Background. Implanon NXT, a long-acting reversible contraceptive, was introduced in South Africa (SA) in early 2014, aiming to expand the method mix and increase its effectiveness. Initial uptake was high, but has since declined considerably. In these early years after the implant's introduction, it is important to identify reasons for the decline, and remedy gaps in services. Objectives. To determine periods of use, reasons for the use and early removal of the implant Implanon NXT. Methods. In 2016, we recruited 152 women from six clinics in the City of Johannesburg, and six in North West Province, SA. A semistructured interview was administered to 91 women currently using the implant and 61 previous users. We examined user perspectives, factors influencing women's experiences with the implant and reasons for discontinuation. Results. The participants' mean age was 30 years, with only 15% aged <25. Implant uptake was motivated by convenience (less frequent visits required than for short-acting methods) and by favourable views of the method among friends, family and healthcare providers. Only about a quarter of women recalled being counselled pre-insertion about implant effectiveness, and half about side-effects pre-insertion. Among discontinuers, the median time to device removal was 8 months (interquartile range 6 -12), and this was primarily as a result of sideeffects (90%), especially bleeding-pattern changes and headaches. Removals were most common among married and cohabiting women, often ascribed to the effects of bleeding on their sexual relationships. Rumours and misinformation contributed to some removals. Overall, women's experiences with the implant were rated 'good' or 'very good' by 74% of those continuing use, many of whom reported not having experienced any side-effects or that these had diminished over time. Conclusion. Levels of acceptability among continuing users were high, mainly linked to the method's convenience. While early favourable views drove uptake, negative perceptions, if unaddressed, may now undermine services. Deficiencies in counselling around effectiveness and side-effects may extend to contraceptive services more generally. Women require more intensive support when experiencing sideeffects, including effective systematic approaches to ameliorating bleeding and headaches. Implant services could specifically target young women and first-time contraceptive users. These actions together could reverse the persistent decline in implant use in SA.
MeerKAT’s large number (64) of 13.5 m diameter antennas, spanning 8 km with a densely packed 1 km core, create a powerful instrument for wide-area surveys, with high sensitivity over a wide range of angular scales. The MeerKAT Galaxy Cluster Legacy Survey (MGCLS) is a programme of long-track MeerKAT L-band (900−1670 MHz) observations of 115 galaxy clusters, observed for ∼6−10 h each in full polarisation. The first legacy product data release (DR1), made available with this paper, includes the MeerKAT visibilities, basic image cubes at ∼8″ resolution, and enhanced spectral and polarisation image cubes at ∼8″ and 15″ resolutions. Typical sensitivities for the full-resolution MGCLS image products range from ∼3−5 μJy beam−1. The basic cubes are full-field and span 2° × 2°. The enhanced products consist of the inner 1.2° × 1.2° field of view, corrected for the primary beam. The survey is fully sensitive to structures up to ∼10′ scales, and the wide bandwidth allows spectral and Faraday rotation mapping. Relatively narrow frequency channels (209 kHz) are also used to provide H I mapping in windows of 0 < z < 0.09 and 0.19 < z < 0.48. In this paper, we provide an overview of the survey and the DR1 products, including caveats for usage. We present some initial results from the survey, both for their intrinsic scientific value and to highlight the capabilities for further exploration with these data. These include a primary-beam-corrected compact source catalogue of ∼626 000 sources for the full survey and an optical and infrared cross-matched catalogue for compact sources in the primary-beam-corrected areas of Abell 209 and Abell S295. We examine dust unbiased star-formation rates as a function of cluster-centric radius in Abell 209, extending out to 3.5 R 200. We find no dependence of the star-formation rate on distance from the cluster centre, and we observe a small excess of the radio-to-100 μm flux ratio towards the centre of Abell 209 that may reflect a ram pressure enhancement in the denser environment. We detect diffuse cluster radio emission in 62 of the surveyed systems and present a catalogue of the 99 diffuse cluster emission structures, of which 56 are new. These include mini-halos, halos, relics, and other diffuse structures for which no suitable characterisation currently exists. We highlight some of the radio galaxies that challenge current paradigms, such as trident-shaped structures, jets that remain well collimated far beyond their bending radius, and filamentary features linked to radio galaxies that likely illuminate magnetic flux tubes in the intracluster medium. We also present early results from the H I analysis of four clusters, which show a wide variety of H I mass distributions that reflect both sensitivity and intrinsic cluster effects, and the serendipitous discovery of a group in the foreground of Abell 3365.
Background. The South African (SA) government introduced Implanon NXT, a long-acting subdermal contraceptive implant, in 2014 to expand contraceptive choice. Following an initial high uptake, its use declined considerably amid reports of early removals and frequent side-effects. We examine providers' perceptions of training and attitudes towards Implanon NXT, as well as their views on the causes of early removals and the impact on the implant service. Objective. To assess healthcare providers' perceptions and attitudes towards implant services in SA. Methods. In-depth interviews were conducted with eight nurses providing implant services in public facilities in Gauteng and North West Province. Emerging themes were identified, manually coded and thematically analysed following an interpretivism approach. Results. Nurses lacked confidence in providing implant services effectively, particularly removals, which they ascribed to the brief, cascade-type training received. Nurses generally held negative views towards the method. They also reported that side-effects are the most common reason for early removals -particularly irregular bleeding -and that men often do not support their partners who use the method. Lastly, it was found that providers require guidance on counselling regarding the method and standardised guidelines on the management of side-effects. Conclusion. Retraining and support of providers are needed to address competency gaps and negative attitudes towards the method. Assessment of providers' readiness to perform removal procedures is also important. Finally, effective plans are necessary to improve implant continuation rates, especially among women whose partners are unsupportive.
In 2014, South Africa (SA) introduced the subdermal contraceptive implant with the aim of expanding the contraceptive method mix and availability of long-acting reversible methods in the public sector. Three years on, concerns have been raised about the decline in uptake, early implant removals and challenges in service delivery. This article explores the lessons learnt from the introduction of contraceptive technologies elsewhere and applies these to the SA context. Drawing on the World Health Organization’s conceptual framework for the introduction of new contraceptive methods, and subsequent literature on the topic, lessons are classified into six cross-cutting themes. Recommendations highlight the need for SA to review and explore strategies to strengthen current implant services, including the provision of improved provider training aimed at sensitive, client-centred approaches; increased community engagement; and improved systems for programmatic monitoring and evaluation. With implementation of these recommendations, worrying trends in the provision of implants could be reversed.
The MeerKAT Exploration of Relics, Giant Halos, and Extragalactic Radio Sources (MERGHERS) survey is a planned project to study a large statistical sample of galaxy clusters with the MeerKAT observatory. Here we present the results of a 16–hour pilot project, observed in response to the 2019 MeerKAT Shared Risk proposal call, to test the feasibility of using MeerKAT for a large cluster study using short (0.2–2.1 hour) integration times. The pilot focuses on 1.28 GHz observations of 13 massive, low-to-intermediate redshift (0.22 < z < 0.65) clusters from the Sunyaev-Zel’dovich-selected Atacama Cosmology Telescope (ACT) DR5 catalogue that show multiwavelength indications of dynamical disturbance. With a 70 per cent detection rate (9/13 clusters), this pilot study validates our proposed MERGHERS observing strategy and provides twelve detections of diffuse emission, eleven of them new, indicating the strength of MeerKAT for such types of studies. The detections (signal-to-noise ratio ≳ 6) are summarized as follows: two systems host both relic(s) and a giant radio halo, five systems host radio haloes, and two have candidate radio haloes. Power values, k-corrected to 1.4 GHz assuming a fiducial spectral index of α = −1.3 ± 0.4, are consistent with known radio halo and relic scaling relations.
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