qu’en postabortum, les méthodes de longue durée étaient plus choisies notamment les implants (20%), le injectables (6,1%) et le dispositif intrautérin (5,2%). Ceci s’expliquerait par le fait que la plupart des avortements étaient provoqués car les grossesses étaient non désirées et certaines femmes utilisent l’avortement comme un moyen pour planifier les naissances. En ce qui concerne la contraception d’urgence, les méthodes fréquemment utilisées étaient: le levonorgestrel 61,5%), la méthode de YUZPE (36 ,5%). Les raisons de non utilisation de la contraception étaient: – La perception de la contraception comme un facteur favorisant les comportements sexuels à risque tels que les rapports sexuels non protégés et les rapports sexuels précoces (70,6%); – La peur des effets indésirables (42,2%); – Barrières socioculturelles (31,8%); – L’inaccessibilité de certaines méthodes contraceptives. Conclusion: Les méthodes de longue durés d’action sont plus choisies en post abortum: – Le niveau de connaissances des prestataires de soins sur la contraception moderne est faible – L’inaccessibilité est un obstacle à l’utilisation de la contraception moderne. Suggestions: – Renforcer les capacités des prestataires sur la contraception moderne à travers les formations continues – Promouvoir la distribution communautaire des méthodes contraceptives. Mots clés: contraception, planning familiale, avortement.
035 – Impact of training on uptake of family planning methods in four hospitals in Rwanda
Samson Habimana1,2,3, Kenneth Ruzindana4, Diomede Ntasumbumuyange4, Stephen RULISA4
1Nyagatare Hospital, Nyagatare, Rwanda. 2Mount Kenya University, Kigali, Rwanda. 3Atlantic International University, Honolulu, USA. 4University of Rwanda, Kigali, Rwanda
Background: Availability of health care providers trained in family planning delivery increase uptake of family planning methods and this increased uptake is needed to address the problem of unmet needs for family planning. Unmet needs for family planning in Rwanda are currently estimated at 14%. Center for Reproductive Health Training at the University of Michigan (UM-CIRHT) together with University of Rwanda has conducted a training (in multiple sessions) of health care providers in four hospitals in Rwanda hosting obstetrics and gynecology residents, medical, nurse and midwives students. This study was aimed to assess the impact of training on family planning uptake in family planning services in four hospitals which have benefited from the very training. Methods: We have conducted a cross-sectional study in four hospitals namely, data were collected from family planning clinics. Data about uptake of family planning methods before and after training have been collected, paired t-test has been used to determine the difference in uptake of family planning before and after training and p value of 0.05 has been considered as statistically significant. Results: There has been an increase in uptake of family planning methods after training and this increase is statistically significant at one study site (Rwamagana Hospital) with p value of 0.01. In addition, there has been a statistically significant decrease in uptake of IUD after training at Muhima hospital, p=0.016. The decrease in IUD uptake after the training was not statistically significant at Rwamagana and CHUB (p values were respectively 0.264 and 0.15). One hospital (CHUK) has no recorded data before training. After training, there has been an increase in uptake of implants (implanon and jadelle) in all three hospitals with p values of 0.158; 0.013 and 0.85 for Muhima, Rwamagana and CHUB respectively. This change from IUD to implants might have resulted from provider competences and from change of client’s preferences after counseling and discussion of different methods with the health care provider. Conclusion: After training of providers on family planning, there is an increase in family planning uptake and a selective shift to some specific methods according to their competences. Intervention to improve family planning uptake should include capacity building of health care providers.
036 – DUAL CONTRACEPTION AMONG FEMALE COMMERCIAL SEX WORKERS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS
Felix Bongomin1, Ronald Olum2, Jerom Okot1, Bethan Morgan3, Anna Grace Auma4, Peninah Nannono1, Alex Male Kato1, Simple Ouma5, Francis Pebalo Pebolo1
1Gulu University, Gulu, Uganda. 2Nsambya Hospital, Kampala, Uganda. 3Manchester University NHS Foundation Trust, Manchester, United Kingdom. 4Lira University, Lira, Uganda. 5The AIDS Support Organization, Kampala, Uganda
Background: Female commercial sex workers (FCSWs) are at increased risk of both unintended pregnancies and sexually transmitted infections (STIs), including HIV, which could be minimized through dual contraception. We aimed to determine the pooled prevalence of dual contraception and contraceptive mix among FCSWs in Africa. Methods: MEDLINE, EMBASE, African Journal Online, and Google Scholar were searched all years through May 2022. Bibliographies of review articles and retrieved articles were searched to identify additional articles. There was no language restriction. Observational and interventional studies reporting dual contraceptive use among FCSWs in Africa. Reviews and case reports and series were excluded. Two reviewers independently assessed study quality using the modified New Castle Ottawa Score. Data were extracted on proportions of dual contraceptive use, methods, and associated factors. Random-effects and fixed-effect models meta-analysis as appropriate using STATA version 17.0. Prospero registration:CRD42022323848 Results: We included 13 studies, involving 128,984 FSW from 10 African countries; Tanzania (n=120,127, 2 studies) Cameroon (n=1,292, 1 study), Ghana (n=212, 1 study), Kenya (n=2,211, 3 studies), Madagascar (n=986, 1 study), Swaziland (n=325, 1 study), Uganda (n=1,219, 2 studies), Zambia (n=946, 1 study), Burkina Faso, Togo and Swaziland (n=1,666, 1 study). Dual contraception prevalence ranged from 4 — 91% across individual studies, with a pooled prevalence of 30% (95% Confidence Interval [CI]: 14—45; I2 = 99.92%, p < 0.001). HIV prevalence ranged from 1—55% across studies, with a pooled prevalence of 24% (95% CI: 13—34; I2 = 99.89%, p < 0.001). Conclusions: Dual contraception remains low among FSW in Africa, with only about 1 in 3 individuals utilising these essential reproductive health package. Moreover, HIV prevalence is unacceptably high in this population. Targeted strategies to improve utilisation of dual contraception among this marginalised population is recommended to reduce the incidence of HIV infection and other STIs.
037 – Factors associated with male partner involvement in Family Planning services utilization in Barapwo Sub-county, Lira city, Uganda
Raymond Otim1,2, Deborah Ahimbisibwe1, Henry Ochola2, Harriet Akello2, Beatrice Lanyero2, Sande Ojara2,3
1Lira University, Lira City, Uganda. 2St. Mary’s Hospital Lacor, Gulu City, Uganda. 3Gulu University, Gulu City, Uganda
Background: Male partner involvement in family planning (FP) services utilization is an important public health intervention aimed at abating the upsurge of maternal mortality related to un-intended pregnancy and unsafe abortions. Male partner involvement increases both the uptake and continuation of FP use. However, little is known about the determinants of male partner involvement in FP services utilization in Lira City. Objective: To determine factors associated with male partner involvement in FP service utilization and continuity in a rural community in Northern Uganda Methods: A mixed-method study was conducted among men aged 18 – 50 years in Barapwo sub-county, Lira city, Uganda. Quantitative data was collected using a standardized interviewer administered semi-structured questionnaire and qualitative data using a key informant interview. The study recruited 3 key informants. Results: A total of 122 participants were enrolled. The median age 48 (range: 36-45) years. Overall, 122 (68.0%) participants were involved in FP services utilization of their spouses. Spousal communication accounted for 63.4% (n=122) of the participant. Factors associated with male partner involvement include; Age of the respondent (aOR: 0.091, 95% CI: 0.027 — 0.393, p < 0.001), marital status (aOR: 0.105, 95% CI: 0.015 — 0.722, p=0.022), number of wives (aOR: 2.826, 95% CI: 1.192 — 6.699, p=0.018), number of children (aOR: 0.262, 95% CI: 0.094 — 0.735, p=0.011), and discussion among partners (aOR: 0.029, 95% CI: 0.007 — 0.120, p < 0.001). Qualitative analysis revealed men who had knowledge on FP generally encouraged their spouses to utilize family planning methods and vice-versa. Conclusions: Discussion among partners influenced decisions on family size and male involvement in uptake and continuous utilization of FP services. Male partner awareness of FP was high but majority had a negative attitude towards FP services. Therefore, there is need to escalate male friendly reproductive health services and clinics educating men about the relevance of their involvement on FP services utilization and other SRHR services. Key words: male involvement, factors, family planning service utilization
038 – Contraceptive decision-making and use in sexual relationships among Addis Ababa university students, Addis Ababa, Ethiopia: A phenomenological study.
Nebiyat Lemma,Endalew Gemechu Sendo, Workinesh Sineshaw
Addis Ababa University, Addis Ababa, Ethiopia.
Background: Research on contraceptive use and decision-making among Ethiopian students in higher education institutions is scarce. The aim of this qualitative study was thus to learn about the perspectives of young women and men in sexual relationships on contraceptive decision-making and use. Methods: A Phenomenological qualitative study design was employed for this study. The participants were recruited using purposeful sampling. Twenty eligible study participants [10 female and 10 male] were interviewed face-to-face. Data were analyzed concurrently with data collection from February 2nd to March 15th, 2022. Thematic analysis was done for the study, which comprises three stages: data reduction, data display, and data conclusion. Both a priori codes (from the query guide) and emerging inductive codes were used in the study. Results: The analysis of the data from the in-depth interviews revealed three overarching themes that are consistent with the study’s aims, namely: types of relationships, level of communication, and contraceptive decision-making with a partner, and contraception use. In this study’s analysis, the first emerged theme was the types of relationships, which may be divided into two categories: dating/causal and intimate partnerships. Participants described their relationship with their partner as intimate and exciting, which includes feelings of emotional closeness and connectedness. On the other hand, participants in the causal relationship claimed that while they now spend time together and enjoy themselves, they lack open communication and trust in their relationship. The second theme that emerged was the level of communication and decision-making with partners. Men and women in close relationships, according to our data, feel comfortable discussing their sexuality and contraception use. Most discussions were believed to be initiated by the male partner, and the majority of the decisions were made jointly, according to our findings. According to the study’s findings, the degree of intimacy with their partner in a relationship, their partner’s desire, and contraceptive-related concerns are all factors that impact contraception use decision-making. The majority of male and female interview participants stated that the length of a relationship was an important consideration when deciding whether or not to use contraception. Participants in stable long-term relationships were more likely to choose protection than those in short-term relationships. The third theme that emerged from the in-depth interview analysis was contraception use which has five categories: types of contraception used, concerns and doubts about adverse effects of contraception use, reasons for contraception use, trust between partners determines contraception use, and barriers to contraception use. The findings of this study demonstrated that communication and using contraception is a common practice and is accepted as a positive thing on campus, mostly to prevent unexpected pregnancy. The major obstacles to using contraception are believed to be a lack of available contraceptives on campus and cost-related concerns. The university administration and other interested stakeholders need to pay close attention to efforts to increase the use of contraceptives among high-risk young university women while helping guide actions to involve young men in making contraceptive decisions on campus. Keywords: Decision-making, contraception use, Addis Ababa University, Ethiopia.
039 – Predictors of intrauterine contraceptive device (IUCD) uptake among women of reproductive age in rural northern Uganda
Samson Udho, Susan Akello, Anna Grace Auma
Department of Midwifery, Faculty of Nursing & Midwifery, Lira University, P.O. Box 1035, Lira, Uganda
Background: Intrauterine Contraceptive Devices (IUCD) is a highly effective method of contraception and yet it is underutilized. In Uganda, scanty literature exists on the uptake of IUCD among rural women of reproductive age (WRA). We aimed to determine the predictors of IUCD uptake among WRA seeking care at a rural health facility in northern Uganda. Methods: A cross-sectional study was conducted among 203 selected women aged 15 to 49 years at Alebtong Health Center IV, Alebtong District, northern Uganda. Data were collected using an interviewer-administered structured questionnaire. Data collected included sociodemographic characteristics, individual, and facility-related factors. Data analysis consisted of descriptive statistics, cross-tabulations, and logistic regression at a 95% level of significance in SPSS version 25. Results: The mean age of the study participants was 28.11±6.59 years, nearly two-thirds (62.1%) had attained primary-level education, while 84.2% of the participants were married. Of the 203 participants, only 16.2% had ever used IUCD. Predictors of IUCD uptake were: being single (AOR: 7.93 95% CI: 0.07-3.79 p=0.019); good knowledge on IUCD (AOR: 25.46 95% CI: 21.64-26.75 p=0.008); satisfaction with IUCD (AOR: 6.86 95% CI: 3.74-8.37 p=0.003); and good attitude towards IUCD (AOR: 14.17 95% CI: 9.34-14.84 p=0.021). Conclusion: Only 1 in 6 of the study participants used IUCD as a method of contraception. The Ministry of Health and supporting stakeholders should combine efforts to build synergy to strengthen the uptake of IUCD as a method of contraception among women in rural northern Uganda. Keywords: ‘Intrauterine Device’; Utilization; Predictors; ‘Women of Reproductive Age’; ‘Northern Uganda’.
040 – Working together: interprofessional and global collaborations for reproductive health research training in Sub-Saharan Africa.
Julie Buser, Ella August, Rachel Gray, Faelan Jacobson-Davies, Tamrat Endale, Yolanda Smith
Center for International Reproductive Health Training (CIRHT), University of Michigan, Ann Arbor, USA
Background: Interprofessional and global training collaborations have the potential to enhance reproductive health outcomes in sub-Saharan Africa. Healthcare professionals often lack comprehensive training to conduct research crucial to identifying context-specific solutions to better meet the reproductive health needs of women and girls. To strengthen capacity in global reproductive health, the Center for International Reproductive Health Training at the University of Michigan (CIRHT-UM) collaborates with Schools of Nursing and Midwifery and Departments of Obstetrics and Gynecology at partner health institutions to enhance effective family planning (FP), comprehensive abortion care (CAC), and sexual and reproductive health and rights (SRHR). Methods: CIRHT-UM facilitates training for faculty and trainees to develop their skills as independent research investigators through hands-on workshops, webinars, coaching, and courses, as well as access to our carefully curated open-access research toolkit. The competitive seed grants we award to researchers at our partner institutions enhance this training by allowing awardees to carry out their own research while receiving guidance throughout the research lifecycle. To support the sustainability of this initiative, CIRHT-UM coaches partner institutions on research administration and fosters inter-institution networking among African researchers through conferences and online communities of practice. Importantly, the Ministries of Health and policymakers are involved in each country, including in the research projects, mentoring and training. Research training is ongoing in Rwanda, Uganda, and Ethiopia, and is being planned in Cameroon, Benin, and Zambia. Results: Global interprofessional collaborative reproductive health training and research strengthening activities are active with partner institutions in several sub-Saharan African countries. CIRHT-UM conducts research gap analyses for faculty at each new prospective partner institution to determine specific research training needs. CIRHT-UM partners with the PREPSS (Pre-Publication Support Service) to provide writing support, identify target peer-reviewed journals for manuscript submissions and provide guidance during the publishing process. After 66 initial seed grants were awarded in Ethiopia, CIRHT-UM awarded 89 seed grands in Rwanda and Uganda. To date, 46 manuscripts are published and 20 are under review or in preparation. More than 120 abstracts have been submitted to various national and international scientific conferences. Conclusions: CIRHT-UM initiatives promote interprofessional education for improved healthcare in Africa and beyond. CIRHT-UM continues to share global reproductive health program lessons learned with a wider audience through international conferences, peer-reviewed publications, grand rounds, a webpage, and social media updates. Within CIRHT-UM programs, interdisciplinary and South-South collaborations are encouraged. Moving forward, CIRHT-UM and our partners will improve the lives of women and girls in Sub-Saharan Africa and beyond by strengthening FP/CAC/SRHR through research and public policy.
041 – Gulu University Reproductive Health Simulation Training for Final Year Medical Students and Medical Interns: Feasibility and Self-Reported Efficacy
Pebalo Pebolo, Felix Bongomin, Jerom Okot
Gulu University, Gulu, Uganda
Background: Simulation-based training (SBT) has been shown to augment bedside teachings and enhance clinical competence at various levels of training. The use of SBT has not been well studied in Uganda. We aimed to assess the impact of a comprehensive SBT on major reproductive health emergencies and procedures on competencies of 5th-year medical students and medical interns in Gulu University (GU) and Gulu University Teaching Hospitals (GUTHs). Methods: We conducted a 4-day hands-on covering the following areas of reproductive health training: adult learning, communication in reproductive health, infection prevention, and control knotting techniques labor and delivery, vacuum-assisted delivery, cesarean birth, Manual Vacuum aspiration, obstetrics hemorrhage, neonatal resuscitation, family planning skills. 5th-year medical students of GU and medical interns of GUTHs rotating in obstetrics and gynecology constituted the trainee population. A self-administered pre-and post-course test, consisting of 43 multiple choice questions was completed by the trainees. Paired sample student’s t-test was used to compute the difference between the pre-and post-training scores. P< 0.05 was considered statistically significant. Results: A total of 38 5th-year medical students and 20 interns completed both pre-and post-tests. Overall, post-test scores were significantly higher than pre-test scores (66.4±8.2% vs. 59.8 ± 14.8%, p < 0.001). The mean difference in pre and post-test scores was higher for fifth-year medical students compared to medical interns (17.7±10.1% vs. 7.3±3.7%, p < 0.001). The mean difference in pre-and post-test scores were significantly higher for intern nurses compared to other interns (14.5±3.4% for intern nurses (n=2) vs. 8.8± 3.2% for intern midwives (n=9) vs. 5.1±3.9% for intern doctors (n=9), p < 0.001). Conclusions: SBT was feasible and effective in transferring key competencies and skills to medical students and interns. This could be adopted in medical schools and for continuous medical education for qualified healthcare workers.
042 – Partnership of Health Professional Associations with training institutions to improve Comprehensive Abortion Care (CAC) training: A case study in Uganda
Simon Peter Kayondo1, Dan Kaye2, Francis Pebalo3, Othniel Musana1, John Paul Nsanja1
1The Association of Obstetricians and Gynaecologists of Uganda, Kampala, Uganda. 2The Association of Obstetricians and The Association of Obstetricians and Gynaecologists of Uganda of Uganda, Kampala, Uganda. 3Department of Reproductive Health, Gulu University, Uganda, Gulu, Uganda
Background: Unsafe abortion remains a major cause of maternal mortality in Uganda (MMR 336/100,000 live births) and in many countries with restrictive abortion laws. In Uganda, it contributes 8% of maternal mortality (MPDSR report 2021). Negative attitudes of health workers, limited understanding of abortion laws, and limited skills remain a hinderance to offering quality Comprehensive Abortion Care (CAC) services. Thus, training health workers on CAC, pre and in-service is an essential part of the solution. Gulu University was identified for support by Centre for International Reproductive Health Training (CIRHT-Africa/CIRHT-University of Michigan) to improve training and delivery of CAC services to meet this need. They in turn identified the Association of Obstetricians and Gynaecologists of Uganda (AOGU) as a partner due to their extensive work along the spectrum of CAC for over 35 years from prevention of unwanted pregnancy, abortion harm reduction, abortion advocacy, to quality post-abortion care. Methods: In November and December 2021, Gulu University partnered with AOGU to do Training of Trainers (TOTs) for lecturers at Gulu University and health providers from teaching hospitals of Lacor and Gulu. A one-day Values Clarification and Attitude Transformation (VCAT) training for 22 participants, and a 4-day clinical training using simulation including Manual Vacuum Aspiration (MVA) for 27 participants, were done. VCAT assists participants self-examine their values and beliefs about abortion, aimed at positively transforming their attitudes and practices towards abortion. To assess the impact of the trainings, pre- and post-training tests were administered. Follow-up for observable change among the trainees was further done by the Gulu Simulation laboratory secretariat from January 2022. Results: 22 lecturers and health workers were trained in VCAT and 27 in clinical simulation. Post-training tests showed an overall improvement in participants’ knowledge and skills for simulation training, and a positive attitudinal shift after VCAT. Since the TOTs, observable changes have been reported in the following areas: – Eight of 22 participants in the TOTs, have already given 80 medical students from Gulu University and 24 intern doctors from Gulu and Lacor hospitals clinical simulation training at Gulu simulation laboratory. – There has been a 60% increase in MVA use for abortion care in Gulu hospital over five months after training, Jan to May 2022, (210 MVAs) as compared to Aug to Dec 2021, (131 MVAs). – About 40 educational videos were produced through the Gulu simulation laboratory recording studio, with views exceeding 1400. https://youtube.com/c/pebalofrancispebolo – There has been a reported improvement in health provider attitudes when handling patients seeking CAC. Conclusion: Health professional associations have a big role to play in pre-service training in Sexual Reproductive Health and Rights service delivery standards including CAC. Because many components of CAC are not well taught in medical and nursing schools, they are forced to carry out continuous in-service training to plug these gaps. If these associations can work together with pre-service health training institutions, through TOTs for tutors, it can assist produce better CAC service providers, hence reducing the bad outcomes as a result of unskilled providers with a poor attitude towards CAC.
043 – Interventions for Preventing Unintended Repeat Pregnancy among Teenage Mothers: A Review of The Evidence and Lessons for Low-Resource Countries
Lira University, Kampala, Uganda
Background: Rapid repeat pregnancies expose young mothers and their children to multiple health and socioeconomic risks. However, in low-resource settings, little evidence for the effectiveness or cost-effectiveness of any of the interventions to reduce repeat pregnancy in young women was found. Thus, the available literature was reviewed to establish interventions for preventing unintended repeat pregnancy among teenage mothers. Methods: The author searched databases for evaluations of interventions published in English. The author included evaluations that assessed a programmatic intervention specifically designed to prevent rapid repeat pregnancy (occurring less than 24 months after the index birth) or birth (occurring less than 33 months after the index birth), or that reported on a contraceptive continuation for at least 2 years. Results: The reviewed literature showed that many repeat conceptions occurred in the context of poverty, low expectations and aspirations and negligible opportunities. The available literature shows that the most effective interventions were contraceptive services and information, postpartum contraceptive counselling and services provided soon after delivery, preparing contraceptive plans, social and behavioural change activities and activities that provide mentoring, goal setting, and motivation. Conclusion: Evidence from the available literature may provide adolescent-friendly methods for preventing teenage and rapid repeat pregnancy. Published research highlighted the importance of context, motivation, future planning and giving young women a central and active role in the development of new interventions. The result may benefit policymakers and stakeholders to improve the prevention of repeat teenage pregnancy. Keywords: Teenage pregnancy, Prevention, Repeat conception.
043b – Association between Chlamydia trachomatis, Neisseria gonorrhea, Mycoplasma genitalium, and Trichomonas vaginalis and Secondary Infertility in Cameroon: A case-control study.
Clarisse Engowei Mbah1,2, Amy Jasani3, Kristal J. Aaron3, Jane-Francis Akoachere1,2, Jules Clement Assob Ngeudia4
1Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon. 2Institute of Medical Research and Medicinal Plants Studies, Center for Research on Health and Priority Pathologies, Yaoundé, Cameroon. 3Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, USA. 4Department of Laboratory Medicines, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
Objective: Data on the prevalence and etiology of infertility in Africa are limited. Secondary infertility is particularly common, defined as the inability of a woman to conceive for at least one year following a full-term pregnancy. We describe a prospective study conducted in Cameroon designed to test the hypothesis of an association between common treatable sexually transmitted infections (STI): Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), and Trichomonas vaginalis (TV) and secondary infertility in women. Methods: In this case-control study, we enrolled women in Fako Division, Cameroon between November 2017 and December 2018 with secondary infertility (cases) or current pregnancy (controls). We conducted a baseline survey to collect sociodemographic, and sexual and medical history information. Nucleic acid amplification testing using Aptima (Hologic, San Diego, CA, US) was performed on endocervical swabs for CT, NG, MG, and TV. Multivariable logistic regression was used to assess the relationship between active STI and secondary infertility. Results: A total of 416 women were enrolled: 151 cases and 265 controls. Compared to controls, cases were older (median age 32 vs 27 years) and had more lifetime sexual partners (median 4 vs 3) (p < 0.001). Cases were more likely to report dyspareunia, abnormal menses, prior miscarriage, and ectopic pregnancy (all p < 0.05). STI positivity was not significantly different among cases and controls (2.7% vs 5.4% for CT, 1.3% vs 2.9% for NG, 6.0% vs 7.0% for MG, respectively), with the exception of TV which was more common in pregnant controls (0.7% vs 5%; p = 0.02). Conclusion: Study findings did not support an association between active STI and secondary infertility in Cameroon. Given high rates of pre-existing tubal damage, routine STI screening and treatment in younger women may be more impactful than costly STI testing during infertility assessments.
044 – POST ABORTION FAMILY PLANNING UPTAKE AMONG WOMEN RECEIVING CARE AT GULU REGIONAL REFERRAL HOSPITAL AND ASSOCIATED FACTORS
Jerom Okot1, Francis Pebalo Pebolo1, Ronald Olum2, Janet Anying1, Ahmed Didat1, Alex Dramadri1, Simple Ouma3, Felix Bongomin1
1Faculty of Medicine, Gulu University, Gulu, Uganda. 2Nsambya Hospital, Kampala, Uganda. 3The AIDS Support Organization, Kampala, Uganda
Background: Unintended pregnancies are the major contributors to unsafe abortions hence increased risk of maternal mortality and morbidity. Evidently, post abortion contraception helps prevent future unwanted pregnancies and repeat unsafe abortions. We aimed to determine the prevalence of post abortion family planning uptake among the women receiving care from Gulu referral hospital. Methods: This was a hospital based descriptive, cross-sectional study at Gulu Referral Hospital, Gulu, Uganda. Sociodemographic data were collected; contraceptive method chosen and other factors associated with post abortion family planning uptake among women aged 15 to 49 years old. Multivariable logistic regression analysis was used to evaluate for factors independently associated with post abortion family planning Uptake. Data was analyzed using STATA 17.0. p < 0.05 was considered statistically significant. Results: We recruited 302 females for the study with median age of 25 (Interquartile Range: 20-30). Majority attained either primary or secondary level of education, 42.2%(n-127) and married (68.1%, n=205). Post abortion family planning uptake among the participants was 55.2%(n=166). Factors independently associated with post abortion family planning uptake were having heard about modern methods of contraception (adjusted odds ratio,aOR:0.3, 95% CI: 0.09-0.77, P=0.014), injectables (aOR:0.3, 95% CI: 0.12-0.64, p=0.003), implants (aOR:0.4, 95% CI:0.18-0.76, p=0.007), vasectomy (aOR:0.5, 95% CI:0.27-0.79, p=0.005), ever used modern methods of contraception (aOR:0.4 95% CI: 0.24-0.65, p < 0.001), implants (aOR:2.1, 95% CI: 1.18-3.80, p=0.001), received contraceptive counselling (aOR: 0.2, 95% CI: 0.10-0.29, p < 0.001) and chose and received any method of contraception(aOR: 0.02, 95% CI: 0.01-0.05, p < 0.001) Conclusions: There is high post abortion family planning uptake among the women receiving care from Gulu Referral Hospital.
049 – Factors influencing male involvement in family planning at Kasaana health centre III, Birere sub-county Isingiro district.
Otika Donald1,2, Nareeba Innocent3,4, Biryeija Tarsisio3
1Gulu University, Gulu, Uganda. 2Mbarara Regional Referral Hospital, Mbarara, Uganda. 3Bishop Stuart University, Mbarara, Uganda. 4Kasaana Health Center III, Isingiro, Uganda
Background: Globally, modern contraceptive utilization has increased in the recent past – from 54% in 1990 to 57% in 2012. However, the estimates in Africa remain persistently low at 23% and 24%, among males and females respectively. Unintended pregnancy is common in Uganda due to unmet family planning needs which exceeds 33%. Low contraceptive use has been highlighted as one of the key contributing factors to the high maternal mortality rate in the country estimated at 438 deaths per 100,000. Most of these deaths are due to unsafe abortion practices. One approach to decreasing unmet need is promoting male involvement in family planning. Objective: The purpose of the study was to determine the factors influencing male involvement in family planning at Kasaana health centre III, Birere Sub-county, Isingiro district, with a view of improving involvement, thus reducing accompanying burdens like maternal mortality. Methods: A cross-sectional descriptive study design was used employing quantitative methods, involving 133 men accessing out-patient services, obtained through convenient and purposive sampling. Results: Majority of the respondents; 81.2% had an average monthly income below Ugx. 50,000/=, 36.8% gave side effects as the main reason for not embracing family planning, A large proportion of study subjects; 54.2% stated that they had more than 5 children, 63.9% live more than 2 kilometers from the health facility. 24.8% stated that they had never used any family planning method, 72.2% blamed negative attitudes of health care workers, 42.9% stated that they did not get involved in family planning, 49.6% blamed lack of gender-specific services that addresses men’s issues as a major hindrance to male involvement. Conclusion: Inadequate knowledge about family planning, low socio-economic status, misconceptions about side effects of family planning, attitude of health care workers, distance to health facilities and lack of gender-specific services (male) seem to play lead roles in discouraging male involvement in family planning. Recommendations Eliminating barriers to family planning services will reduce unmet need for contraception. Prioritizing gender-specific services especially focusing on encouraging male involvement.
050 – In Search of Authenticity: Teaching Social Justice in SRH Education
Tayechalem G. Moges
University of Global Health Equity, Butaro, Rwanda
Abstract: In search of Authenticity: Teaching Social Justice in SRH Education Social justice centered teaching and learning has become the focus of higher education learning around the world. The University of Global Health Equity (UGHE) is also one of such institutions that centers its preservice training on social justice and equity. The purpose of this article is twofold. First, the article serves as an introduction to the orientation of social justice in health education in the university. Secondly, the article examines the challenges associated with developing content for a social justice course in SRH education at UGHE. In doing so, it explores the issue of authenticity in social justice education in SRH in terms of political philosophy, origin, and postcolonial feminist thought. Note: The article is based on the author’s own involvement in designing and teaching social justice courses in SRH education. Author’s Bio Tayechalem G. Moges is an assistant professor at the Centre for Gender Equity in the University of Global Health Equity. She teaches and researches in human rights, gender & SRH and was a teaching fellow at the University of Melbourne, Australia. She holds a PhD in Law from Melbourne University and a Master of Laws from the Central European University.
051 – Knowledge and attitude of mothers towards giving birth in recommended health facilities of kinoni community, rwampara district
Caroline Ampaire1, Otika Donald2,3, Olinga Charles1
1Mbarara University of Science and Technology, Mbarara, Uganda. 2Gulu University, Gulu, Uganda. 3Mbarara Regional Referral Hospital, Mbarara, Uganda
Background: Death of women due to complications of labor has a world-wide significance. Globally, 289,000 maternal deaths took place in 2013. Western Africa has among the highest maternal mortality rates in the world, with a maternal mortality ratio of 679 per 100,000 births in 2015. The current maternal mortality ratio in Uganda is 438 per 100,000 births. Many interventions have been taken among which is increasing the accessibility to maternal health care services and sensitization on the importance of their utilization. While a considerable progress has been made particularly in recent years, it is still extremely unlikely that the SDG goal 3 will be met by target date 2030, as many mothers opt for other alternatives. It is estimated that up to 74% to 90% of deliveries still occur at home. This has resulted into consistently high numbers of maternal mortality in most parts of the country, including Kinoni county, Rwampara district. Data from Kinoni health Centre IV showed that in the financial year 2016/2017, out of 2,505 mothers who attended ANC services, only 29.4% delivered from the health facility Objective: This study was to assess the knowledge and attitude of mothers towards giving birth from recommended health care facilities. Methods: A cross sectional descriptive survey was used, employing quantitative methods of data collection. The study was carried out in Kinoni community, Rwampara district, targeting all mothers aged 18 to 45 years. A total of 342 respondents were recruited for the study, using systematic random sampling techniques, however, response rate was 96.2% from 329 valid questionnaires received. Results: It was indicated that 81.7% were knowledgeable in that they disagreed to safety of home delivery, 41% blamed lack of materials to use as the main reason for not supporting home deliveries, meanwhile 29.7% confirmed that the people who conduct home deliveries are not well trained. It was also observed that 5.86% stated that one can safely have a delivery from home and from the TBAs. Majority of the respondents; 53.3% who agreed to home delivery ascertained that it is not costly as being the main reason for embracing home delivery. A considerable percentage; 31.7% also gave a reason of getting social support from family members as the main reason for embracing home delivery. Majority of the respondents 32.5% stated fear of hospitals as their main reason for choosing to deliver from home. A significant percentage; 24.3% also stated comfort of home as being their main reason for choosing home delivery. Conclusion and Recommendations This study concluded that respondents portrayed a good level of knowledge regarding health facility delivery. However, despite a few exceptions, it is evident that their attitudes concerning institutional delivery are largely poor. Effective sensitization of pregnant mothers would be important in reversing the negative attitudes towards institutional delivery. Strengthening maternal child health services in the district at large would help improve on health facility delivery, hence lower incidences of maternal and neonatal complications and death.
052 – ASSESSMENT OF PAIN MANAGEMENT PRACTICE DURING UTERINE EVACUATION PROCEDURES
SPHMMC, ADDIS ABABA, Ethiopia
Introduction: Uterine evacuation procedures encompass surgical procedures done for diagnostic as well as therapeutic purposes. One of the complications that occur during uterine evacuation procedures is pain. Even though pain intensity is different based on different factors; it needs to be managed. The goal of pain management during uterine evacuation is to help women remain as comfortable as possible while minimizing medication induced risks and side effects. Objective: The general objective of this study is to assess pain management practice for uterine evacuation procedures in three teaching hospitals affiliated to Addis Ababa University. Method This study was a facility-based, descriptive cross sectional quantitative study. Data has been collected from three teaching hospitals, i.e. Tikur Anbessa Hospital, Gandhi Memorial Hospital and Zewditu Memorial Hospital. The source population of this study was all women who came to these hospitals for uterine evacuation procedure. Study participants were selected consecutively during the study period till sample size of 422 women who undergo uterine evacuation was fulfilled. Data was entered, cleaned and analyzed using IBM SPSS 20 statistical software. Descriptive statistics used to describe study population in relation to relevant variables. Bi-variate and multi-variate logistic regression analysis with the help of odds ratio along with their 95% confidence interval was used to assess the degree of association and important conclusions were generated. Results: Of the 422 respondents who came for uterine evacuation procedure, 88.4% were surgical evacuations and 11.6% were medical evacuations. Pain medication was given for 86.3% clients in the study population for the procedure done; the rest, 13.7% were not given pain medication. From those who were not given pain medication the commonest procedure, 57% were medical evacuation procedure. The commonest drug administered was IM Tramadol was given for 57.3% of subjects; followed by IM Diclofenac. Paracervical block was only given for 6(1.4%) of clients, of this five of them were satisfied. Bivariate and multivariate regression showed significant association between patient satisfaction and patient’s pain expectation, type of diagnosis and person who did the procedure. Conclusion: Nearly 9 of 10 clients were given analgesic during uterine evacuation procedure. But still, 60.5% of clients were unsatisfied despite taking IM Tramadol. Participants who underwent medical evacuation procedures were not given any pain medication.
053 – Effectiveness of a community-based Intervention in preventing early marriage for Girls in rural Gambia
Society for the Study of Women’s Health (SSWH), Kanifing, Gambia
Background: Child marriage is a global problem and a major violation of the right of the girl child. Although rate of child marriage has declined in The Gambia over the past two decades, the practice of child marriage is still in perpetuation. The aim of this study was to assess effectiveness of a community based intervention to prevent early marriage for girls in two districts in The Gambia. Methods: Cross-sectional (post-test) was adopted to assess the effect of the intervention. The target population were community members including boys and girls who are at least 10 years of age. Simple random sampling was employed to get sample size and house to house survey method to collect data. The assessment was conducted in two districts. Descriptive statistics, cross-tabulation, chi square and logistic regression methods were used to analyse the data. Results: The study found that at both baseline and midline, girls in the districts marry at an average age of 18, with a narrowing interquartile range towards the lawful marriage age. There is a significant reduction in the proportion of parents who know of families that married an under 18 daughters out, an indication a significant prevalence of the phenomena in the two districts. Regarding the right time for a girl to marry, the results show a significant increase from a baseline of 44.8% to 70.7% at midline among the parents who have the view that the girl needs to come of age before going into marriage. At both base and midline, there is a fear that girls may break their virginity by indulging in premarital sex if they do not marry early. Though this fear is widespread, there was a significant decrease from 51.7% at baseline to 10% (p-value < 0.001) in the proportion of parents who think girls must marry early to avoid premarital sex. The results show an increasing acceptance by the adolescents that parents should decide for their children in relation to marriage which has the potential of influencing the perpetuation of early marriage. However, there is between 2% and 7% increase from baseline to midline on the view that adolescents have the right to choose when and who to marry. Conclusions: The findings in this study showed the effectiveness of community-based interventions in preventing early marriage for girls in rural Gambia. The findings have important implications for policy and practice in the prevention of early marriage in rural Gambia.
054 – TEENAGE pregnancy is associated with increased risk of adverse pregnancy outcomes in post-conflict northern Uganda: a community-based cross-sectional study
Beatrice Odongkara 1,2, Thorkild Tylleskar3, Vincentina Achora4, Grace Ndeezi5, Harriet Ajilong1, Anna Agnes Arach6, Agnes Napiyo7, David Mukunya8, Justin Tongun9, Victoria Nankabirwa10, James K. Tumwine11
1Department of Paediatrics and Child Health, Faculty of Medicine, Gulu University, Gulu, Uganda. 2Center for International Health, University of Bergen, Bergen, Norway. 3Center for International Health, niversity of Bergen, Bergen, Norway. 4Department of Reproductive Health, Faculty of Medicine, Gulu University, Gulu, Uganda. 5Department of Paediatrics, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda. 6Lira University, Lira, Uganda. 7Uganda Matyrs’ University,, Kampala, Uganda. 8Busitema University, Mbale, Uganda. 9University of Juba, Juba, South-Sudan. 10School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda. 11Department of Paediatrics and Child Health, Kabale University, Kabale, Uganda
Background: Adverse pregnancy outcomes (APOs) are a complex public health emergency worldwide. It is the leading cause of neonatal and maternal morbidity and mortality in low-resource settings. APOs may include preterm births (PBs), low birthweight (LBW), abortions, still births (SBs) and early and late neonatal deaths. We aimed to estimate the prevalence and factors associated with APOs in post-conflict northern Uganda. Methods: We conducted a community-based cross-sectional study, nested in a cluster randomised trial (CRT). The CRT was designed to study the effect of mamakit and peer counselling intervention combinations during pregnancy on health facility delivery in rural Lira District, Northern Uganda. A total of 1833 pregnant mothers with >28 or more weeks of gestation, were recruited and followed-up to 50 days of postnatal life. We defined adverse pregnancy outcomes as a composite of: pregnancy history which did not result into live births – abortion or still births (pregnancy loss), PBs, LBW, and SBs. Data was collected using open data kit (ODK) and sent to a server, from where it was downloaded to Stata 14, analysed, and summarised into proportions. Multivariable analyses for factors associated with APOs were done using the generalised estimation equation (GEE) with a log link to Poisson family. Results: An estimated 629/1833 or 34.3% (95% CI: 32.2% – 36.5%) of mothers had APOs. The respective prevalence of APOs among mothers aged < 19-; 20 – 34-; and >35-years were: 32.7% (95% CI: 28.7% – 36.9%), 33.9% (95% CI: 31.2% – 36.7%), and 41.3% (95% CI: 34.4% – 48.4%). The overall proportion of pregnant women with history of pregnancies that did not result into live births (pregnancy loss) was 31.0% (95% CI: 28.6% – 33.4%), while the respective proportion of pregnancy loss among mothers aged < 19-; 20 – 34-; and >35-years were: 58.5% (95% CI: 50.8% – 65.9%); 26.9% (95% CI: 24.3% – 29.7%); and 29.6% (95% CI: 23.3% – 36.5%). Teenage pregnancy was associated with 1.6 (95% CI: 1.4 – 1.8) times the risk of APOs than pregnancies among mothers aged 20-34 years. Other factors that were associated with increased risks of APOs were: maternal parity >7 children (adjusted risk ratios or aRR: 1.5, 95% CI: 1.2 – 1.9) compared to < 6 children, father’s unemployment (aRR: 1.3, 95% CI: 1.02 – 1.7) compared employment status, unknown malaria status in pregnancy (aRR: 1.2, 95% CI: 1.02 – 1.3) compared to no malaria in pregnancy. Conclusion: The prevalence of APOs in post-conflict northern Uganda was high. The proportion of APOs increased with increasing maternal age. Teenage pregnancy was associated with a 60% higher risk of APOs compared to mothers aged 20 – 34 years. Teenage pregnancy prevention programs may reduce the burden of APOs in post-conflict settings. Key words: Adverse pregnancy outcomes, abortions, stillbirths, teenage pregnancy, post-conflict, northern Uganda.
055 – Evaluation of safe abortion service in Nampula, Zambézia and Tete provinces in Mozambique, 2020
Associação Moçambicana de Obstetras e Ginecologistas, Maputo City, Mozambique
Background: The Ministry of Health in Mozambique is improving the response capacity of the National Health Service ensuring the availability and readiness of these services, as a strategic priority. The Associação Moçambicana de Obstetras e Ginecologistas (AMOG) decided to conduct an assessment to generate reliable information on service delivery, to contribute to advocacy for health facility expansion to improve access for Safe Abortion. One specific component of the report that summarizes the key findings about the availability and readiness of safe abortion services in Health Units (HUs) in Mozambique is conducted in the framework of the Advocacy for Safe Abortion project. Methodology: For the analysis, 37 health providers, including maternal and child health nurses and other maternity and gynaecology emergency services personnel were interviewed, in 31 HUs from 24 districts in 3 provinces out of 11. In addition, the Service Availability and Readiness Assessment tool was used to follow the inventory of HUs based on the Service Availability Mapping methodology. Data collection covers availability of key human and infrastructure resources, basic equipment, medicines, medical materials and supplies, and diagnostic capabilities and basic interventions in the HUs that provide the service for safe abortion. These provided updated evidence on the situation of the National Health Service regarding the provision of the service. Results: Overall, the study showed that safe abortion services are available at all levels of care, the availability of some informative elements, such as explicit display indication of the services offered in the HUs (35%), drugs, observation material, follow-up of procedures, precautions and examination conditions is relatively poor, impacting the delivery of quality health services. The number of health professionals in some categories remains low considering the reference value established by the World Health Organization. The category of mid-level maternal and child health nurses (35.5%) is the most predominant and is available at all levels of care. General practitioners are concentrated in one third of the HUs and specialist doctors in five (5) HUs in the three provinces studied. Only a fifth of Matrons (5.4%) were trained to perform safe abortions. Users’ adherence to the service in most cases is due to unwanted pregnancies and the partner’s refusal to assume the child. On the other hand, the husbands’ refusal and the population’s lack of knowledge about the services may be the possible reasons for not seeking the services under analysis. Conclusions: The readiness rate of safe abortion services in HUs remains precarious, influenced by the variable availability commodities, transport, the fact that in most units there is a lack of fuel, basic medicines and diagnostic capacity. Service quality control is performed poorly in a large part of the HUs in the three provinces. The evaluation recommendations show the need to address cross-cutting constraints and highlight options that both the Government of Mozambique and cooperation partners can pursue to improve the delivery of health services in the area of safe abortion in the country.
056 – Persuasive communications through values clarification and attitude transformation (VCAT) workshops to increase access to safe abortion service in Mozambique.
Associação Moçambicana de Obstetras e Ginecologistas, Maputo City, Mozambique
Background: High maternal mortality associated to unsafe abortion in Mozambique remains a problem to be addressed within the scope of the promotion of Sexual and Reproductive Health and the offer of safe abortion to women and girls. AMOG carried out workshops on Value Clarification and Attitude Transformation (VCAT) in 4 Health Units (HUs) of Sofala Province, Mozambique, due to an increase of complaints regarding health personnel’s work ethic. Methodology: This analysis examined the validity of various theoretical assumptions about cognitive and behavioral change following VCAT workshops among 52 health staff in Sofala. Firstly, we accessed the abortion service delivery quality in different HUs, including in the largest hospital of the province, to survey the main challenges and feel the satisfaction of the team prior to the activity. Afterwards, teams carried out VCAT workshops to discuss abortion and maternal mortality, the law, clinical abortion norms, factors that negatively affect access and use of services and conscientious objection. This gave opportunity to mentor the teams while studying the possible flexibility of activities and procedures. Lastly, an enquiry was carried out to measure content perception and knowledge; severity and susceptibility attitudes and expectations; perceptions of control and intentions; and behavioral skills on service with regard to offering safe abortion. Results: Findings indicated that across the sample, workshops taught recipients about facts related to Clinical Norms, boosting their confidence on comprehensive reproductive health services provision, including safe abortion care; increased favorable attitudes and expectations towards safe abortion; allowed to monitor perceptions; and resulted in stronger willingness to change attitudes, and reverse allegations of conscientious objection in the future, by combining clinical, ethical and advocacy efforts towards guaranteeing the provision of attempted and reliable services for safe abortion. After the sessions, the team recommend additional sessions to expand for more facilities and scale at planning level. 99% of participants affirm that they understood the purpose of the activity, 80,8 % felt empowered and able to explain in-depth the norms of Safe Abortion and improve service offer, 96,2% highly motivated to advocate for safe abortion within work, and 100% are in condition to identify activity’s barriers for safe abortion and work toward their elimination. Conclusion: This process has a teaching-learning component, as well as understanding what challenges and concerns the teams feel. Being able to reach the units to work in a planned and coordinated way is very important to guarantee assistance in accordance with legal provisions and in accordance with the norms issued by the Ministry of Health. The learning is that the sessions offered an understanding on safe abortion and that the VCATs are an important space for debate and change of perceptions, and the exchange of experience between the different categories of professionals revealed itself to be a crucial opportunity to favor sensitive, flexible and critical dynamic in HUs, specially within a context of shortage of personnel and social vulnerability.
057 – Prevalence of and Factors associated with use of Herbal Medicine among pregnant women attending antenatal clinic at Lira Regional Referral Hospital
Jimmy Opiyo1,2, Raymond Otim2, Beatrice Odongkara3
1Lira University, Lira, Uganda. 2St. Mary’s Hospital Lacor, Gulu, Uganda. 3Gulu University, Gulu, Uganda
Background: Use of herbal medicines (HMs) is widespread worldwide. An estimated has 88% of people used herbal medicine globally. HMs use stands at 80% in sub-Saharan Africa, 70.4% in Uganda and 20% prevalence among pregnant women in Northern Uganda. It is known that most HMs are harmful and with unknown safety profiles in pregnant mothers and fetuses. Despite routine health education in ANC on the dangers of HMs, there is a strong cultural believe among pregnant women in the benefits and nor safety of HMs use in pregnancy. Data on HMs use Lira district is unknown, yet cultural beliefs held in the same may lead to poor attitude to health facility services seeking with resultant poor maternal, fetal and delivery outcomes. We thus determined the prevalence and factors associated with the use of HMs among pregnant women attending Antenatal clinic (ANC) in Lira Regional Referral Hospital (LRRH). The results of this study would further help health practitioners’ health educate pregnant women dangers of using of herbal medicines in pregnancy and delivery on pregnancy outcomes Methods: We conducted a cross-sectional study involving 179 pregnant women attending ANC in LRRH. Data was collected using structured pre-coded questionnaire. Data entry and analysis were done using Statistical Package for Social Sciences (SPSS) version 23. Results: The study recruited 179 participants, of which majority 56 (31.3%) were between 20 and 29 years of age. The prevalence of use of HMs among the participants was 75 (42%). The factors associated with use of HMs during pregnancy included believe that HMs are effective and safe, their culture supports use of HMs (95%CI 0.088-0.210) easy to access free from farm land, relative or herbalists (95%CI 0.033-0.007) and dissatisfaction at different health facilities (95%CI 0.104-0.153) Conclusions: The use of HMs during pregnancy among pregnant women attending ANC in LRRH was high. Factors associated with reduced or increased risk of HMs among pregnant women in Lira were belief in effectiveness of HMs, etc. This therefore calls for community sensitization drives on the dangers of indiscriminate use of HMs in pregnancy, as well as integration of trained herbalists and all those community persons who influence the process in addressing the varied health needs of pregnant women. Key words: Herbal medicines, pregnancy, maternal mortality, maternal health service
058 – Case report on rudimentary horn pregnancy
SPHMMC, Addis Ababa, Ethiopia
Abstract: Arrested or defective development of only one of the müllerian ducts results in a unicornuate uterus. We report a case of 23 years old primigravid, referred and admitted to SPHMMC, CAC room with a diagnosis of missed abortion after the ultrasound was done and showed 14+ gestational ages and negative FHB. After multiple attempts with misoprostol; suspicion of corneal pregnancy was considered and went for Laparotomy. The intraoperative finding was unicornuate uterus with non-communicating rudimentary horn pregnancy. Wedge resection of the pregnancy with horn and left salpingectomy was done. Diagnosis of rudimentary horn pregnancy is difficult and can be missed in ultrasound. Reproductive performance of the unicornuate uterus is significantly impaired and fetal survival rates are poor. Early surgical intervention with removal of the rudimentary horn containing the gestational sac along with the ipsilateral fallopian tube has been recommended for cases of rudimentary horn pregnancy.
059 – Lessons learnt from using Value Clarification and Attitude transformation (VACT) role plays targeting different audiences during advocacy for safe abortion in Uganda.
Association of Obstetricians and Gynecologists of Uganda (AOGU), Kampala, Uganda
Background: From April 2019 to March 2022, the International Federation of Gynecology and Obstetrics (FIGO) worked with ten of its member associations to make them both leading actors in safe abortion advocacy and national leaders in sexual and reproductive health and rights (SRHR). The objective is to share experiences and lessons learnt about using value clarification and attitude transformation (VCAT) with the abortion harm reduction model as the advocacy theoretical framework for safe abortion advocacy by the Association of Obstetricians and Gynecologists of Uganda. Methods: The Uganda project envisioned reaching its advocacy objectives through targeting different stakeholders for advocacy, namely the media (print, broadcast, and social media bloggers), policy makers (in Ministries of Health, Justice, Education and Gender, Labor and social Welfare), judicio-legal department (police officers and judges), parliamentarians, tutors from academic institutions, religious leaders, health workers (district health officers, pharmacists and healthcare providers in public and private facilities), traditional leaders, civic leaders and the public. The abortion harm reduction model focuses on primary, secondary and tertiary prevention of abortion complications. During each meeting, VCAT was used for the audience to identify what roles they can play along the continuum of strategies that can ultimately reduce or prevent maternal death from complications of unsafe abortion. The different VCAT role plays include Thinking about my values. Comfort Continuum, Hopes and Hesitations, Cross the Line statements, Reasons Why statements, The Four Corners statements, Why Did She Die and The Last Abortion. Results: Through VCAT, audiences were prompted to both identify values that inform their beliefs and attitudes about abortion and contemplate about alternative values and their consequences. Through the role plays, specific audiences were able to: 1) recognize the induced abortion context; 2) reflect and distinguish between assumptions, myths and realities surrounding unwanted pregnancy and abortion; 3) recognize the imperative to address conflict between personal and professional values, 4) recognise different roles audiences could play, 5) identify values that inform empathetic and positive attitudes for supporting behaviors that mitigate abortion harms; 6) Appreciate what roles the audience can play in reducing/mitigating harms from unsafe abortion. Conclusion: Using the Abortion Harm Reduction model, sharing of experiences and critical reflection, VCAT enabled 1) appreciation of the root causes of unsafe abortion;2) reframing appropriate advocacy messages for each audience; 3) acceptance of the relevance of an open discussion about safe abortion to mitigate abortion harms; 4) Recognition of the conflict between personal and professional values; 5) Identification of missed opportunities to prevent abortion morbidity and mortality; 6) Appreciation of positive values needed to balance professional obligations and client/patient needs. VCAT enables audiences to appreciate the components of an enabling environment (needed data, increased awareness, open debate, enabling laws, policies and regulations, management guidelines and advocacy strategies) than can support safe abortion. VCAT with appropriate reframing of advocacy messages may contribute to increased acceptance of safe abortion.
060 – Knowledge and practices of postnatal mothers regarding family planning uptake at lira regional referral hospital, Uganda.
Emmanuel Ekung, Patricia Akello
Lira University, Lira, Uganda
Background: The Government of Uganda committed to increase the modern contraceptive prevalence rate (mCPR) for all women from 30.4% in 2020 to 39.6% by 2025 and reduce unmet need from 17% in 2020 to 15% by 2025. There is still low utilization of family planning among women after delivery in Uganda as well as other low-income countries. This is associated with risk of infant mortality, childhood malnutrition and maternal complications during pregnancy (Rutstein, 2011) and childbirth. Total fertility rate for Uganda was 4.7 births per woman in 2020 (UDSH 2020), this is still high meaning there is a gap in the utilization of family planning that needs addressing. The aim of this study is to determine the knowledge and identify the practices of postnatal mothers regarding Family Planning at Lira Regional Referral Hospital. Methodology: This study was a quantitative, descriptive cross-sectional design, it was used since it allows the measurement of selected variables at a single time (Gordis, 2009). The study population includes all mothers attending Postnatal Clinic at Lira Regional Referral Hospital. A convenience sampling technique was employed in the study. Data was be analyzed using SPSS version 23. Descriptive statistic was employed in analysis where correlation and chi-square statistic were used to examine the relationship between knowledge and practice regarding family planning. The findings were presented inform of tables, pie charts, graphs and text after analysis. Results: Data was collected among 117 postnatal mothers in total where findings of the study showed that a higher number of participants 90(76.6%) were below 30 years. Of these interestingly almost all the participants 94(80.3%) were married. 63(53.8%) of the participants stayed within rural setting and 43(36.8%) within 0-2Km from the health unit, 48(41.0%) of respondents were Catholics. However, a small percentage of 11.1% of the participants had not attended school. Additionally, majority of participants 76(66.7%) were not employed. Majority 107(91.5%) reported to have heard about family planning, 84(71.8%) had an idea on the correct definition of family planning. Majority 86(73.5%) were knowledgeable about the different types of family planning methods. Surprisingly, almost all the respondents 104(88.9%) were not knowledgeable about the exact time to return for family planning after giving birth. Most of participants 65(55.6%) got the information about family planning from health workers, 98(83.8%) reported that they knew the advantages of family planning and among those, 20(17.1%) could not mention these advantages during the interview. Conclusion: Knowledge regarding family planning was generally high (71.8%) and majority of the mothers were married, educate, earned satisfactory level of income though most of them were not employed. Much as the respondents in the study had relatively good practice (57.3%) regarding family planning, a high number still reported that their partners do not support family planning practice. Recommendation: All health workers should put more emphasis on health education among postnatal mothers on family planning to improve its uptake. Inclusion of male partners in family planning services uptake.
061 – The significance and impact of abortion advocacy work done by professional associations of obstetrics and gynaecology: an evaluation of FIGO’s Advocating for Safe Abortion Project
FIGO, London, United Kingdom
Background: The International Federation of Gynecology and Obstetrics (FIGO) has been implementing an Advocating for Safe Abortion (ASA) Project with 10 national professional associations of obstetrics and gynaecology (OBGYN) since 2019: Kenya, Mozambique, Uganda and Zambia in East and Southern Africa; Benin, Cameroon, Cote d’Ivoire and Mali in West Africa; and Panama and Peru in Latin America. The project has aimed to strengthen these OBGYN associations to be able to act as champions for improving access to safe abortion through a range of advocacy activities appropriate to each country’s specific context. During its initial three-year period, the ASA project was based around five core strategies to: – Strengthen the management and organisational capacities of the national associations; Establish or strengthen a coordinated network of like-minded stakeholders and health system partners to advocate for safe abortion and improved access to comprehensive abortion care; Create increased acceptance of safe abortion among health workers, policymakers and the general population; – Ensure communication and sensitisation about national legal frameworks and guidelines on safe abortion and, where applicable, engage in educational non-lobbying advocacy for improved legal dimensions and guiding principles; – Advocate better generation and use of evidence on abortion in the country. Methods: An external evaluation of the project across all ten countries was carried out at the end of the three-year period of April 2019 to March 2022 by KIT Royal Tropical Institute. A process of outcome harvesting was used throughout the project to identify advocacy outcomes in each country. In addition, key informant interviews with primary stakeholders (N=92), semi-structured interviews with secondary stakeholders (N=192), survey of members of the societies (N=568) and a desk review of project documents across ten countries were carried out to evaluate the project’s relevance, effectiveness, efficiency and sustainability. Results: The outcome harvest identified a total of 207 substantiated outcomes (strategy 2-5) across all project countries. The highest numbers of outcomes were under strategy 2, demonstrating that effective advocacy requires strong collaborations with a diversity of partners, and under strategy 3, with all societies observing positive change in professional perceptions or attitudes (e.g. acceptance and openness) towards safe abortion among targeted groups. Under strategy 4, amongst other outcomes, society members and health workers expressed feeling better informed about the legal framework for abortion in all countries. Under strategy 5, generation of evidence took place in some societies through research studies or by strengthening routine data collection systems. The project enabled societies to strengthen management, operational and technical capacity (strategy 1) in all ten societies. Challenges were identified and areas of recommendation presented. Conclusions: The ASA project evaluation demonstrates that advocacy for safe abortion requires strong organisational structures and supportive leadership within national OBGYN societies. Altogether, the outcomes identified under the five project strategies demonstrate an amplified role of national professional associations as sexual and reproductive health experts by national stakeholders. Consequently, across different country contexts OBGYN associations are well-placed to advocate for safe abortion and contribute to significant improvements in safe abortion care.
062 – Exploring the experiences of peer educators of the sexual and reproductive health peer education program in Kirehe District-Rwanda
Aimable Nkurunziza1,2, Germaine Tuyisenge3, Michael F. Habtu4, Van Endert Nadja5, Jusine Bagirisano2, Jean Bosco Henry Hitayezu2, Jans Goele5, Olive Tengera2
1Western University, London, Canada. 2University of Rwanda, Kigali, Rwanda. 3London School of Hygiene and Tropical Medicine, London, United Kingdom. 4Mount Kenya University, Kigali, Rwanda. 5University Colleges Leuven-Limburg, Genk, Belgium
Background: Many programs and interventions are available to prevent adolescent pregnancies in Rwandan schools. However, in the previous ten years, most of the interventions seemed less effective than expected, considering the growing number of teenage pregnancies. This issue informed the development of the sexual and reproductive health peer education program (SRHPEP) in the Eastern Province-Kirehe District. It was implemented in 2019 by the collaboration between the University of Rwanda (UR) and University Colleges Leuven-Limburg (UCLL) members funded by VLIR-UOS. A total of 30 Peer Educators (PEs) were trained to be the source of accurate information for sexual and reproductive health. Although the PEs were trained, no single study has been conducted to explore their experiences when executing the program in their respective schools. Therefore, this study aims to explore the experiences of trained PEs in implementing an SRHPEP. Methods: This was a qualitative exploratory study design. Data were collected using three Focus Group Discussions (FGDs) of 22 PEs and in-depth interviews with five key informants (KIs) to gain insight into how PEP is being implemented among school teachers and directors. Data were transcribed verbatim, translated back into English, and thematically analyzed using NVivo 12 software. The Ethical Review Board approved this study from the University of Rwanda, College of Medicine and Health Sciences, Institutional Review Board, Approval No 158/CMHS IRB/2019. Results: Three main themes emerged, including 1) perceived benefits of being PEs, 2) perceived challenges of being PEs, and 3) facilitators of being PEs. The study participants reported the benefits of being a PE of SRH, including increased competencies, improved relationships, and improved society understanding. They have also encountered bullying, limited resources, and time constraints. Facilitators were regular refresher training, good organization and administration, high spirit of cooperation and support (among PEs themselves, by school teachers, school administrators/director). Conclusion: The study found various benefits, facilitators and challenges of implementing SRHPEP. Therefore, to ensure the sustainability of the PEP, there is a need to consider the capacity of the settings before training PEs and providing enough contextualized resources. Anti-bullying training should be part of the project to ensure the safety of PEs.
063 – Lessons learnt in the use of audio-visual aids to improve health education in Antenatal clinic of Gulu Regional Referral Hospital – Gulu, Uganda
Grace Lanyero1, Jackline Ayikoru2, Pebalo Francis Pebolo2
1Gulu Regional Referral Hospital, Gulu, Uganda. 2Gulu University, Gulu, Uganda
Background: Health education in antenatal clinic (ANC) provides education reassurance and support to address the minor disorders of pregnancy and effective screening. Exploring current practices in this regard revealed the need for more organized educational activities to ensure high quality education and client satisfaction. Patients need the tools and methods necessary to receive and, understand and comprehend the available information. This will help to process and evaluate and use the information to impact their own health. Uganda still grapples with under staffing at a ratio of 1:11,000 nurse to patient, which is way below the WHO recommendation. The situation is not any good in Gulu Regional Referral Hospital (GRRH) antenatal clinic. The clinic is maned by 3 midwives and one counsellor yet on average 50-60 mothers attend ANC daily. The few staff means not much is put for ANC education. To help in strengthening ANC education, an innovation like pre-recorded videos to be played on a screen in waiting areas. Methods: The Gulu University Sexual and Reproductive Health Resource Center with funding from Center for International Reproductive Health Training (CIRHT) has established an audio-visual lecture production studio which partners with GRRH to produce audio-visual materials for patient education. The project aims at improving patient education and other sexual and reproductive health related activities in the region. Lessons learnt: The established use of pre-recorded health education videos at Antenatal clinic in GRRH has greatly lessened the burden of work load on the few staff, reduces monotony of one staff educating time and again, mothers have shown more interest and pay more attention watching a pre-recorded health talk on television, and up to 4 topics are covered per day compared one previously. More topics are now covered compared to few before this intervention. Conclusion: Use of audio-visual aids improves the quality and effectiveness of health education in ANC improves efficiency in poorly staffed facilities. Further study should be done to document its effectiveness in low resource settings like Uganda.
064 – PREVALENCE AND FACTORS ASSOCIATED WITH IMMEDIATE POSTPARTUM FAMILY PLANNING UTILIZATION BY WOMEN IN NYABIHU DISTRICT, 2021.
Emmerance HIRWA IGIHOZO1, Dr Judith MUKAMURIGO2, Prof Joseph NTAGANIRA3
1MOH/SHYIRA District hospital, Nyabihu, Rwanda. 2University of Rwanda, kigali, Rwanda. 3AFFINET/FETP, Kigali, Rwanda.
Corresponding Author: Emmerance Igihozo Hirwa, Email:email@example.com; Tel: +250781141570
INTRODUCTION: Immediate Postpartum Family Planning (PPFP) is the initiation of Family Planning (FP) methods within 48 hours after delivery; It focuses on preventing unintended births and short inter-birth intervals. This is a main public health concern, as 20 % of obstetrical deaths are related to short inter-birth intervals. Therefore, this study aimed to assess the prevalence of immediate postpartum family planning use and associated factors among postpartum women in Nyabihu district. Methods: A health facility-based cross-sectional study design was used to identify the factors associated with immediate post-partum family Planning utilization by women in Nyabihu District from January –to June 2021. Secondary data on social demographic and obstetric characteristics were extracted from health facility medical records. The data were entered in Excel and exported in STATA for analysis. Both bivariate and multivariate logistic regression analysis were performed to identify associated factors. P values < 0.05 with a 95% confidence level were used to declare statistical significance. Results: Of the 1682 of postpartum women, 38.05% accept immediate postpartum family planning. Having an antenatal care visit [adjusted odds ratio (AOR) =7.7 (95%CI, 4.3-13.5 ), previous use of family planning [adjusted odds ratio (AOR) = 3.4(95%CI, 2.3-5.03)], being married (adjusted odds ratio (AOR) = 1.9 (1.07 – 3.5), having a university level of education (AOR) = 13(2.1-81), having 30-39 years AOR = 0.4 (0.2 – 0.7), being in Ubudehe cat 3 AOR =5.4 (2.1 – 12.2) and having more than 5 children AOR = 9.2 (5.1-16) were significantly associated with utilization of Immediate postpartum family planning. Conclusion: This study showed the low prevalence of immediate postpartum family in Nyabihu district. Therefore, strengthening family planning counseling during antenatal and postnatal care visits, improving utilization of postnatal care services, and improving women’s educational status are crucial steps to enhance contraceptive use among postpartum women. Keywords: Prevalence, Postpartum, immediate Family planning, Utilization
065 – Family planning …
UWAMAHORO Marie Yvonne
Inkurunziza Orthopedic Specialized Hospital, Kigaki, Rwanda
066 – The qualitative evaluation of the impact of the SafeChoices campaign
Swebby Macha 1,2, Benedictus Mangala1, Lambwe Kachali1, Musonda Makasa3,4
1Zambia Association of Gynaecologists & Obstetricians, Lusaka, Zambia. 2Women & New-born University Teaching Hospital, Lusaka, Zambia. 3Zambia Association of Gynaecologists and Obstetricians, Lusaka, Zambia. 4Women and New-born University Teaching Hospital, Lusaka, Zambia
Background: Young people in Zambia face a lot of challenges with regards to their Sexual Reproductive Health and Rights (SRHR). Among the many problems include early and unwanted pregnancies and high incidences of unsafe abortions. Despite these problems, discussions on SRHR issues are considered taboo and culturally unacceptable in many communities, especially the rural areas. These traditional and cultural beliefs lead to young girls becoming pregnant and resorting to unsafe abortions due to lack of accurate information on how to avoid pregnancies. It is for this reason that the Zambia Association of Gynaecologists and Obstetricians (ZAGO) launched a nationwide SafeChoices campaign to break traditional and cultural barriers and promote knowledge on SRHR among young people. The SafeChoices campaign in its messaging, availed the availability of reproductive health options that could enable young people, particularly girls avert and prevent early, unintended and unwanted pregnancies. Emphasizing use of various contraceptive choices: use of condoms, abstinence, and access to legal and safe abortion services – as a means to prevent high cases of unsafe abortions, morbidity and deaths – resonated well with young people. This evaluation was under the FIGO supported three years capacity building project on prevention of unsafe abortions in Zambia. Methods: The aim of the evaluation was to assess the impact of the SafeChoices campaign that had been running since June 2020. The evaluation design employed a qualitative approach. Both purposive and convenient sampling were used in identifying the participants. Qualitative data was collected from 98 youths through 8 focus group discussions and 18 in-depth interviews to determine young people’s knowledge, attitude, and behavior about reproductive health before and after the launch of the SafeChoices campaign. Data was collected between January and March 2022 from young people aged 16 to 32 years. The data and the youths were selected from seven (7) districts in three (3) provinces of Zambia: Copperbelt, Central and Lusaka Provinces. Data was analyzed based on the questions that were set out in the evaluation questionnaires. Results: The evaluation reveals that the SafeChoices campaign has had a huge impact on young people’s knowledge and understanding about safe abortion services in the country. The sensitization workshops, community dialogue meetings, use of social media platforms, word of mouth among young people, radio and television programs have been the means in which young people got to know about the SafeChoices campaign. Because of the huge youth participation and buy-in, young people took the campaign as their own (ownership), and are now free to discuss and conduct awareness on SRHR and safe abortion in schools, churches, homes and other public spaces for the first time in history. Conclusions: The SafeChoices campaign enhanced knowledge and accelerated positive behavioral change toward sexuality and decision-making for both girls and boys. As a result, young people are now able to exercise their right to safe abortion, and demand for the services in health facilities.
068 – Uptake of Modern Family Planning among Postpartum Women attending Postnatal Clinic in Busolwe Hospital, Butaleja District, Eastern Uganda.
Fred Mubale1,2, Nelly Atim2, Ann Grace Auma1, Raymond Otim2
1Lira University, Lira, Uganda. 2St. Mary’s Hospital Lacor, Gulu, Uganda
Background: Family planning (FP) is a key intervention to preventing the social, economic and health consequences resulting from unintended pregnancies. Failure to control family size and child spacing has pressing negative effects on the health of women, their children, the community and the nation at large. Despite various family planning interventions such as Uganda Family Planning Costed Implementation Plan (UFPCIP) and Postpartum Family Planning Action Plan (PFAP), the unmet FP need still stagnates as high as 28%. Therefore, this study determined the prevalence and assessed the factors associated with modern family planning uptake among postpartum women attending Postnatal Care (PNC) in Busolwe Hospital, Butaleja district, Uganda. Methods: A cross-sectional study was conducted among 361 postpartum mothers attending PNC. Quantitative approach was applied and data collected using pre-tested semi-structured questionnaire. Participants recruited by consecutive sampling. Ethical considerations and approval was sought from Lira University institutional research board (IRB) and data was analyzed using SPSS version 23. Results: A total of 361 participants were recruited for the study. Majority of the participants 167(46.3%) aged between 17-24 years with mean age 26.01 (SD±5.877). Over all 122(34%) was the prevalence of modern FP uptake. Factors independently associated with modern family planning at multivariate analysis were; Education level (P=0.007, OR 0.048, 95% CI 0.005-0.435); occupation (P= 0.039, OR 0.432, 95% CI 0.195-0.958), Income (P=0.000, OR 0.209, 95% CI 0.088-0.494), Side effects (P=0.014, OR 3.062, 95% CI 1.249-7.508), and Perception about many children (P=0.000, OR 0.128, 95% CI 0.049-0.339). Conclusion: The prevalence of modern family planning was low in Butaleja district. This was due to inadequate education among women, unemployment, low-income status, desire for many children and the side effects associated with family planning use. This study recommends that; – Family Planning Education should be Integrated in the higher secondary level curriculum to provide enough knowledge especially to girl children who have no access to tertiary learning (who are actually the majority) – Youth friendly Family Planning service centers should be implemented in all health facilities for easy accessibility of family planning services. – Programs aimed at enhancing girl-child education e.g. girl-child bursaries should be implemented, monitored and evaluated for effectiveness and schemes for women employment should be reviewed to ensure equity aimed at improving the women’s socio-economic status. Key words: modern family planning, contraceptives use, family planning, associated factors
069 – Experience with community health volunteers in the prevention of unsafe abortion and improving access to post-abortion care in a semirural county in Kenya
Moses Obimbo 1,2, Elly Odongo1, Gacheri Mwenda1, Gabriella Umubyeyi1, Jeffrey Kanyiri1, Nelly Munyasia3
1Kenya Obstetrical and Gynecological Society, Nairobi, Kenya. 2The University of Nairobi, Nairobi, Kenya. 3Reproductive Health Network Kenya, Nairobi, Kenya
Background: In Kenya, universal access to safe abortion services is legally restricted contributing to a significant proportion of unsafe abortions. Community health volunteers (CHVs) are integral in the delivery of essential health services although their potential contribution to the prevention of unsafe abortion and improving access to postabortion care (PAC) across rural communities has not been explored. There is a need to examine their significance in this aspect to inform future research and policy-making on how CHVs can be scaled to improve care. Here, we describe our experience with and feedback from the CHVs, community members, and other stakeholders about CHVs in the prevention of unsafe abortion and improving access to PAC. Material and Methods: This was nested in a larger study conducted in selected facilities and communities from the sub-counties in Kajiado to assess the preparedness of these facilities to offer PAC and applied health system, responsiveness model. For this objective, we focused on training community health volunteers on information about (un)/safe abortion, facilitating community dialogues on PAC, and clarification of the Kenyan legal framework on abortion. A CHV handbook and manual were developed to guide the training sessions. Feedback data were collected from the community, practitioners, and other stakeholders aimed at delineating the impact and role played by the CHVs in campaigning against unsafe abortion and improving knowledge on PAC. To conduct these activities, the Kenya Obstetrical and Gynecological Society (KOGS) initiated collaboration with the county government of Kajiado. Results: Community perceptions on abortion varied with a myriad of opinions from not wanting to hear anything on abortion to tolerating the provision of comprehensive abortion services. CHVs conducted over 1,800 household visits to discuss the prevention of unsafe abortion. In addition, they held 57 community dialogues and distributed over 200 Information, Education, and Communication (IEC) materials. CHVs reported that they noticed a change in the way healthcare providers handled clients in need of comprehensive abortion services post-intervention. Previously, health workers would call the police if they had a patient with incomplete abortion, but now such a patient would be treated with care, compassion, and dignity. In addition, many community members indicated that more women sought PAC and CAC services in hospitals. Although the community members showed appreciation for knowledge of the legal framework and availability of PAC services in facilities, they maintained a strong stigmatized perception of abortion. Interviews with the secondary stakeholders indicated that focusing at the community level with this information was the right thing because unsafe abortion was a major problem in the community. The training of CHVs on unsafe abortion enabled them to identify and refer clients for PAC. The findings and feedback from the community were used by KOGS to further advocate the information needs in the community with the Ministry of Health. Conclusion: CHVs are useful in the delivery of impactful information on unsafe abortion and PAC in semi-rural communities. This approach appears relatively easy to implement, scalable, and promising. Pervasive success, however, requires a cooperative administration and strong policy backing.
070 – Disparities to Access and Utilization of Sexual and Reproductive Health services among Adolescents in selected sites in Zambia; a Mixed Method Design
Alice Ngoma Hazemba, Choolwe Jacobs, Mwiche Musukuma, Margarate Munakampe, Mutale Sampa, Charles Michelo
University of Zambia, School of Public Health, Lusaka, Zambia
Introduction: Disparities in coverage of key Sexual Reproductive Health (SRH) services has implications on health outcomes of adolescents. Therefore, improving their health status ranks highly on the priorities of policymakers. This study forms part of the main research conducted to estimate selected national, provincial and district health indicators for the period 2014—2018 and explore availability, accessibility, and quality of care provided among adolescents. We sought to determine the disparities to access and utilization of selected SRH services among adolescents in Zambia. Study Design: The study used a sequential explanatory mixed methods design combining quantitative and qualitative approaches. In the quantitative arm we used a survey approach to analyse the trends and patterns in selected adolescent indicators at the national and provincial levels with focus on four provinces with poor indicators. This analysis was a precursor to an equity analysis which involved disaggregating the various indicators by stratifiers such as residence (rural/urban), wealth and level of education. While the qualitative component used an explanatory approach to understand the patterns observed in the quantitative results. Data Sources and Extraction-Survey data from the 2013/4 and 2018 waves of the Zambia Demographic and Health Survey (ZDHS) were used to compute estimates of selected adolescent health indicators. Standardised definitions for the various indicators were used, based on the DHS Statistics program guide (https://dhsprogram.com/data/Guide-to-DHS-Statistics/index.cfm). Further, the qualitative approach utilised semi-structured interview guides to conduct Focus Group Discussions, In-depth and key informant interviews. Thematic analysis was employed following transcribing and data coding supported by Nvivo version 12 qualitative software. Key Findings: Males and females in the age group 20-24 years in rural areas engaged in sexual activity at earlier ages (male = 16.3; female = 16.4) than their counterparts in urban areas (male = 18.8; female = 18.1) in 2018. The national contraceptive prevalence rate among adolescents increased from 10.2% in 2013/14 to 12.0% in 2018. At the national level, 29% of the adolescents had begun childbearing and across the four provinces, Southern had the highest percentage (43%) in 2018, closely followed by Eastern province (40%). National fertility rates among adolescent girls declined slightly from 141 in 2014 to 135 in 2018. Luapula province had a noticeable decline in the adolescent fertility rate from 160 in 2013/14 to 153 in 2018. Available adolescent health services included contraception, condom distribution, dedicated ART services, and support for girl child to go back to school after giving birth. Barriers to access bordered on lack of dedicated staff time to adolescent services, fear and embarrassment to access services, stock out of condoms and lack of privacy. In Southern Province, some in rural areas reported that traditional medicines were more accessible than health facility services/products. Use of adolescent services was unacceptable by the community leadership to protect their image. Conclusion: Disparities in access and utilization of SRH services impacts uptake of key interventions. Creating demand, access and use of quality services improves coverage and enhances safe sexual practices for adolescents’ general health and wellbeing.
071 – Challenges, opportunities and lessons learnt regarding safe abortion advocacy in Uganda
Dan Kaye1, Simon Peter Kaypondo2, Stella Nabatanzi2, Susan Nassuuna2, John Paul Nsanja2
1Kampala, Kampala, Uganda. 2Association of Obstetricians and Gynecologists of Uganda, Kampala, Uganda
Background: In 2018, FIGO embarked on implementation of the Safe Abortion Advocacy project to support national obstetrics and gynecology societies of member countries (Kenya, Benin, Cameroon, Ivory Coast, Mali, Mozambique, Panama, Peru, Uganda, Zambia) become advocates for safe abortion specifically and leaders of Sexual and Reproductive Health and Rights (SRHR) in general. This report describes the outcome of evaluation of the nation-wide advocacy activities by the Association of Obstetricians and Gynaecologists of Uganda (AOGU). Methods: The goals of the advocacy (which corresponded to the theory of change) followed predefined strategies from an extensive needs assessment prior to the project. These strategies were: 1) Strengthening AOGU’s capacity as safe abortion advocates; 2) Establishing a coordinated and vibrant network of partners supportive of safe abortion; 3) Transforming the social and gender norms at all levels regarding safe abortion; 4) Raising awareness of the legal and policy environment regarding abortion, 5) Promoting the generation and use abortion data for evidence-informed policy and practice. The advocacy targeted different stakeholders (such as healthcare providers, civic leaders, traditional healers, politicians, judicio-legal officers, religious leaders, tutors of health professional institutions, civil society organisations, the media and the public). Secondary stakeholders were social actors, and people the society aimed to influence by advocacy, who included members of general obstetric and gynaecological societies, network members, healthcare workers, policymakers (MoH), media, community groups or representatives, researchers. Tertiary stakeholders included community members, such as women and their partners accessing abortion care services. The report presents data collected from baseline and endline surveys of members of the society, key informant interviews with stakeholders at various levels, and discussions from 2 stakeholder workshops held during mid-term and endline evaluations of the project. Results: The respondents at the surveys and key informant interviews and participants in the advocacy meetings confirmed that unsafe abortion and its complications is a major problem in Uganda, endangering the lives of many women. AOGU highlighted the root causes of abortion, including the restricted abortion law, absence of a supportive policy environment, pro-life cultural and religious beliefs, absence of open discussion on abortion, and pervasive abortion stigma, all of which make it extremely challenging to provide safe abortion services. AOGU enhanced awareness of the abortion-related laws and policies. AOGU promoted inclusion of abortion data in surveys and routinely reported health management information systems. AOGU provided sub-grants to specialized organizations, and small grants to the media and graduate students to promote dialogue on abortion, evidence-based reporting on abortion and availability of abortion-related data. Value clarification and attitude transformation (VCAT) role plays were critical in identifying and developing appropriate messages for different stakeholders. Conclusion: AOGU’s capacity for advocacy improved, and a position paper and 4 policy briefs on abortion were developed. The five pathways of the theory of change reinforced each other. VCAT enabled critical reflection of individual beliefs and values versus professional obligations and responsibilities, and promoted active attitude change towards safe abortion. Partnerships are key for safe abortion advocacy.
072 – MOTHERS’ experiences of receiving MALE midwives’ assistance during birth: a qualitative study in Kween district-Uganda.
WILFRED SIMBA SOYEKWO
GULU UNIVERSITY, KAMPALA, Uganda
Background: In ancient Egypt between 1900 and 1550 BC, midwifery was a recognized female occupation (Rushana M, 2012). However, midwifery and care for mothers during delivery in the health centres began to change from a female art into a male occupation, though the shift was not a smooth one globally (Samuel S. Thomas, 2009). Kween district recruiting 10 male midwives in 2010 to support maternal health including delivery. In Uganda, over 40% of mothers still deliver under the hands of unskilled attendants (AHSPR, 2019/20), and this is a similar case in Kween district (52%). This study explored the perceptions and experiences of mothers under the care of the MMWs during delivery process in Kween District, a rural district in Eastern Uganda. Methodology: This was a cross sectional study that utilized purely qualitative phenomenological approach to document responses of participants. Data was collected from three health facilities with actively serving male midwives (Ngenge HCIII, Chemwom HCIII and Kaproron HCIV) and targeted postnatal mothers 18-49 years who had ever been assisted by male midwives during birth. Registers were reviewed at the 3 facilities to identify appropriate mothers. Then randomly selected and engaged 15 of them in in-depth interview and 18 in 3 separate FGD sessions. Collected data was transcribed in word, coded in excel and exported to Atlas.t 7 for analysis. Thematic and content analysis were utilized to derive insights from the data collected. Approved by TASO-Uganda IRB. Results: The study found out that; the perceptions regarding assistance of male midwives varied significantly across participants. Respondents are still attached to certain beliefs and perceptions that the delivery process is an intimate matter that should only be handled by fellow women. Fear and discomfort when a male midwife touch a woman, discomfort by mothers’ partner, perception of male midwives as being strong, responsible, and friendly came out strongly. In regard to experiences, there was consensus across majority of the respondents that although some expectant mothers were afraid in the beginning especially the first-time visitors, they had the best experience being attended to by male midwives. This was backed up by the fact that male midwives handled them with respect, sympathy, care, passion, and love as opposed to their female counterparts who they reported as being harsh, corrupt, and exploitative. Conclusion: Majority of the mothers reported awesome experience during MMW’s assistance at birth. However, the perceptions were negative. This is in line with several other studies reviewed during the study. Currently health programme improving efforts are based on the scientific understanding of the expatriates with very little involvement of the beneficiaries. This study emphasizes that a lot more effort should be put towards understanding the perception and experience of the service recipients’ and their thought and suggestions be in cooperated into the design of the health system and service provision processes. Comprehensive sensitization and awareness programs on the existence and value of male midwives should be conducted. This is necessary as the Country move towards achieving it’s 64% target for institutional deliveries.
073 – USING a multi-pronged approach to improve uptake of Immediate (48 hours) Post-Partum Family Planning- Lessons from Patongo HC III, Agago District – Uganda
WILFRED SIMBA SOYEKWO
GULU UNIVERSITY, GULU, Uganda
Abstract: Public health facilities located in Patong TC, Agago District. Started on 15th June 1928, Catchment population of 23,302. Number of expected pregnancies – 1,208. Number of women of childbearing age 15-49 Years- 4,952. Mission Statement: To provide health care through preventive, curative, promotional and rehabilitative services to the people in Patongo. Vision: Improvement in the total health of the people within Patongo TC in order to promote a productive population. Services offered: Outpatient services, Inpatient services, Laboratory services, Maternity services, Antenatal services, YCC Services, ART Services, Postnatal services, Family Planning services, Adolescent friendly services, and VMMC services. Methodology: Data reviews to appreciate the performance gap, noted several mothers coming back with pregnancy within a year. Interventions were designed to increase the percentage of women who delivered at the facility and initiate or leave with a modern contraceptive method of choice prior to discharge from 14% in October – 21 to 50% by end of February 2022 A problem root cause analysis was conducted and revealed the following gaps: Lack of family planning supplies in maternity, skills gap especially on IUD, need to consult the husbands before taking up a method and lack of awareness among mothers and their partners To address the identified root causes, immediate postpartum family planning was integrated into routine antenatal care health education, maternity department conducted bi-weekly work improvement (Quality Improvement) team review meeting to track progress, ensured one stop centre by ensuring family planning supplies are readily available within the maternity unit, conducted daily family planning stock status review, facility staff mentorship and skilling especially on IUD services and community dialogues mainly focusing at men. Results: Improvement on FP counselling prior to discharge from 0% up to 100% by end of March 2020. And improvement of the mothers initiated or leave with a modern contraceptive method of choice prior to discharge from 0% to 93% by end of March 2022. Conclusion: Improving up take of immediate (48 hours) postpartum family planning methods requires a multi-pronged approach. Facility and community interventions including Improving mother’ awareness early enough is critical. It’s important to Establish a one stop centre within maternity to ease access, Skilling the service providers and community engagements are critical.
074 – Two consecutive ruptured tubal ectopic pregnancies after interval bilateral tubal ligation: a case report
Moses Owiny, Joram Okeng, Monica Acen Okwir, Oliver Akello Anyeko
Lira University, Lira, Uganda
Background: Bilateral tubal ligation (BTL) is an effective permanent method of birth control preferred by women or couples who have achieved their reproductive potential and do not desire to have any more children. Although considered permanent, there is a very low risk of method failure with a subsequent pregnancy which is likely to be ectopic. The purpose of this case report therefore is to present a rare case of two consecutive raptured tubal ectopic pregnancies following an interval BTL Methods: A 40 years old gravida 9 para 7+1 with seven previous successful vaginal births and one previous ectopic pregnancy of October 2019, presented at the Lira University Teaching hospital emergency department in October 2021 with an acute abdominal pain for 2 days and amenorrhea for 6 weeks. She previously underwent an interval BTL in December 2016 during a community outreach program and an exploratory laparotomy with left salpingectomy for a left ruptured tubal ectopic pregnancy in November 2018. On physical examination, she was fully conscious, in pain, anxious, afebrile, with a pulse rate of 98beats per minute and a blood pressure of 121/78mmHg. Abdominal examination revealed generalized abdominal tenderness with guarding and rebound tenderness. On vaginal examination, she had cervical motion tenderness. Laboratory investigations revealed a positive urine pregnancy test and hemoglobin level of 12.9 grams per deciliter. A trans-abdominal ultrasound scan revealed a tender echo-complex right adnexal mass, free fluid in the Cul-de-sac measuring 5.2 centimeters and an empty uterine cavity. A diagnosis of ruptured right tubal ectopic pregnancy was made and the patient was counseled and consented for an emergent exploratory laparotomy. Results: On exploratory laparotomy, approximately 300mls of blood in the peritoneal cavity and a ruptured right distal tube containing well circumscribed mass was found. The proximal and distal ends of the right fallopian tubes visibly cut and separated from the previous BTL and there was evidence of left salpingectomy, a normal uterus and ovaries. The hemoperitoneum was evacuated and a right total salpingectomy done. The excised right tube containing the mass was sent for histological examination. Histopathology revealed chorionic villi and hemorrhagic vascular decidual tissue in the fallopian tube, features suggestive of tubal ectopic pregnancy. Post-operative patient management was uneventful. On further discussion with the couple prior to discharge of the patient, they expressed their dismay about the two ectopic pregnancies and dissatisfaction in the previous BTL as well as concerns about having sex in future in fear of subsequent ectopic pregnancy. We counseled the couple to relieve their fears about sex and future ectopic pregnancies. Conclusion: Two consecutive ruptured tubal ectopic pregnancies can happen after interval BTL and is associated with a high risk of maternal morbidity and mortality if not recognized and treated early. Client and/or couple anxiety and dissatisfaction in the service and the method is a possible outcome. Keywords: Ruptured, Tubal Ectopic, Pregnancy, Interval, Tubal ligation
075 – ‘Others Will Even Call us Terminators’: Barriers and Facilitators to Provision of Comprehensive Abortion Care (CAC) in Zambia – A Qualitative Study
Christabel Chigwe Phiri1,2, Choolwe Jacobs3, Victor Sichone4,5, Patrick Kaonga6,3, Musonda Makasa7,5,8, Andrew Kumwenda2,5,7,8, Moses Mukosha9,10,11, Theresa Nkole12,5, Jane Mumba13,5, Margarate Nzala Munakampe14, Bellington Vwalika2,5,7,8, Benedictus Mangala5,Mwansa Ketty Lubeya2,5,15,8,10
1Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia. 2Young Emerging Scientists Zambia,, Lusaka, Zambia. 3Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia. 4Department of Obstetrics and Gynecology, Kitwe Teaching Hospital, Kitwe, Zambia. 5Zambia Association of Gynaecologists and Obstetricians, Lusaka, Zambia. 6Department of Bioethics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. 7Department of Obstetrics and Gynaecology, School of MedicineThe University of Zambia, Lusaka, Zambia. 8Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia. 9Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia. 10School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa. 11HIV and Women’s Health Research Group, University Teaching Hospital,, Lusaka, Zambia. 12Department of Obstetrics and Gynecology, Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia. 13Department of Obstetrics and Gynecology, Ndola Teaching Hospital, Ndola, Zambia. 14Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia. 15Department of Obstetrics and Gynaecology, School of Medicine The University of Zambia, Lusaka, Zambia.
Background: It is estimated that one in every five pregnancies globally ends up as an abortion, with about 40% being unsafe. Previous literature showed that abortions account for approximately 5.9% of all maternal mortalities and 50% of gynaecological admissions in Zambia. Despite implementing Comprehensive Abortion Care (CAC) in certain circumstances, which aims to provide high-quality, safe and affordable services to women, unsafe abortion rates remain high. In this study, we explored the barriers and facilitators to CAC provision in selected health facilities of Lusaka and Copperbelt provinces in Zambia to explore why the uptake of safe abortion services remains low. Methods: A qualitative case study using in-depth interviews with health care providers was conducted between July – August 2021 in nine selected public health facilities in Lusaka and Copperbelt provinces of Zambia. The chosen facilities offered various reproductive health care services, including family planning and abortion care. A total of 20 interviews were done with participants purposively sampled as Comprehensive Abortion Care services providers. This study included Medical Doctors, Nurses, Midwives and Clinical Officers. A pretested interview guide with probe points was used to conduct in-depth interviews. It covered questions on duration in service, understanding of Zambia’s legal framework on abortions, perspectives on service provision, enablers and challengers to service provision and recommendations for better service delivery. The interviews were digitally recorded and transcribed verbatim. Data analysis was done using content analysis. Results: The study revealed several barriers and facilitators, most of which are health system-related. The health system-related barriers included: few CAC providers (despite many having received the training but not practising due to consescious objection); healthcare provider perception that provision of CAC was optional; lack of CAC dedicated space and privacy; frequent shortages of medical supplies; and lack of incentives. The individual-related barriers included stigma surrounding CAC provision and religious and moral dilemmas. Facilitators to CAC provision included having providers trained and mentored in CAC, availability of a liberal legal framework, accessible services, task shifting and external financial support. Conclusions: The findings of this study on the several barriers to accessing CAC reinforce the idea that despite having appropriate legal provisions for CAC provision in Zambia, challenges in implementing the law and related service provisions continue to persist. The identified barriers suggest incorporating CAC services into the pre-service training to ensure more trained and skilled providers are available in the public facilities. The Zambia Association of Gynaecologists and Obstetricians (ZAGO) has been conducting awareness workshops with tutors in selected nursing schools.
076 – A triple gain for one investment in Maternal, perinatal death review, surveillance and response (MPDSR)
Baifa Arwinyo1,2, Steven Baguma1, Francis Pebolo Pebalo2, Jackline Ayikoru2, Richard Mugahi3, Francis Obot1, Elvis Okello1, Ronald Okello2
1Gulu Regional Referral Hospital, Gulu, Uganda. 2Gulu University, Gulu, Uganda. 3Ministry of Health, Kampala, Uganda
Background: The policy of the Ministry of Health (MoH) of Uganda states that all maternal and perinatal deaths occurring in health facilities and communities must be timely audited and notified to the MoH. Missed opportunities identified surrounding the causes of death should be appropriately addressed to combat recurrent preventable deaths. Despite this effort, National Maternal and Newborn death rates have stagnated and remained high at 336/100,000 live births and 27/1000 births respectively. Recurrent preventable causes of death have been classified into the 3 delays model. However, Gulu Regional Referral Hospital (GRRH) embarked on a quality improvement project to reduce deaths resulting from the third delay; the failure to access appropriate care for the pregnant woman while at the health facility. Knowledge/skills gap, drug stock outs, staff absenteeism and weak referral systems have been the recurrent missed opportunities identified during death audits. It was acknowledged by the team that failure to follow up on and correct the above missed opportunities identified during the facility level MPDSR meetings, were responsible for the recurrent deaths. Importantly GRRH had failed to involve referring facilities in MPDSR processes that address missed opportunities. The objective of this quality improvement project was to provide facility level feedback and mentorship of the referring facility staff on effective referrals and emergency obstetric and newborn care, to improve birth outcomes. Methods: The Hospital appointed an MPDSR focal person whose role was to carry out surveillance on maternal and perinatal death cases and near misses in the maternity and new born intensive care unit. This involved isolation of case files to await a scheduled date for audit, which happens weekly. Weekly death audit meetings were conducted, during which missed opportunities and avoidable factors surrounding the deaths were documented and corrective action plans were drawn for follow up. Follow up was timely done to include feedback to the referring facilities and targeted capacity building was done in relation to the identified knowledge or skills gap. This surveillance process was carried out for up to 6 months. Results: Following implementation of the corrective action plans from the meetings, to include capacity building of the GRRH and referring facility staff on emergency obstetric and newborn care, there was notably a reduction in referral from lower level IV facilities from 752 to 420 from the first and second half of the financial year (FY) 2021/2022 respectively. Secondly, annual maternal deaths at GRRH were kept as low as 5 deaths out of 5,551 maternal admissions during the FY. Thirdly, access to caesarian section at Pajule HCIV (one of the referring facilities) was increased from 0/596 (0%) to 36/540 deliveries (7%) from the first to the second half of the year when skills mentorship was done. Conclusion: Improving the quality MPDSR and implementation of recommendations generated during audit meetings is a yard stick in improving the quality of maternal and newborn health care and overall reduction in facility maternal and perinatal mortality.
077 – Strengthening access to safe abortion in Rwanda: Evaluating the experiences of health workers and service-users.
Rwanda Society of Obstetricians and Gynecologists, Kigali, Rwanda
Background: Rwanda expanded access to abortion in 2019, abortion is now permitted if the person seeking an abortion is a child; if the pregnancy is a result of rape and/or incest (second degree kinship); if the person was subjected to a forced marriage; if there is a risk to the health of the person and/or foetus. Abortion care can take place in public and private hospitals and polyclinics – private health facilities that have doctors available. To ensure that the 2018 abortion law is effectively implemented Rwanda Society of Obstetricians and Gynecologists (RSOG) conducted a training and mentorship programme (2019-2021) with health workers at district hospitals, health centres and some health posts in 30 districts in five provinces across Rwanda. Methods: RSOG developed an anonymous questionnaire to ascertain experience/perception of the health workers that took part in the training and mentorship programme. The questionnaire identified three areas for feedback, (i) demographic characteristics of the health worker, (ii) knowledge, attitude and practice of safe abortion, (iii) self-confidence to provide safe abortion care. In addition, RSOG conducted a selection of interviews with service-users that required a safe abortion. Results: Of 1,043 health workers who completed RSOG’s training and mentorship programme, 601 (52.6%) (with representation across 26 selected districts) completed the questionnaire. On knowledge, the majority of health workers were aware of the conditions under which abortion is legally permitted. According to Rwanda’s law abortions are not accessible at health centres because they do not have doctors available and therefore do not meet the criteria who can perform an abortion and where it can be conducted – e.g. at a hospital or polyclinic. In addition, 4.93% of health facilities are run by the Catholic Church – where safe abortion services would not be provided. 37 Service-users from four districts were interviewed and the average age of the respondents was 19 years. Overall, the Service-users were pleased with the abortion care they received from health workers. Key recommendations identified by Service-users were: (i) better access to information on safe abortion services – where to access them and the safety of the process, (ii) privacy and confidentiality – the need to have private rooms and waiting areas in the health facility, (iii) the removal of the requirement for under 18 years old to have a caregiver or parent sign the consent form. Conclusion: The evaluation provided ample evidence of the importance of the training and mentorship program being rolled out by RSOG given the finding that many eligible facilities were not providing abortion care. The barriers to this will need to be examined and rectified to ensure women and girls are not forced to travel far to access these services. RSOG will use the findings to continue to build capacity of health workers and improve health services for women and girls.
078 – MEDICINAL PLANTS USED AS CONTRACEPTIVES, AND ABORTIFACIENTS IN NORTHERN UGANDA
Lawaka Alice Veronica, Pebalo Francis Pebolo
GULU UNIVERSITY, GULU, Uganda.
Introduction: There is growing body of knowledge in using herbal medicine for management of various medical conditions despite lack of efficacy studies. As high as 80% of the population in low income countries depends on herbal medicine for their primary healthcare needs. Herbal medicinal plants have been used for induction of labour as well as abortion. Most of these practices are done clandestinely by women themselves or the Traditional Birth Attendants (TBAs). The Utero-tonic properties of these herbs if combined with other Utero-tonic agents such as Misoprostol may have synergistic effect with disastrous consequences. This information is rarely voluntarily given to the attending health care workers unless the delivery becomes complicated. Indigenous knowledge has been used to control birth, induce milk secretions and treat menstrual pain amongst the Acholi peoples of Northern Uganda and South Sudan. Homemade ancient birth control methods such as herbs, heavy metals, homemade barriers, methods from animal guts, were used to prevent pregnancy. Recently, some herbal regimens Uganda has documented as being effective for Contraception, spermicidal and for abortion. The knowledge about these medicinal plants is normally passed on from one generation to the next through indigenous Knowledge, indigenous cultures and indigenous knowledge systems. Although claimed to be effective, most of these medicinal plants are unknown and are often cleared away along with the rest of weeds and hedges from time to time. The known ones are collected from the wild using destructive harvesting techniques such as uprooting and debarking that endangers their survival. Identifying these plants, documenting their efficacy and safety is timely and will contribute to the development of natural products including contraceptives and Utero-tonic agents. Specific objectives: The following study will be undertaken:- – To identify all-natural products used as contraceptives, and determine the spatial distribution of the medicinal plant species in Northern Uganda. – To identify all-natural products used as spermicidal, determine the spatial distribution of the medicinal plant species in Northern Uganda – To identify all-natural products used as Utero-tonics, determine the spatial distribution of the medicinal plant species in Northern Uganda. – To identify and documents the active phyto-chemicals efficacy and safety Methodology: The study will be carried out in 3 PHASES – PHASE I – Identification of herbs and documentation of claims used – PHASE II – Study their safety and efficacy profile – PHASE III – Clinical trials to recommend it for use as a clinical instrument. Significance: This study will support identification of medicinal plants that has contraceptives, spermicidal and Utero-tonic properties to help in planned conservation and identification of active phyto-chemicals contributing to the development of natural products. Safe and cost effective natural products that can be used as contraceptive, spemicidal and Utero-tonic agents will be made available for the general population to enhance access to the critical needs of reproductive health in the country.
079 – Re-envisioning Sexual and Reproductive Health Practices during Crises in Acholi -land: Local Partnerships as Pathways to Improved Programming
James Onono Ojok
Gulu University, Gulu, Uganda
Background: The Maputo Declaration of 2004 mobilizes activism toward health as a human right. The ICPD of 1994 acknowledges that reproductive health is related to human rights as well as development and it emphasized women’s rights to access sexual and reproductive health services such as family planning, antenatal and delivery care, and safe abortion where legal (UNFPA 1995). There are a plethora of global commitments to sexual and reproductive health since ICPD. These include Sustainable Development Goals 3 on good health and well-being and Sustainable Development Goal 5 on gender equality (United Nations General Assembly 2015). Despite these commitments, each year, there are still millions of women with unmet needs for modern contraception and safe abortions and men and women without treatment for curable STIs (See Starrs et al 2018). Moreover, in crisis contexts, like in Northern Uganda, women and men resort to local cultural practices in meeting their sexual and reproductive health needs. This knowledge and experience have worked for them in such contexts. This research, therefore, sought to explore local solutions for women and men in response to their sexual and reproductive health needs in times of crisis. The project sought to explore ways of learning from this context and sharing knowledge and cultural practices that work in enhancing sexual and reproductive health. Methods: The research deploys qualitative methods using arts-based approaches to produce map out local solutions to sexual and reproductive health practices during crises. This project utilizes arts-based approaches to collect, document and share the voices and perspectives of women and mothers, in ways which align with local knowledge systems and uphold safeguarding and ethical principles. T The arts-based approaches contributed towards empowerment, equity, and obtaining valuable evidence in the project (Powers, 2017; Tanabe, Pearce, & Krause, 2018). This project centred 15 women and mothers living in Gulu City in Northern Uganda. To localize the research, we utilized indigenous and decolonial knowledge production methods. Data was collected over 30 days with the same women and mothers. These women were purposively selected. Results: The findings indicate that there are a plethora of progressive locally driven and community-centered initiatives of contraceptives and abortion that exist among the Acholi during crisis situations. These practices ought to be considered alongside outsider-driven donor-driven models in order for sexual and reproductive health rights and goals to be realized. These indigenous practices among respondents in the region were documented. Conclusion: The research notes the urgency for the de-hierarchization of sexual and reproductive health programming in post-conflict contexts. Ideas, views, and aspirations of communities in these of locals should respectfully be harnessed and integrated into programming and implementation during crisis interventions. The research also calls upon donors to collaborate with actors at the local level during emergencies to ensure voices and practices from below (bottom-up approach) ought to be implemented in interventions in times of crisis. Finally, the research concludes that indigenous knowledge and practices complement the formal interventions in sexual and reproductive health care provision in Acholi-land in Northern Uganda.
080 – ASSESSMENT OF THE USE OF MODERN CONTRACEPTIVE METHODS IN TEENAGERS OF G.S RWAMAGANA
MUSENGIMANA DENISE1, NIYOMAHIRWE JULIENNE2, KALINIJABO SYLIVIE1, NIYIRAGIRA SHALIF1, NSHUMUYIKI JOEL3, NDAGIJIMANA SEBASTIEN4
1UNIVERSITY OF RWANDA, KIGALI, Rwanda. 2university of rwanda, KIGALI, Rwanda. 3UNIVESITY OF RWANDA, RWAMAGANA, Rwanda. 4UNIVERSITY OF RWANDA, RWAMAGANA, Rwanda
Abstract: Teenager’s pregnancy is a problem of concern worldwide mainly in developing countries. Despite the rate of teenagers’ pregnancy, there is a low rate of use of modern contraceptive methods in teenagers as one of the method to prevent teenagers’ pregnancy. Teenager’s pregnancy is a consequence of inadequate or no access to teenagers’ sexual and reproductive health services and information.(Anon,2018). In Africa the rate of adolescent contraceptive use ranges from 3–49%.(WHO,2014),in the developing world in 2015, 12.8 million adolescent girls have an unmet need for family planning.(UNFPA, 2016), teenager’s pregnancy is a result of inadequate use of contraceptive methods to teenagers.(WHO, 2018). a study done by Dennis et al in 2017 in the analysis of time trends in contraceptive need and use among adolescents and young women in Kenya, Rwanda, Tanzania, and Uganda, have shown that only 20 % of women aged 15-24 years have a met need for contraception, which was lower compared to older women.(Dennis et al., 2017) Objectives: The objectives of this study was to identify different contraceptive methods and factors associated with modern contraceptives use among sexually active teenagers of Group Scholaire Rwamagana. Methods: This study used a cross sectional research design the study sample size of 133 teenager girls aged 13-19 years old. Convenient sampling strategy was used to get the required respondents. A structured, closed-ended questionnaire was used for data collection. Descriptive and bivariate analysis techniques were used to analyse, present the data and obtain the level of significance between dependent and independent variables. Ethical clearance, voluntary participation, Consent and assent and confidentiality were all considered mandatory in this study. Results: The prevalence of contraceptive use among teenagers was found to be very low and 81.2% report having never used contraceptive methods.The male condom was the mostly used method on a rate of 27%. In this study it has been seen that there is a statistical significant relationship between having heard of contraceptive methods and formal training about contraceptives and modern contraceptive use with p-value of 0.022 and 0.000 respectively in additional, data on the relationship between age and use of modern contraceptive method. The p value of 0.047 was evident to explain the relationship between age and contraceptive use moreover, results show that there is a statistical relationship between level of education and contraceptive use with a p value of 0.001.with statistical significance relationship between religious prohibition and use of contraceptive methods with p value of 0.04 Conclusions: The results have shown that contraceptive usage is at a low rate of 18.8 %. Age, education level, trainings on contraceptive methods and religious prohibition are factors that affect use of contraception in G.S Rwamagana. Therefore, not only sexually active teenagers should be educated about contraceptive use, however all teenager should be given enough information regarding contraceptive methods use, safety and side effect to answers all question which can hinder effective use of contraceptive methods when in need.
081 – Factors Associated with Intended Abortion Prevailing Among Women of Reproductive age Attending Gynecological Services in Yumbe Regional Referral Hospital, Yumbe District
Gulu University, Gulu, Uganda. Milhen Medical Center, Gulu, Uganda
Background: Unsafe abortion is a neglected public health problem contributing to 13% of maternal deaths worldwide.In Africa, 99% of the abortions are unsafe resulting in one maternal death per 150 cases. The prevalence of unsafe abortion is related to abortion laws, poor quality of health service, and low community awareness, low knowledge on contraceptives The Ugandan ministry of health in the annual health sector performance report of 2017-2018 estimates that as of 2018, 5.5% of all maternal deaths result from abortions complications. Its reported to be the fourth leading cause of maternal deaths in Uganda. Abortion is illegal in Uganda thus the Ugandan women turn to Intended abortion practices. In Yumbe district, there are limited studies under taken on factors associated with unsafe abortion among reproductive age women, however according to a 2021 report from United Nations Population Fund (UNFPA), the six regions with the highest numbers of teenage pregnancies were recorded between 2019 to 2021.West Nile being fifth out of the 6 regions and Yumbe as the second highest (Arua 4,705 and Yumbe 3,973). Other regions included the following with their positions; Busoga(1), North central(2), Lango(3), South central(4), and Tooro/ Rwenzori(6). Majority of these unwanted pregnancies end up in unsafe abortions. This study investigated the factors associated with intended abortion among women of reproductive age in Yumbe district Methodology: Cross section study was carried using a purposive sampling method with a pretested questionnaire was used to collect data. The study was carried out at Yumbe Regional Referral Hospital to identify factors associated with unsafe abortion prevalence among women of reproductive age attending gynecological services with a study population of 400 women and a sample size of 200 women aged 15-49 years. Results: Majority (35.3%) were between the age of 15 -34 years, (30%) were from urban areas, (37.3%) attained secondary level of education. (62.7%) were unemployed ,majority(45.1%) were moslems meanwhile most(37.3%) were cohabiting.(66.7%) had ever heard about abortion law in Uganda, majority (58.8%) received the information from health facility,( 62.7%) knew about safe places of abortion and most(93.7%) knew health Facility.(84.3%) had knowledge about unsafe abortion complications ,most(67.4%) knew about death,(90.2%) were aware of modern family planning methods ,majority(32.6%) were aware of condom and injectable, most(72.6%) had ever used the methods ,majority(51.4%) used condom,(76.5%) lack knowledge on how to use the methods. Most (35.3%) terminated the pregnancies with the desire to pursue education, (54.9%) agreed legalization of abortion, and (60.8%) accepted that in cases of rape, pregnancy should be terminated. (58.8%) had a positive attitude towards modern family planning methods, majority (71.4%) had fear of side effects of modern family planning. Conclusion: Therefore the study participants were knowledgeable with positive attitude towards unsafe abortion but with limited knowledge on how to use modern family planning methods, fear of side effects related to conceptive use. The leading cause of unsafe abortion was desire to pursue education.
082 – Integrating adolescent-friendly services in health facilities in lira district, northern Uganda
Caroline Nabasirye1, Felister Apili1, Annet Patience Nakalega2 1Department of Midwifery, Faculty of Nursing and Midwifery Lira University, 2Department of Public Health, Faculty of Health Sciences, Victoria University
Background: Young people (10-24 years) in Uganda face many sexual reproductive health and rights (SRHR) challenges stemming from early, unprotected and forced sexual activity. An underlying factor to this is limited access to youth-friendly SRHR information and services, which impact on young people’s ability to make informed and healthy life choices. Especially in many rural areas of Uganda, the provision and uptake of quality adolescent SRHR services remains low. Adolescent-friendly services are essential in addressing the issues that could threaten the achievement of the sustainable development goal. Lira district is one of the districts in northern Uganda that is falling apart, with the second highest teenage pregnancy rates in the Lango subregion, which is recovering from the effects of the civil war. It is crucial to comprehend the integration of services that could prevent problems with teenage pregnancies and maternal mortality in a region where contraceptive use is low and fertility rates are high. Therefore the study sought to assess the integration of adolescent friendly services among health facilities in lira district northern Uganda in order to inform health systems. Methods: We used keywords to search electronic databases like PubMed and Google Scholar. Peer-reviewed articles released in English between June 1, 2015, and December 31, 2020 were taken into consideration. The peer-reviewed studies that were taken into consideration concentrated on identifying the facilitators and hurdles that health facilities faced while integrating adolescent-friendly services. Results Twenty-two papers that identify elements influencing the integration of family planning into HIV services satisfied the criteria for inclusion and underwent thematic analysis. Results: Human resource turnover and shortages, a lack of policy direction on integrated care, poor oversight, ambiguous service delivery rules, inadequate infrastructure, and weak monitoring systems were health systems’ characteristics that limited the integration of family planning and HIV services. Training in family planning for service providers, the development of supportive policy environments to accommodate service integration, supportive supervision, and a positive attitude by service providers toward service integration were identified as facilitators to the successful integration of family planning into HIV services. Conclusion: The improvement of family planning commodity stock levels, expansion of the health workforce to enable integrated service delivery, and skill development for service providers all play crucial roles in making it easier to integrate family planning into HIV services. Integrating SRHR strategically into community outreach programs that target adolescents who are difficult to reach is crucial.
083 – Abortion care services in Lusaka and Copperbelt provinces of Zambia: Users’ experiences and perceptions
Mwansa Ketty Lubeya1,2,3,4, Margarate Nzala Munakampe5, Musonda Makasa1,2,4, Moses Mukosha6, Choolwe Jacobs7, Christabel Chigwe Phiri8,3, Bellington Vwalika1,2,3,4, Victor Sichone9,4, Benedictus Mangala4, Andrew Kumwenda1,2,3,4, Melissa Haketa3, Meek Mwila3, Patrick Kaonga7,10
1Department of Obstetrics and Gynecology, School of Medicine, University of Zambia, Lusaka, Zambia. 2Women and Newborn Hospital, University Teaching Hospitals, Lusaka, Zambia. 3Young Emerging Scientists Zambia, Lusaka, Zambia. 4Zambia Association of Gynaecologists and Obstetricians, Lusaka, Zambia. 5Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia. 6Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia. 7Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia. 8Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia. 9Department of Obstetrics and Gynecology, Kitwe Teaching Hospital, Kitwe, Zambia. 10Department of Bioethics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
Background: Globally, 10 to 15 per cent of women who knew they were pregnant experienced a miscarriage. The sub-Saharan region shares this burden disproportionately, with abortion-related mortality estimated at 90 per 100,000 live births. In Zambia, 7% of all maternal deaths are abortion-related despite the country having made a long-standing political and policy commitment to address morbidity and mortality associated with abortion, evident from the 2009 Standards and guidelines for reducing unsafe abortion morbidity and mortality in Zambia. These guidelines are operationalized from the Termination of Pregnancy Act of 1972. Despite the available provisions, women continue to face barriers to accessing abortion care services, such as low knowledge of the legal provisions, high financial and emotional costs, conservative attitudes towards safe abortion, and hostility or lack of willingness to provide services by healthcare workers. Universal Health Coverage goals assert the right to essential and quality healthcare across the life course without enduring financial hardship. As a key national partner in maternal and reproductive health, the Zambia Association of Gynaecologists and Obstetricians (ZAGO) undertook this research to complement the national efforts to attain United Nations sustainable development goal # 3i through evidence generation. ZAGO is one of the associations funded by the International Federation of Gynecology and Obstetrics (FIGO) to promote women’s health through advocacy for safe abortions. Therefore, this study aimed to explore the experiences and perceptions of women receiving post-abortal care services. Methods: A qualitative case study was conducted between August and September 2021 in nine selected government hospitals in Zambia’s Lusaka and Copperbelt provinces. Participants were purposively enrolled on discharge from the health facility after obtaining written informed consent. In-depth interviews were conducted in private rooms for confidentiality, using audio recorders, and transcribed verbatim. Data were analysed through thematic analysis, we used the Availability, Accessibility, Acceptability and Quality (AAAQ) framework to understand how women claimed their rights when seeking care. The right to health as the central standard for assessing health care imposes four essential standards on health services, availability, accessibility, acceptability and quality. Results: We purposively enrolled 15 participants after reaching thematic saturation, the age range of 17 to 45 years. Three major themes emerged- (i) women’s experiences of abortion and their healthcare-seeking behaviour, (ii) perceptions of the healthcare system and their knowledge of the legality of abortion (iii) their views on possible measures to improve post-abortion care services. Some women delayed seeking post-abortion care (PAC) because they feared the negative attitudes from their communities and the health care system. In some cases, clients reported making payments for services directly to the provider and not direct costs for tests or consumables. Conclusion: Women seeking post-abortion care services experienced barriers to accessing quality health services. Therefore, there is a need to continue strengthening post-abortion care to ensure that women easily access the service. Further, there should be continued community education around Zambia TOP act in a culturally sensitive manner.
084 – Assessement of the factors associated with positive visual inspection with acetic acid and vision inspection with lugor’s iodine results among the women screened for cervical cancer at Muhima District Hospital, Rwanda
University of Rwanda, Kigali, Rwanda
Introduction: Cervical cancer is a grave threat to women’s health and lives globally (Bray et al. 2018). It is estimated that one woman dies of cervical cancer every two minutes (Bray et al. 2018). Visual Inspection of uterine cervix with Acetic Acid (VIA) and Lugol’s iodine (VILI) are cervical cancer screening options recommended by World Health Organization (Uken et al., 2016). Positive VIA and VILI confirms the presence a precancerous lesion. In Rwanda, little is known about data regarding factors associated with positive VIA/VILI. Aim: The overall objective of this study was the assessment of factors associated with positive result of VIA and VILI among the women attending Muhima District Hospital for cervical cancer screening. Methodology: It was a descriptive retrospective study and was conducted at Muhima District Hospital. The study population was 2160 files of women screened for cervical cancer using VIA/VILI. A Yamane Taro formula was used to find a study sample equivalent to 339 files. After systematic random selection of 339 files, the researcher found that 332 files had all eligibility criteria completed and were used for analysis. A checklist developed for the study was used to collect data from the files and the SPSS version 22 was used for data analysis. Frequency distribution and chi-square test were used to determine the factors associated with positive VIA/ VILI. Result: The current study revealed that the prevalence of VIA/VILI positive result was 18.07%. The age [AOR (95%CI) = 2.8.9, p-value of 0.00] and number of sex partners [AOR (95%CI) = 8.78, p-value of 0.03] of the participants were significantly associated with positive VIA/VILI. However, age at first sex, HIV-status and HAART-status, and history of STIs were not found to be predictive of VIA positive results in this study. Conclusion and recommendation: The prevalence of positive VIA/VILI was 18.07%. Age and number of sex partners was found to significantly associate with positive VIA/VILI. Efforts such as screening with VIA/ VILI test for all eligible women (30-49) and women with more sex partners could be considered to reduce the burden of cervical cancer.
085 – The impact of male partner companionship during antenatal care and labor on the uptake of postpartum contraception among Rwandan women
Aimee Nyiramahirwe1, Polyphille Ntihinyurwa2,3, Diomede Ntasumbumuyange2
1Rwanda Military Hospital, kigali, Rwanda. 2Kigali University Teaching Hospital, Kigali, Rwanda. 3SPIRHR, Addis Ababa, Ethiopia.
Background: Strategies to increase the uptake of contraception services have been adopted in Rwanda but the unmet needs for family planning remains high. Women in postpartum period are at higher risk for unintended pregnancy due to the silent conversion from lactational amenorrhea to reactivation of Ovulatory cycles. The purpose of this study was to explore the role of male partners on the uptake of postpartum contraception. Methods: A prospective cross-sectional study was conducted among women who delivered at the University Teaching Hospital of Kigali during a period of 3 months with random sampling. A Questionnaire was used to collect socio-demographic and antenatal data, information on male Companionship, and intent to use postpartum contraception at admission. Participants were contacted 6 weeks later to collect data on contraceptive use. The outcome variables were uptake of postpartum contraception and types of contraceptive taken (long acting vs short acting) controlling for male companionship during antenatal period. Chi-square test was used and p-value ≤0.05 was considered significant. Results: A total of 209 women were recruited with mean age of 30.8±5.2 years. The majority (60.9%) were multigravida, 66.5% were multiparous. More than half (55%) had male partner companionship, 18.3% had companionship for 4 antenatal visits, 28.2% had education on contraception with their male partner. Factors significantly associated with uptake of postpartum contraception were: age above 30 years, owning or heading a business, multigravidity, multiparity, antenatal care at health center or district hospital, caesarean delivery, and previous utilization of contraception. Male companionship significantly increased the intent to use contraception, uptake of modern contraception in general and uptake of long active contraceptives but did not predict the uptake of short acting contraceptives. Conclusions: Our study demonstrates positive association between male companionship during antenatal care, labor and delivery with uptake of postpartum family planning. Our study suggest, more sensitization to involve the male partners, improve the education on contraception during antenatal care and further research to assess the sustained uptake of contraception beyond the postpartum period Key words: Postpartum, Family planning, Contraception, Male Partner, Uptake
086 – Association between Chlamydia trachomatis, Neisseria gonorrhea, Mycoplasma genitalium, and Trichomonas vaginalis and Secondary Infertility in Cameroon: A case-control study
Clarisse Engowei Mbah1, Amy Jasani2, Kristal J. Aaron2, Jane-Francis Akoachere3, Alan T. N. Tita4, William M. Geisler2, Barbara Van Der Pol2, Jodie Dionne-Odom Dionne-Odom2, Jules Clement Assob Ngeudia5
1Institute of Medical Research and Medicinal Plants Studies, Center for Research on Health and Priority Pathologies, Yaounde, Cameroon. 2Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, USA. 3Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon. 4Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Alabama at Birmingham, Birmingham, USA. 5Department of Laboratory Medicines, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
Objective: Data on the prevalence and etiology of infertility in Africa are limited. Secondary infertility is particularly common, defined as the inability of a woman to conceive for at least one year following a full-term pregnancy. We describe a prospective study conducted in Cameroon designed to test the hypothesis of an association between common treatable sexually transmitted infections (STI): Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), and Trichomonas vaginalis (TV) and secondary infertility in women. Methods: In this case-control study, we enrolled women in Fako Division, Cameroon between November 2017 and December 2018 with secondary infertility (cases) or current pregnancy (controls). We conducted a baseline survey to collect sociodemographic, and sexual and medical history information. Nucleic acid amplification testing using Aptima (Hologic, San Diego, CA, US) was performed on endocervical swabs for CT, NG, MG, and TV. Multivariable logistic regression was used to assess the relationship between active STI and secondary infertility. Results: A total of 416 women were enrolled: 151 cases and 265 controls. Compared to controls, cases were older (median age 32 vs 27 years) and had more lifetime sexual partners (median 4 vs 3) (p< 0.001). Cases were more likely to report dyspareunia, abnormal menses, prior miscarriage, and ectopic pregnancy (all p< 0.05). STI positivity was not significantly different among cases and controls (2.7% vs 5.4% for CT, 1.3% vs 2.9% for NG, 6.0% vs 7.0% for MG, respectively), with the exception of TV which was more common in pregnant controls (0.7% vs 5%; p = 0.02). Conclusion: Study findings did not support an association between active STI and secondary infertility in Cameroon. Given high rates of pre-existing tubal damage, routine STI screening and treatment in younger women may be more impactful than costly STI testing during infertility assessments.
087 – Improving Preservice Education in Gulu University Using Technology
Pebalo Francis1, Jackline Ayikoru1, Jimmyy Opee1, Sande Ojara2, Baifa Arwinyo3, Felix Bongomin1
1Gulu University, Gulu, Uganda. 2Lacor Hospital, Gulu, Uganda. 3Gulu Regional Referral Hospital, Gulu, Uganda
Background: Gulu University Sexual and Reproductive Health Resource Center (GU-SRHRC) was established in 2021 with funding from CIRHT-Africa/UM with the aim of improving Pre-service training, clinical service provision and research capacity building in sexual and reproductive health at Gulu University and its affiliated teaching hospitals. To help strengthen pre-service trainings, user friendly technology such as an audio-visual simulation laboratory, lecture production studio and teleconference facility have been established. Methods: The following innovations were employed. 1) The Simulation laboratory: a high-tech audio-visual facility records the demonstrated clinical skills and this is played later during debrief session in an interrupted manner as the lecturer and learners review the student’s demonstration in an interactive manner and learners can see their own strengths and flaws and learn from it. The display screen allows interactivity such as annotations, whiteboard features as well as incorporation of online audio-visual materials. 2) Interactive screen allows presentations demonstration, annotations as well white/black board features that can be stored and retrievable. There is an inbuilt camera application which enables us to use it for online meetings and conferences and to access any other web-based features. 3) Demonstrations of psychomotor skills such as knot tying, dissection, demonstration on a model, paper-based annotation can be recorded using a document camera. This has helped us to build a collection of locally made videos for training. 4) The lecture production studio: A simple and yet sophisticated innovation used to record and produce lectures, educational videos, livestreaming are made possible. To help reduce the needs of having a camera operator, an automated pan tilt and zoom (PTZ) self-adjusting camera that has well defined sensors that detects and records sound, motion and rotates through 180-degree angles are installed into the lecture production studio. With a computer software, recording lectures demonstrations, livestreaming to have an interactive teaching are done. The recorded lectures, procedural skills, demonstrations, and health educational materials are uploaded to YouTube and students can access them, anytime and anywhere. Results: The incorporation of audiovisual technology in medical education has introduced other pedagogy methods such as flipped classroom and this has enhanced interactive learning; Lecturers are able to conduct lectures remotely and produce teaching materials which are sent to learners or uploaded on online platforms for learners to access here at convenience; Learners have demonstrated interests in this as seen by the number of videos watched, link to video here https://www.youtube.com/c/pebalofrancispebolo/videos. Students have reported increased confidence in clinical skills, communication skills. Flipped classes has made students to be more interactive and more involved in learning. Conclusion: Use of technology can help improve on preservice medical education by incorporating new pedagogical methods of instruction into the current curriculum. This is very important especially due to the need for blended lectures brought by COVID-19 challenges. There is need to embrace this current practice to improve on learning outcomes, especially in low resource settings.
088 – Knowledge, Attitude and Practices Towards Contraception Among School-Going Adolescents and Young People in Mbale, Eastern Uganda
Ronald Olum1,2,3, Emmanuel Makai1,4, Robert Mutyaba1,5, Joseph Okot1,2, Levi Gizamba1
1Makerere University, Kampala, Uganda. 2St. Francis Hospital, Nsambya, Kampala, Uganda. 3Gulu University, Gulu, Uganda. 4St. Mary’s Hospital, Lacor, Gulu, Uganda. 5Our Lady of Consolata, Kisubi Hospital, Wakiso, Uganda
Introduction: Globally, about one-tenth of all births are to women below 20 years old, and the majority occur in developing countries. In Uganda, 24% of adolescents aged 15-19 have begun childbearing and Eastern Uganda is among regions with the highest prevalence. Provision and timely access to contraception has been proven to prevent unwanted pregnancy, even among adolescents. There is however limited data on their knowledge, attitude, and practices towards contraception in Eastern Uganda, necessitating our study. Methods: This was a cross-sectional study design employing quantitative techniques among adolescents and young people aged 11 – 25 years attending four primary schools in Mbale city, Eastern Uganda. All the students in the final years (primary seven and senior four) were enrolled into the study because the rest of the classes were closed due to the COVID-19 government guidelines. A self-reported questionnaire adopted from previous KAP studies on contraception was used to collect the data. Data was entered using a mobile application designed via KoBo Toolbox. All analyses were performed using Microsoft Excel, STATA 15, and GraphPad Prism. P < 0.05 was considered statistically significant. Results: Data from 316 participants with a mean age of 16 (SD: 2.4, range: 11 to 25) years were analyzed. The majority were below 18 years (70.3%, n=222), Moslems (72.2%, n=228), and Gishu speaking (83.9%, n=265). Overall, only 30.7% (n=97) of the participants had adequate knowledge on contraception. At bivariate analysis, contraception knowledge was associated with religion (p=0.010), but this was not significant at multivariable logistic regression. Attitudes were moderately positive towards contraception (mean score: 12/18, SD: 1.9) with about half (49.1%) agreeing that contraception allowed parents to take good care of their children. However, up to 46.8% believed that using a condom reduces pleasure during sexual intercourse. Some 109 participants (34.5%) had used contraception. Self-reported contraceptive methods included condoms (58%), abstinence (50%), safe period (18%), pills (15%), injectables (7%), diaphragm (3%), and implants (3%). Conclusion: Contraception knowledge was poor among school-going adolescents and young people in Eastern Uganda. However, attitudes towards contraception were moderately positive. Routine health education on sexual and reproductive health are recommended among students to improve their understanding and acceptance of contraception to reduce the burden of adolescent pregnancy in this region.
089 – Male involvement in family planning services utilization in a rural community in Serere District Eastern-Ugandan
Lenia Maurine1, Kalema George, Kalyowe Denis2, Kugonza Richard, Okiah Lindah3 and Onyango E Ouma
1St Marys Lacor Hospital, Gulu, Uganda. 2Busitema University Faculty of Health Sciences, Mbale, Uganda. 3Serere Health Centre IV, Serere District, Uganda
Background: Family planning (FP) is one of the major components of reproductive health and utilization of modern family planning method among women of reproductive age (15-49) still remains a public health challenge. The unmet need for family planning points to the gap between couples reproductive desires to avoid pregnancy and contraceptive behavior. In Uganda FP uptake is at 35% among women of reproductive age with unmet need as high as 28%. The percentage utilization of FP is still low in the rural population, this is attributed to low level of education, cultural, social and religious norms. The government of Uganda has pledged to increase uptake of modern FP to 50% and reduce the unmet need to 10% through creating awareness, targeting youth and addressing the misconception across various social and cultural settings. Despite all the vigorous efforts in place, there is still widespread failure to implement contraceptive use. It is in this background that the present study aims at examining the utilization and level of male participation in preventing unwanted pregnancies, reducing mortality rates hence improving on the health of the population through modern family planning. Methods: The research was conducted through community based cross-sectional survey of 100 randomly selected adult male aged 18-49 in Serere Town council in Serere District Uganda. Data was collected through pretested interviewer guided questionnaires about sociodemographic information of participants, knowledge on contraceptives, contraceptive use and fertility desires, couples’ communication and decision making on family planning. Results: The results revealed the complexity of the roles male partners play. Culturally influenced gender roles and inadequate understanding of FP information were the key factors that influenced the male attitude and use. Male opposition was attributed to limited understanding 35%; misunderstandings about side-effects 25% of the respondents; male dominance in relationships and physical abuse. These factors contributed to covert or discontinued use by female partners. Pathways identified through which male partners positively influenced FP uptake and access include: social support, adequate information, and shared responsibility. Despite of the positive response from majority of participant, their active participation is greatly influenced by the 35% and 25%. Conclusion: Understanding the role that male partners play in FP/C uptake and use is important in preventing unintended pregnancies and improving family planning policy and service delivery programs. It is equally important to identify how male partners facilitate and promote adherence and use of FP, and how these positive strategies can be incorporated into policy to improve the uptake and use of FP.
090 – Knowledge, attitudes, practices and factors influencing contraceptive use and perceptions on safe abortion among unmarried female university students in Rwanda
Athanase Rukundo1, Bertin Sitini2,3, Louange Twahirwa Gutabarwa1, Kagaba Aflodis1, Eugene Ngoga2,3
1Health Development Initiative, Kigali, Rwanda. 2Rwanda Society of Obstetricians and Gynecologists, Kigali, Rwanda. 3Rwanda military Hospital, Kigali, Rwanda
Background: effective use of contraceptives prevents unintended pregnancies and is highly influenced by culture and social background. While contraceptive use is a reproductive right and one of the pillars of safe motherhood, still the number of unmet needs remains high mainly in low and middle income countries, leading to increased number of unintended pregnancies, adversely resulting in unsafe abortions and subsequent maternal morbidity and mortality. This study aimed to determine the knowledge, attitudes, and use of contraception with associated factors among unmarried female university students in Rwanda, and their perception towards safe abortion. Methodology: This was a quantitative cross-sectional study conducted among unmarried female university students within 4 universities in Kigali-Rwanda, which are UR/CMHS, MKUR, UTB and UNILAK. Online questionnaires were used for data collection then processed and analyzed using IBM-SPSS version 25. Descriptive statistics were used to present background information of the study population, inferential statistics were used to determine the knowledge and attitudes of the study population, multivariable analysis was used to determine the factors associated with contraceptive use, P value was calculated using Chi-Square and Fisher’s exact test. Results: A total number of 552 participants were recruited. The mean age of participants was 25±3.2, the majority of respondents were single at 86.2%. Undergraduates students represented 86.1%, and 41.5% were in health sciences studies. 45.5% were catholic and nearly half (46.6%) of all respondents were living in rented houses. The results showed that the knowledge of unmarried female students is generally good and their attitudes towards contraceptives are positive. Among all respondents, 82.8% reported to be sexually active, 91.2% had used at least one type of modern contraceptive, but also 86.2% of them had had unprotected sexual intercourses at least once. Among sexually active students 29.1% had had unintended pregnancies, that resulted either in abortions or live births. The most commonly known and used methods were condoms and pills. The most highlighted barriers for contraceptive use were lack of enough information about existing methods, lack of contraceptive methods at the campus, and fear of side effects. Only 39.1% of the all participants knew correctly the abortion law in Rwanda. Conclusion: The study concluded that there is still a gap in contraceptive use among sexually active students, and tailored interventions should be undertaken to enhance effective use to prevent unintended pregnancies.
091 – Prevalence and maternal outcomes of grandmultiparity at a tertiary level hospital in Lusaka, Zambia
Malita Kasongo, Andrew Kumwenda
Department of Obstetrics and Gynaecology, Women and Newborn Hospital, P.O. Box RW1, Lusaka, Zambia
Introduction Grand multiparity is known to be associated with increased risks of adverse pregnancy outcomes such as post-partum haemorrhage, gestational hypertension, gestational diabetes mellitus and high perinatal mortality. This study aimed at determining the prevalence and associated adverse pregnancy outcomes of grand multiparity at the Women and Newborn hospital (WNH), a tertiary level hospital in Lusaka, Zambia over a six-months period. Method This was a prospective cross-sectional study. A convenient sample of 161 labouring women at the study site was studied. Ethical approval was granted by the University of Zambia Biomedical Research Ethics Committee (UNZABREC). Bivariate and multivariate logistic regression was conducted. A p-value of < 0.05 at 95% confidence interval (CI) was considered significant. Results: The mean age of the participants was 31.1 years ranging from 19 to 46 years with 70 (43.5%) of the women aged between 26 and 34 years. The prevalence of grandmultiparity (GMP) over a six-months period was 32.3% with the mean parity of 5.9. The maternal outcomes of GMP were, in comparison to the low parity women, chronic hypertension 4(57.1%) vs 3(42.9%), preeclampsia 13(34.2%) vs 25(65.8%), GDM 1(33.3%) vs 2(66.7%), anaemia 9(39.1%) vs 14(60.9%), placenta previa 3(42.9%) vs 4(57.1%) and postpartum haemorrhage 8(47.1%) vs 9(52.9%). The prevalence of adverse maternal outcomes was 94(58.4%) with a higher proportion of mothers in the low parity group that developed maternal complications than grand multiparas (i.e., 61(64.9%) vs 33(35.1%). The logistic regression model suggested that advanced age [≥35 years] adjusted odds ratio (AOR): 11.69, 95% CI: 3.02 – 45.33), alcohol consumption (AOR: 3.04; 95% CI: 1.09 – 8.47), contraceptive use (AOR: 5.90; 95% CI: 1.60 – 21.81), and unplanned pregnancy (AOR: 3.31, 95% CI: 1.37 – 8.01) were significantly associated with GMP. Parity however did not show a statistically significant difference with adverse maternal outcomes. Conclusion: The study revealed that the prevalence of GMP at WNH is high like what was found in other areas in the sub Saharan region, and that this group of women is prone to complications. Hence the need for continued vigilance in their management. Few adverse pregnancy outcomes were however reported to be higher in grand multiparas than in the low parity women at WNH which could be because of the management they receive as they are classified high risk. Further research to include more sites is needed to better elucidate this finding. Modern contraception counselling and utilization are very important factors in reducing maternal mortality and at WNH this should be promoted in this group of women. Keywords: Maternal outcome; Grand Multiparty; Multiparity; Pregnancy outcome
092 – Sexual and reproductive health and rights knowledge and reproductive health services among adolescents’ girls and young women living in Mungula I and II Refugee camps and host communities in Intirikwa sub county Adjumani district
HENRY DRASIKU1,2, MILTON ANGUYO3,2, LOYCE APIA1,2, Felix Bongomin3
1GULU REGIONAL REFERAL HOSPITAL, GULU, Uganda. 2MILHEN MEDICAL CENTER -GULU, GULU, Uganda. 3Gulu University, GULU, Uganda
Background: Various countries in the world have achieved promising progress in promoting protecting, and guaranteeing sexual and reproductive health rights since the 1994 international conference on population and development in Cairo. Sexual and reproductive health and rights have not been recognized to their maximum in Uganda despite the domestication of the international instruments related to their successful implementation. However SRHRs are critical entitlements best supported through human rights based approaches empowering right holders to claim their rights and duty bearers to fulfill their obligations. Implementing these requires information on the current needs and challenges faced by those seeking to claim their rights. Our main aim of the research was to identify the underling factors influencing the realization of sexual reproductive health and rights for adolescent girls living in the refugee camps and host communities, empowering the roles of relevant stake holders and uncovering the knowledge and gaps in protecting adolescent girls sexual reproductive health and rights in Intirikwa sub county adjumani district which is a home to over seven thousand (7000) south Sudan refugees and over 200000 host communities Methods: A community based, cross-section study, was conducted among 100 adolescent girls in refugee camps and host communities of Intirikwa sub county, Adjumani district, Uganda. A systematic random sampling method was employed to select the households and structured questionnaires was used to gather the data.EPI INFO version 7 was used to enter the data and SPSS version 23 was used to analyze the data . Results: Overall, 100 adolescent girls and young women aged between 13.0 to 24 years took part in the study. Only 15. % of the Adolescent girls and young women in the refugee camps and host community had a fair knowledge of SRHRs and 26% had used at least one sexual and reproductive health services. Variables that had a statistically significant association with SRHR knowledge in multivariable analysis were: had formal education, household with highest income, having information sources for sexual SRH services, and knowing about sexual reproductive health services and providing institutions. SRH service utilization was associated with; having information sources for SRH services, had formal education, household with the highest income and knowing about SRH services and providing institutions however this results indicated adolescents and young women Lacked information regarding their sexual reproductive health and rights, services available and redress mechanisms for rights violations. Formal sources of information were frequently inaccessible. Conclusions: Adolescent girls continue to face obstacles in achieving their full sexual and reproductive health and rights. Targeted interventions for realization of adolescent girl’s sexual and reproductive health and rights can address underlying causes and positively shift attitudes to promote health. Therefore responsible government sectors and NGOs should design and implement programs to promote women’s educational status and household economic status to enhance women’s SRHR knowledge and SRH services utilization.
093 – Evaluation of the Rwanda Comprehensive Abortion Care Program on the Capacity Building Section Conducted by Rwanda Society of Obstetricians and Gynecologists
John Muganda1, Athanase Rukundo2, Louange Gutabarwa2, Eugene Ngoga1, Aflodis Kagaba2
1Rwanda Society of Obstetricians and Gynecologists, Kigali, Rwanda. 2Health Development Initiative, Kigali, Rwanda
Background: Abortion has been and remains a controversial topic, whether safe or unsafe, legal or illegal, throughout history. In countries where the government has changed the legislation to provide abortion on demand and to make services accessible, political and policy impediments continue to obstruct these changes. Rwanda is one of the few African countries that has progressive laws determining safe abortion (SA). The current law allows the accessibility of safe abortion under five grounds, i.e., incest, rape, forced marriage, child marriage, and medically related conditions that may put the mother in danger. This resulted in the need to train healthcare providers to ensure that they are ready to provide services related to safe abortion. The Rwanda Society of Obstetricians and Gynecologists (RSOG), in partnership with the Rwanda Biomedical Center (RBC) and Imbuto Foundation through the Baho Neza project, has implemented different activities focusing on strengthening healthcare providers’ competencies in improving women’s health. This study was therefore conducted to evaluate the training and mentorship outcomes related to safe abortion, post abortion care (PAC), and family planning (FP) methods among health care providers trained by RSOG’s in 26 districts. Methodology: This was a quantitative cross-sectional study that evaluated the mentorship and training outcomes of 601 service providers in relation to safe abortion, post-abortion care, and family planning methods from 26 districts in Rwanda. The data was collected using a questionnaire that had three parts: demographic information, number of services provided, and KAP of health care providers about SA, PAC, and FP methods. For data analysis, we report the descriptive analysis, knowledge attitude, and practice outcomes of the study. Results: Preliminary results indicate that the majority of trained providers were nurses (40%) and midwives (53%) in all the districts. Overall, the majority had knowledge of the following indications to terminate a pregnancy as determined by the law: termination of pregnancy results from rape (93.7%), termination of pregnancy results from incest (92.9%), termination of pregnancy results from forced marriage (89.7%), termination of pregnancy results from child pregnancy (94%), and termination of pregnancy results from the pregnancy to save unborn baby or mother’s life (94.8%). More than half of participants (62.9%) indicated that abortion services are provided at the hospital level. The majority (97%) of service providers encouraged participants to visit their nearest health facility for post-abortion care. Approximately 96% of providers recommended long-acting family planning methods after safe abortion and post-abortion care. Conclusion: Service providers are at the forefront of the journey to ensure that women have access to safe abortion services in Rwanda. Ensuring that they have the needed capacity for the provision of this service is crucial for the success of ending unsafe abortions in the country. There is a need for continuous mentorship to ensure that they have the needed skills to provide services on SA, PAC, and FP methods.
094 – OUTCOMES OF TRAINING OF TRAINERS IN VALUE CLARIFICATION AND ATTITUDE TRANSFORMATION TRAINING (VCAT) TO IMPROVE COMPREHENSIVE ABORTION CARE IN NORTHERN UGANDA
Pebalo Francis Pebolo1, Felix Bongomin1, Jackline Ayikoru1, Jimmyy Opee1, Sande Ojara2, Baifa Arwinyo3, Simon Peter Kayondo4, Dan Kaye5
1Gulu University, Gulu, Uganda. 2St Mary’s Hospital Lacor, Gulu, Uganda. 3Gulu Regional Referral Hospital, Gulu, Uganda. 4Association of Obstetricians and Gynecologists of Uganda, Kampala, Uganda. 5Association of Obstetricians and Gynecologists of Uganda, Gulu, Uganda
Background: Morbidity and mortality due to unsafe abortion remains a global reproductive health challenge across the world. Moreover, many health facilities and providers have negative attitudes towards patients undergoing abortion, and do not provide post abortion counseling and care. The unclear and ambiguous interpretation of the laws on induced abortion in Uganda has created stigma and diverse attitudes among the skilled healthcare providers. Stigma and passive resistance among healthcare providers remain insidious barriers to the full realization of reproductive equality. The aim of this training was to conduct value clarification and attitude transformation (VCAT) for staff at Gulu University and affiliated teaching hospitals. Methods: Gulu University Reproductive Health Resource Centre (GURHRC) in collaboration with Association of Obstetricians and Gynecologists of Uganda (AOGU) conducted a 1day training on VCAT as a way of clarifying what healthcare providers hold dear and think is important and can influence how they conduct themselves in relation to abortion care. The training involved PowerPoint presentations, interactive discussions and answer sessions, limited small groups discussions and large group role plays. After each training sessions, a question-and-answer session to elicit comments, clarifications and feedback was organized. The VCAT workshop activities used most frequently are “Cross the Line”, “Four Corners”, “The Last Abortion” and “Why Did She Die?”. Pre- and post-test assessments attitude questions were done. Results: A total of 21 trainees, consisting of 7 doctors and 14 nurses were trained. For trainees who agreed or strongly agreed, the value classification score improved from 77.4% to 85.7%, the knowledge statement score from 77.4% to 92.9%, attitude statement from 87.3% to 96.8% and intention statement from 73.0% to 93.7% (all P-values <0.001). Conclusions: VCAT workshop participants demonstrated improvements in knowledge, attitudes, Practices and behavioral intentions related to abortion care. It can be a good intervention in training programs for abortion providers and managers, to address abortion related stigma that prevents women from getting care they need.
095 – Integrating long-acting reversible contraceptive methods within comprehensive abortion care increases uptake – findings and lessons learned from a quality improvement project in northern Uganda
Gasthony Alobo1, James Okello2, Josaphat Byamugisha3
1Lira University, Lira, Uganda. 2Lira Regional Referral Hospital, Lira, Uganda. 3Makerere University, Kampala, Uganda
Background: In countries where the unmet need for contraceptives is high among young and unmarried women, the risk for unintended pregnancy and unsafe abortion is also very high. Integrating family planning services into comprehensive abortion care (CAC) presents a critical opportunity to reduce future unintended pregnancies due to poor access to contraceptives. The long-acting reversible contraceptive (LARC) methods provide continuous protection against unwanted pregnancy, with higher continuation rates than short-acting methods, while serving a range of clients’ intentions to delay or space births. However, most surveys done show that the uptake of LARC is still very low, especially as post-abortion family planning methods due to knowledge gap among the providers and lack of information by clients, coupled with occasional stock out. To address this, the work improvement teams at two tertiary hospitals in northern Uganda initiated quality improvement (QI) projects within their gynecological units from January 2018 to December 2020. The QI projects involved the following key health system strengthening strategies: promotion of youth-friendly services, integration of CAC and comprehensive contraceptive training to address knowledge gaps among health workers, mentorship and support supervision, and ensuring constant stock of methods. Methods: We conducted a cross-sectional study at Lira Regional Referral Hospital and Lira University Teaching Hospital in Lira district. We reviewed charts of patients who were managed for unsafe abortion and also reviewed the register from the gynecological ward. Data was collected using a checklist to determine the socio-demographic, contraceptive method chosen and client factors that influenced the choices. Analysis of the trend in uptake of LARC in comparison with the short-term methods was made. A waiver of informed consent was granted by the Lacor Hospital research ethics committee since the study involved the review of charts only and presented no more than minimal risk. Results: The QI intervention significantly improved the uptake of LARC among women who were managed for unsafe abortion. The proportion of clients who were discharged from the facilities with a contraceptive method increased from 46% in the calendar year2018 to 70% in the calendar year 2020. The share of method mix for LARCs rose from 5% in 2018 to 58% in 2020, while the share for short-term methods (barrier methods, injectables, and oral contraceptives) declined from 90% to 33%. Specifically, the use of implants increased from 6% in 2018 to 60% in 2020, while the uptake of intrauterine devices increased from 2% in 2018 to 30% in 2020. Conclusions: In conclusion, postabortion services need to integrate well-planned and organized QI strategies that are cost-effective, feasible, and easily replicable for serving women, especially young women, with an unmet need for contraception who are highly vulnerable to a future unintended pregnancy and repeat abortion.
096 – Increasing uptake of post abortion family planning, a quality improvement approach
Kevin Ajaruva1, Baifa Arwinyo1,2, Pabalo Francis Pebolo2, Jackline Ayikoru3, Suzan Akidi1
1Gulu Regional Referral Hospital, Gulu, Uganda. 2Gulu University, Gulu, Uganda. 3Gulu University, Gulu, Uganda
Background: Gulu Regional Referral Hospital (GRRH) serves an immediate catchment population within Gulu of 181,321 of which 35,000 are women of child bearing age, in addition to its additional coverage of the 8 districts of Acholi sub region for specialized services. The gynecology emergency unit of GRRH is a beehive of activities in the maternal and child health (MCH) department, with an average monthly admission of 250-300 patients. Forty percent (40%) of these are abortions and its complications. Incomplete abortions requiring evacuation is the most common type of abortion complication registered in the unit. The unit offers the entire package of Post Abortion Care (PAC) to include post abortion family planning. However, uptake of family planning methods among these post evacuation patients remained low at about 25%. The base line month considered was June 2022, where post abortion family planning uptake was at 22% (16/74) of abortion managed in the unit. The maternal Child Health Department has a functional Quality improvement committee (QIC) that tasked the gynecology work improvement team (WIT) to consider this service delivery gap for a Quality improvement project to enable the Hospital achieve the national target for post abortion FP of 100%. Methods: The unit work improvement team noted this low Family planning (FP) coverage as a service delivery gap and hence started a quality improvement project whose aim is “to increase the uptake and utilization of post abortion FP from 225 in June to 70% by September 2022. A root cause analysis of the low FP uptake was done through brain storming by the WIT members. During brainstorming; inadequate FP counselling for clients, poor linkage of the post abortion patients to the FP unit that is located outside the gynecology ward and skills gap among staff on FP method application were the leading root causes. The tested change agreed on was to avail FP commodities in the gynecology ward and Evacuation room and assign a post abortion FP focal person coupled with staff orientation on the different FP methods, both long and short term to cover the skills gap. It was also agreed that the daily nurses’ report include the number of evacuations done, patients counseled on FP and FP methods given. This quality improvement project is still being monitored until September 2022. Results: The uptake of post abortion FP has been seen to drastically triple from 22% (16/74) in June to 79% (57/72) in July 2022, within one month of the above tested change implemented. Majority of the clients that did to take the methods in July opted to consult their partners and/or return when fully recovered from the effects of the Evacuation process. Conclusion: Integration of Family Planning service delivery in the emergency gynecology department to create a one stop center for both post abortion care and family planning increases its utilization and uptake. It is a strategy to be adopted by the Department if this increased FP coverage is sustained through the next two months of the QI project period.
097 – Access to Antenatal Care in Mahama Refugee Camp in Rwanda
Background: Antenatal care is an effective means used to improve feto-maternal health either in antenatal or postnatal period worldwide. However, in many developing countries the number of visits recommend by who is still low, much more in vulnerable populations, refugees included. Therefore, this study aimed to assess access to Antenatal services in Mahama refugee camp, frequency of contact and components of services offered during the antenatal contact. Methodology: A cross sectional study was carried out among 102 women whose age was ranging between 15 to 49 and who have ever been pregnant in Mahama refugee camp. Data were collected by in person interview through a structured questionnaire. The camp is made of 3 villages each one composed of 50 communities is located in North Est of RWANDA and it hosts Burundian and Congolese refugees. All women in reproductive age (18-49) who have been pregnant in the camp between 2015 and 2021 were included while all other groups are excluded from the target population. Results: A total of 102 women were recruted in the study. They were between the ages of 18 and 43. The most presented age was 24 at the rate of 8,82% whereas the least represented group was at the rate of 0,98%. During our data collection most of the participants consulted at the rate of 98%. Among those who consulted, 51.12% of the pregnancies had 4 antenatal care visits, 35.96% of the pregnancies had 3 visits and 5.62% had 2 visits while 5.06% had 1 visit. Antenatal care visits in Mahama refugee camp from 2015 was at an average of 2.57 visits. In 2016 increased to 2.85, In 2017 to 3.38, In 2018 the average visits slightly decreased to 3.25, In 2019 in again increased to 3.52, and slightly dropped again to 3.39 visits and 2021 had the highest average visits which are 3.53 ANC contacts. Conclusion: Our findings suggest that the number of antenatal care contact is till low comparing to 8 visits actually recommended by WHO guidelines due to many different reasons reported by interviewed women. Even though the majority have consulted 4 times, there is still a need for strategies and intervention program such as health system in the camp, empowerment of nutrition support for pregnant women, outreach to increase awareness about importance of ANC contacts in pregnant women in Mahama population in general.
098 – Viability age of premature new borns in three Yaounde referral hospitals
Florent Ymele Fouelifack, Detchou Tchami Priscille, Jeanne Hortence Fouedjio, Nguefack Felicite
Gynecologist and Obstetrician. Department of Surgery and Specialities, Higher Institute of Medical Technology of Nkolondom. Obstetrics and Gynaecology Unit of the Yaoundé Central Hospital
Introduction: Fetal viability is the ability of the fetus to live outside the maternal organism. According to the World Health Organization, prematurity is defined as any birth occurring between 22 weeks and 36 weeks + 6 days of pregnancy. We found no consensus study on the age of viability of premature newborns in Cameroon, which has conventionally been set at 28 weeks as in other developing countries. Our objective was to determine the prevalence and gestational age of viability of preterm infants in our setting. Methods: We carried out a descriptive cross-sectional study, with retrospective data collection, over a period of 8 months, in three reference hospitals in Yaoundé: Yaoundé Gyneco-Obstetrics and Pediatric Hospital, Yaoundé Central Hospital and Essos Hospital Center. Our sampling was consecutive and exhaustive. Data were collected using a technical sheet, seized in using CS Pro 7.3 software and analyzed by SPSS 25 software. Results: Out of a total of 6858 births, 1395 (that’s 20.34%) were premature, from which 500 premature babies were selected and analyzed. These 500 files were those of 500 premature babies from 317 mothers because 36.7% were births resulting from twin pregnancies. The most common complication was neonatal respiratory distress. The overall survival rate of preterm babies was 73% at 40 weeks of corrected age. It was 88.08% in the average prematurity; 73.93% in extreme prematurity and 30.14% in extreme prematurity. All newborns born between 22 and 24 weeks died immediately. At 25 weeks, 36.6% of newborns survived until the end of the observation fixed at 40 weeks of corrected age. Conclusion: At the end of this study, we found that prematurity remains a public health problem in our setting. Only 6.8% of premature newborns have a normal birth weight, and 73% of newborns remained alive at 40 weeks of corrected age. The gestational age of optimal viability of preterm infants was 25 weeks. The use of surfactant would improve the age of fetal viability in our context. Keywords: Gestational Age, Prematurity, Viability, Hospitals, Yaoundé
099 – Associated factors of spontaneous abortions in two district hospitals in Yaoundé
Fouelifack Ymele Florent, Tazo Tsopjio Annie Juldas, Fouedjio Jeanne Hortence
Institute of Medical Technology of Nkolondom, Yaoundé, Cameroon. Obstetrics and Gynecology Unit of Yaoundé Central Hospital, Yaoundé, Cameroon.
Introduction: Abortion is the termination of a pregnancy before the age of fetal viability which, according to the WHO, is 22 weeks of pregnancy and/or where the fetus weighs less than 500 g. In developing countries, like Cameroon, this age is set at 28 weeks of pregnancy. Spontaneous abortion is a public health problem because it is one of the most common complications of pregnancy. In order to contribute to the decrease of the morbidity and mortality linked to spontaneous abortions, we conducted this study, which the general objective was to study the factors associated with spontaneous abortion in two district hospitals in the Yaoundé city. Methods: We carried out a cross-sectional case-control study at the Biyem-Assi District Hospital and the Efoulan District Hospital in Yaoundé. For six months, we collected 3774 records of pregnant women consulted in these 2 hospitals from January 1, 2020 to December 31, 2020. The cases were the records of women who had a spontaneous abortion, and the controls were the records of those who gave birth spontaneously at term. For each case, two controls of the same age were immediately recruited. Data were analyzed using IBM SPSS Version.23.0 software. Tools used to assess our results were: Fischer’s exact tests, frequencies, odds ratio and P, with P significant for any value less than 5%. Results: In total, we recruited 104 cases and 208 controls. Being unmarried, being from the littoral region, having a history of stress, smoking, having started ANC and having had premarital examinations independently increased the risk of spontaneous abortion with respectively aOR = 2.8 IC=1.24-6.31 aP= 0.013, aOR=4.31 IC= 1.09-17.02 aP= 0.037, aOR=11.86; CI=3.88-36.19; aP=< 0.001, aOR=8.57; CI=3.41-21.54; aP=< 0.001, aOR=10.4; CI=1.12-96.82; aP=0.04) and aOR=3.37; CI=1.67-6.79; aP=0.00). No protective factor was found. Conclusion: Being unmarried, being from the littoral region, having a history of stress, smoking, having started antenatal care and having had premarital examinations independently increased the risk of spontaneous abortion. These factors being mostly modifiable, should be sought and prevented in order to improve the prognosis of pregnancies in our context. Keywords: Associated factors, spontaneous abortion, District hospital, Yaoundé
100 – Epidemiological and clinical aspects of male infertility in patients consulting at the Urology Department of the Yaoundé Central Hospital
Florent Ymele Fouelifack, Achile Aurele Mbassi, Fatoumata Touda Dehukwe Maguira, Fouedjio Jeanne Hortence, Magloire Sida Biwole
Institute of Medical Technology of Nkolondom, Yaoundé, Cameroon. Obstetrics and Gynecology Unit of Yaoundé Central Hospital, Yaoundé, Cameroon
Introduction About 10 to 15% of couples in the world and 20 to 30% in Cameroon consult for infertility problems. Infertility is of male origin in 40% of cases. Our objective was to evaluate the epidemiological and clinical aspects of male infertility. Methods: the study was cross-sectional descriptive, with retrospective data collection from the files of patients received for male infertility, over 5 years and 6 months at the Urology Department of the Yaoundé Central Hospital. Data were processed using SPSS software. Tools used to assess our results were the number, the frequency and the mean with its standard deviation. Results: out of 110 patients whose records were analyzed, the mean age was 38.26 ± 6.4 years with extremes of 27 and 59 years. Past histories were dominated by mumps 40 (36.4%), surgery for varicocele 25 (22.7%), alcoholism 87 (79.1%) and smoking 15 (13.6%). A spermatogenesis disorder was found in all our patients: azoospermia, asthenospermia and oligospermia respectively in 37 (33.6%), 27 (24.6%) and 26 (23.7) patients. Chlamydia and gonococcal infections were found respectively in 38 (34.5%) and 14 (12.7%) patients, varicocele and testicular dystrophy respectively in 95 (86.4%) and 38 (34.5%) patients. Infertility was primary in 67 (60.9%) patients. Conclusion: the intensification of provider behavior change communication and screening of spermogram abnormalities would reduce the frequency of male infertility. Keywords: Epidemiology, Clinical, Male Infertility, Central Hospital, Yaoundé
101 – Relationship between age of menarche and coitarche in pupils of the Lycée Bilingue d’Emana in Yaoundé
Fouelifack Ymele Florent, Fouedjio Jeanne Hortence, Dia Moundo Christian Franck, Nguefack Félicitée
Institute of Medical Technology of Nkolondom, Yaoundé, Cameroon. Obstetrics and Gynecology Unit of Yaoundé Central Hospital, Yaoundé, Cameroon.
Introduction: The age of menarche corresponds to the age of the first menstrual period. It decreases over time and tends to stabilize around 12-13 years. The age of the coitarch is defined as the age of occurrence of onset of the first sexual intercourse, which would be on average 15 years. According to a study carried out in northern Malawi, there is a strong association between the age at menarche and the age of onset of sexual relations. Our study aimed to determine the ages of onset of the first menstrual period and the first sexual intercourse, and the link that would exist between these two ages. Methods: Our study was descriptive and cross-sectional, with prospective collection of information from the students of the Lycée Bilingue d’Emana, from December 15, 2020 to July 31, 2021. Sociodemographic data, ages at menarche and coitarche were collected on a pretested technical sheet, entered using Cspro 7.6 software, then analyzed using R version 4.0.3 softwares. Results: Of 567 participants, an average age was 17 ± 2 years with the extremes of 13 and 23, 529 (93.3%) were of Christian religion and 563 (99.5%) were unmarried. People from the Center and West regions dominated with 216 (38.2%) participants each. The mean age at menarche was 13 ± 1.4 years, with extremes of 08 and 18. The mean age at coitarche was 18 ± 1.6 years with extremes of 11 and 18. There were no association between age at menarche and age at coitarche (p = 0.396). Conclusion: The average age of onset of menarche was 13 ± 1.4 years, and that of coitarche was 18 ± 1.6 years. There was no dependence between age at menarche and age at coitarche. Sex education for young girls should not be linked to the onset of menarche. Keywords: Relationship, Age, Menarche, Coitarche, Students, Yaounde