Background Uterine fibroids, the most common cause of gynecologic surgery, have a reported cumulative incidence of 59% among Black women in the U.S. Uterine fibroids negatively impact the quality of women’s lives. No study has been found in the literature about fibroids in Haiti. We conducted a mixed methods study to assess the burden and risk factors of uterine fibroids, as well as their effects on women’s quality of life. Methods A convergent mixed methods study was conducted between October 1, 2019 and January 31, 2020 at MUH’s (Mirebalais University Hospital) OB-GYN outpatient department. Quantitatively, in a cross-sectional study 211 women completed consecutively a structured questionnaire. In-depth interviews with 17 women with fibroids and 7 family members were implemented for the qualitative component. Descriptive statistics were calculated for clinical and social demographic variables. Logistic regression was performed to examine associations between fibroids and related risk factors. An inductive thematic process was used to analyze the qualitative data. A joint display technique was used to integrate the results. Results Of 193 women analyzed 116 had fibroids (60.1%). The mean age was 41.3. Anemia was the most frequent complication— 61 (52.6%). Compared to women without uterine fibroids, factors associated with uterine fibroids included income decline (AOR = 4.7, 95% CI: 2.1–10.9, p = < 0.001), excessive expenses for transport (AOR = 4.4, 95% CI: 1.6–12.4, p = 0.005), and family history with uterine fibroids (AOR = 4.6, 95% CI: 1.6–13.6, p = 0.005). In contrast, higher level of education and micro polycystic ovarian syndrome were associated with lower prevalence (AOR = 0.3, 95% CI: 0.1–0.9, p = 0.021) and (AOR = 0.2, 95% CI: 0.1–0.97, p = 0.044), respectively. The qualitative findings delineate how contextual factors such as health system failures, long wait times, gender inequality and poverty negatively affect the quality of women’s lives. The poverty cycle of uterine fibroids emerged. Conclusions A vicious cycle of poverty negatively impacts access to care for uterine fibroids in Haiti. Health insurance, social support, and income generating activities may be keys to promote social justice through access to adequate care for women with uterine fibroids in Haiti.

IntroductionHaiti has an estimated neonatal mortality rate of 32/1000 live births, the highest in the Western Hemisphere. Preterm birth and being born small for gestational age (SGA) are major causes of adverse neonatal outcomes worldwide. To reduce preterm birth and infants born SGA, it is important to understand which women are most at risk and how risk varies within countries. There are few studies estimating the prevalence and risk factors for these conditions in Haiti, particularly in rural regions.MethodsWe conducted a prospective cohort study of pregnant women at a rural tertiary care centre in Haiti from May to December 2017. We collected data during interviews and from the medical record. We built multivariable models to identify risk factors for preterm birth and being born SGA among women who had a facility-based delivery.Results1089 pregnant women delivered at the hospital and were included in this analysis. Median gestational age at delivery was 38 weeks (IQR 36–40). In multivariable analyses, risk factors for preterm birth included maternal age <20 years (adjusted OR (AOR) 1.76, 95% CI 1.14 to 2.72) and >34 years (AOR 1.46, 95% CI 1.01 to 2.11) and severe hunger in the household (AOR 1.57, 95% CI 1.09 to 2.26). Risk factors for SGA were age >34 years (AOR 1.76, 95% CI 1.18 to 2.59), twin pregnancy (AOR 3.28, 95% CI 1.20 to 8.95) and first pregnancy (AOR 1.57, 95% CI 1.12 to 2.23). Number of prior abortions was associated with reduced risk for SGA (AOR 0.41, 95% CI 0.17 to 0.97).ConclusionsFood insecurity as a risk factor for preterm birth stands out as an important addition to the understanding of the risk of neonatal morbidity and mortality. This association highlights a potentially important intervention target to improve birth outcomes and suggests that food support has an important role to play for pregnant women who are food insecure in low-income settings.

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Introduction:IUDs are safe, effective, and used worldwide to prevent unintended pregnancy. However, uptake in Haiti is low. There are limited data on IUD choice and experience in low resource settings; anecdotal reports from providers in Haiti have suggested that Haitian women are unlikely to choose to use or be satisfied with the IUD. The objective of this study is to explore the perceptions of a cohort of IUD users in Mirebalais, Haiti.Methods:In June and July 2015, an IRB-approved mixed methods study of women over age eighteen with hormonal or copper IUDs inserted at Hôpital Universitaire de Mirebalais (HUM) was performed in Mirebalais, Haiti.Results:Twenty-one eligible women participated, out of 58 women identified as eligible. Most women (81%) reported using the copper IUD; most (86%) had used the IUD for 6 months or more. Over half were under 30 years old (62%) and most had completed primary school or less (76%). Almost all (91%) reported prior pregnancies; 65% did not desire more children. The majority of participants were satisfied with the IUD, with 70% being very satisfied and 25% somewhat satisfied. Most women (71%) reported no very bothersome side effects, and would recommend the IUD to others (86%). Qualitative data highlighted positive perceptions of the IUD among users, as well as misperceptions and lack of knowledge regarding the IUD among members of their communities.Conclusion/Implications:Understanding of culture-specific perceptions is critical in addressing barriers to IUD uptake. Our findings indicate that IUDs can be an acceptable contraceptive method for women in Haiti, and suggest the possibility that increased access to the IUD may lead to increased acceptance of this method.

To address the gap in the uptake of long-acting contraception (LAC) methods among high-risk postpartum women who fail to return for a family planning method at HôpitalUniversitaire de Mirebalais in the Central Plateau Department of Haiti, contraceptive implant trainings were held for providers on the Labour and Delivery, Post-Partum and Internal Medicine inpatient wards.A very high maternal mortality rate affects large numbers of women in Haiti; however, contraceptive use can reduce maternal mortality significantly. A quality improvement strategy to offer LAC methods to immediate postpartum women at a University Hospital in rural Haiti was initiated in March 2016. This new strategy produced an average improvement from 5% to 32% of women delivering at the hospital, accepting a long-acting method (including bilateral tubal ligations) by the end of the project and which has proved sustainable at an average of 20% to date.

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Background Uterine fibroids, the most common cause of gynecologic surgery, have a reported lifetime cumulative incidence of 59% among Black women in the U.S. Uterine fibroids increase mortality, morbidity, and negatively impact the quality of women’s lives. To our knowledge, no study has been published in the literature about fibroids in Haiti. We conducted a mixed methods study to assess the burden and risk factors of uterine fibroids, as well as their effects on women’s quality of life. Methods A convergent mixed methods study was conducted between October 1, 2019 and January 31, 2020 at MUH’s (Mirebalais University Hospital) OB-GYN outpatient department. Quantitatively, in a cross-sectional study 211 women completed a structured questionnaire. In-depth interviews with a subset of 17 women with fibroids and 7 family members were implemented for the qualitative component. Descriptive statistics were calculated for clinical and social demographic variables. Logistic regression was performed to examine associations between fibroids and related risk factors. An inductive thematic process was used to analyze the qualitative data. A joint display technique was used to integrate the results. Results The prevalence of uterine fibroids was 60.1%. Anemia and infertility were the most frequent complications— 52.6% and 33.6%, respectively. Factors associated with uterine fibroids included income decline (OR = 4.7, 95% CI: 2.1–10.9, p = < 0.001), excessive expenses for transport (OR = 4.4, 95% CI: 1.6–12.4, p = 0.005), and family history with uterine fibroids (OR = 4.6, 95% CI: 1.6–13.6, p = 0.005). In contrast, higher level of education and presence of micro polycystic ovarian syndrome were found to be protective (OR = 0.3, 95% CI: 0.1–0.9, p = 0.021) and (OR = 0.2, 95% CI: 0.1–0.97, p = 0.044), respectively. Qualitative findings demonstrated that uterine fibroids deeply affected the quality of women’s lives. The concept of a poverty cycle of uterine fibroids emerged. Conclusions A vicious cycle of poverty and women’s experience with fibroids demonstrate the long-term struggle that women endure. Health system strengthening, social support, and economic improvement are keys to alleviate women’s suffering and promote social justice through access to adequate care for women with uterine fibroids in Haiti.

On March 10 to 11, 2016, the Ministère de la Santé Publique et de la Population (Ministry of Health of Haiti) and the Global Health Initiative at Henry Ford Health System hosted their Second Annual Scientific Conference entitled, “Best Practices for Establishing and Utilizing Partnerships for Vaccine-Preventable Diseases in Haiti,” at the National Laboratory in Port-au-Prince, Haiti. The conference brought together Ministry of Health officials, researchers, clinicians, academics, public health professionals, and other stakeholders to discuss vaccine programs and policies in Haiti. This forum provides a learning and discussion space to fuel strategies and public health research responding to priority areas identified by the Ministry of Health, and consequently, this forum serves as counsel for the Ministry of Health in its decision making on strategies to prevent and control infectious diseases in Haiti. The following article summarizes the presentations and conclusions of the March 2016 conference and covers a variety of important issues relating to vaccines and vaccine-preventable diseases in Haiti, including Haiti's Expanded Program on Immunization, surveillance, logistical and funding challenges, and community approaches, as well as case studies detailing introduction of the pentavalent, rotavirus, oral cholera, and human papillomavirus vaccines in Haiti. Most importantly, this article highlights a model for effective partnerships for vaccines, a model that can transcend response to specific diseases and apply to all global health partnerships.