The findings suggest there is a critical need to raise awareness of the issue, reduce stockouts and mitigate their negative consequences. Efforts to eliminate stockouts should include addressing supply chain issues. Raising community awareness and engaging with men on family planning may be ways to deal with the consequences of stockouts.
A substantial proportion of women in developing countries with an unmet need for family planning cite infrequent sex as a reason for not practicing contraception: 6-39% of women with unmet need in Sub-Saharan Africa and 14-35% in South and Southeast Asia.1 Notably, about one in four adolescent women aged 15-19 with unmet need report that they are not using a method because they do not have sex frequently. 2 For women who have infrequent sex, an oral contraceptive pill taken only at the time of intercourse may offer advantages in terms of convenience and ease of use; because this method is discreet and female-controlled, it may appeal to other women as well. Pericoital contraceptive pills-also referred to as "ondemand" or "real-time" contraceptives-are being considered as a way to address unmet need, especially among women who have sex no more than six times a month. There is currently no oral contraceptive pill marketed for such use. Women could take a pericoital contraceptive pill within 24 hours before or after intercourse, rather than daily. Levonorgestrel, one compound being considered as the active component in a pericoital pill, is a synthetic progestin that has been used as an active hormonal ingredient in daily birth control pills for about 40 years. It is also the key ingredient in contraceptive implants, hormone-releasing IUDs and emergency contraceptive pills. Levonorgestrel is off-patent and has a good safety profile. 3Studies from a number of countries suggest that some women are already using emergency contraception offlabel as an on-demand pill, demonstrating latent demand for a pericoital method.4-6 Women who do not have sex frequently are particularly likely to use emergency contraception as their regular method. 4 Moreover, a survey of women in urban Nigeria found that those who reported having used emergency contraception had done so an average of five times in a six-month period. 7 Interviews with WestAfrican women using emergency contraception as a regular method reveal a preference for the convenience of an "occasional pill" and for episodic, rather than sustained, exposure to hormones (reflecting their safety concerns about hormones that remain in the system). 8 These studies show that in the absence of a coitus-related, female-controlled contraceptive method that does not interrupt sexual activity and is labeled and marketed for routine use, women have adapted an existing method to meet that need. There are obvious similarities between a potential pericoital contraceptive product and currently available emergency contraception; for example, both are coitus-related methods, and the same active ingredient may be used for both. That said, a dedicated pericoital pill would be labeled and marketed for use within 24 hours before or after sex, as a routine contraceptive method. While repeat use of levonorgestrel does not pose any known health risks,
BackgroundThe prevalence of HIV infection among older persons is increasing yet older age at initiation of antiretroviral therapy (ART) may be associated with poorer treatment outcomes including mortality. However, majority of these studies have been done in the western world and there is limited data in resource limited settings. Our study used routinely collected health facility data to assess trends in age at initiation of ART, the effect of age at ART initiation on mortality and immunological response at a large urban hospital in south western Uganda.MethodsWe conducted a retrospective records review of patients attending the HIV clinic at Mbarara Regional Referral Hospital in western Uganda. We retrieved records for 8,533 patients who started ART between January 2006 and December 2012. Their data had been collected and stored as part of the larger International Epidemiological Database for the Evaluation of AIDS (IeDEA). Age was stratified into three categories namely; 18–34 (young adults), 35–49 (mid-age) and 50 years or older (older adults). Survival analysis procedures with Kaplan-Meier’s plots were used to calculate the survival probability with mortality as the endpoint and Poisson regression analysis used to determine the adjusted relative risks (RR) of mortality.ResultsThe proportion of young adults and patients at WHO stage I initiating ART increased steadily over the 7-year period. Older age at ART initiation (> = 50 years) was associated with a higher risk of mortality with adjusted relative risk (RR) at 1.63, (95% CI 1.26–2.11) compared to younger age. Male gender, WHO stages III and IV, lower CD4 count and lower body mass index were also all independently and significantly associated with higher risk for mortality. Older adults also had a poorer immunological response RR = 1.79 (95% CI 0.89–3.58) but was not statistically significant.ConclusionsFollowing ART initiation, older adults compared to the young, have a higher risk of mortality. This age group should be targeted first for ‘screen and treat’ approach. Optimization of ART treatment regimens for this age group is also required to reduce mortality and improve immunological response.
BackgroundAerodigestive foreign bodies (ADFB) in children are a common emergency in ENT clinics globally. The aim of this study was to determine the prevalence and common types of ADFB’s presenting to a referral hospital in South Western Uganda, and to review clinical presentation and factors that influence their occurrence among children under 12 years of age.MethodsWe conducted a case control study comprising 40 cases and 80 unmatched controls. Consecutive and random sampling were used for the cases and controls respectively. A questionnaire was used to collect data. Clinic records were reviewed to calculate prevalence.ResultsPrevalence was 6.6 % of all paediatric cases seen in the ENT department that year. The most common symptoms included: history of choking [45 %], sudden cough [72.5 %], stridor [60 %] and failure to swallow [35 %]. The most common location for an airway foreign body was the right main bronchus [40 %] and the upper one third of the oesophagus [32.5 %] for digestive tract foreign bodies. Seeds and coins were most frequently removed. Children from upper level SES had a significantly lower risk of foreign body occurrence [OR = 0.29, p = 0.02] compared to those from a low SES. Also significantly, most cases were referrals from other government health centres [p = <0.01]. The male to female ratio among cases was 2:1. Children of older mothers were less likely to have an ADFB.ConclusionPrevalence of ADFB’s is relatively high. The most common symptoms are a history of choking, cough and failure to swallow. Age under 5 years, male sex, younger maternal age and low socioeconomic status increased odds of ADFBs.
The development of pericoital contraceptive pills is under consideration to address unmet need for family planning, especially among women who have infrequent sexual intercourse. Pericoital pills, an oral contraceptive taken 24 hours before or after intercourse, would be a potentially desirable contraceptive option because it could provide convenience, discretion, and female control over contraceptive use. To gauge receptivity to pericoital contraception, a total of 49 in-depth interviews and 5 focus group discussions were conducted in India and Uganda with family planning providers and stakeholders. In India, the method was seen as filling a demonstrated need, based on perceived widespread and/or repeat use of emergency contraceptives. In Uganda, where emergency contraception has met strong opposition from conservative and religious leaders, respondents were more skeptical about the merits of the product. In both settings, using condoms consistently and taking oral contraceptives daily present challenges for consistent use, thus a new contraceptive method that is easy to use and under female control is likely to be appealing.
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