Caregiver awareness of reproductive health issues for women with intellectual disabilities

Lin, Lan; Lin, Pei; Hsu, Shang Wei; Loh, Ching‐Hui; Lin, Jin Ding; Lai, Chia Im; Chien, Wu Chien; Lin, Fei-Jan

doi:10.1186/1471-2458-11-59

Cited by 18 publications

(13 citation statements)

References 24 publications

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“…Five studies investigated the level of training and support provided to carers (professionals and mothers) on how to manage menstruation of a person with an intellectual impairment [34, 35, 42, 48, 49]. Three of these studies [42, 48, 49] focused on professional carers working in institutions and two studies on mothers at home [34, 35].…”

Section: Resultsmentioning

confidence: 99%

Systematic review of menstrual hygiene management requirements, its barriers and strategies for disabled people

et al. 2019

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BackgroundOne quarter of the global population is of menstruating age, yet menstruation is shrouded in discrimination and taboos. Disability also carries stigma, so disabled people may face layers of discrimination when they are menstruating. The objective of the review is to assess the menstrual hygiene requirements of disabled people, the barriers they face, and the available interventions to help them manage their menstruation hygienically and with dignity.MethodsEligible studies, gathered across all countries, were identified by conducting searches across four databases (MEDLINE, PubMed, EMBASE, Global Health) in May 2017, with alerts set on each database to highlight new titles added until April 2018. Eligible studies incorporated analyses relevant to menstruating disabled people and/or how their carers provide support during their menstrual cycle.ResultsThe 22 studies included were published since 1976; the majority after 2010 (n = 12; 55%). One study was a quasi-experiment; all others were observational. Most studies (n = 15; 68%) were from high income countries and most (n = 17; 77%) focused on people with intellectual impairments, so the review findings focus on this group and their carers. Outcomes investigated include choice and preference of menstrual product, ability to manage menstrual hygiene and coping strategies applied. Barriers faced included a lack of standardised guidance for professional carers; a lack of menstruation training, information and support provided to people with intellectual impairments and their carers; a lack of understanding of severity of symptoms experienced by people with intellectual impairments, the high cost of menstrual products and lack of appropriate options for people with physical impairments. Few interventions were found, and strategies for menstrual hygiene management applied by carers of persons with intellectual impairments include limiting the disabled person’s movements when menstruating and suppressing their menstruation.ConclusionsLittle evidence was identified on the requirements of disabled people and their carers in managing their menstruation, and only one intervention, but a range of barriers were identified. This gap in evidence is important, as the consequences of failing to meet menstrual hygiene needs of disabled people includes shame, social isolation, and even sterilisation.Systematic review registrationPROSPERO CRD42018095497.

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Section: Resultsmentioning

confidence: 99%

Systematic review of menstrual hygiene management requirements, its barriers and strategies for disabled people

et al. 2019

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“…Estimates of number of adverse birth outcomes averted with treatment of pregnant women with syphilis were calculated using data from a review and meta-analysis evaluating the anticipated reduction in adverse birth outcomes with maternal treatment with benzathine penicillin [ 4 ]. Although clinical data and previous studies have identified maternal treatment prior to the third trimester is important in preventing syphilis-associated adverse pregnancy outcomes [ 22 , 23 ], penicillin treatment is recommended for all seroreactive pregnant women regardless of the foetal gestational age at the time maternal infection was detected.…”

Section: Methodsmentioning

confidence: 99%

“…We also assumed 100% treatment of these women estimated as having probable active syphilis during pregnancy. In order to calculate estimates of averted adverse pregnancy outcomes following maternal syphilis treatment, we used previously published estimates by Blencowe et al We calculated global estimates of pregnancy outcome averted for the following: any adverse pregnancy outcome (84% averted), stillbirth (82% averted), neonatal death (80% averted), prematurity/low birth weight (64% averted) and other clinical congenital syphilis (97% averted) [ 4 ].…”

Section: Methodsmentioning

confidence: 99%

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Estimating Benzathine Penicillin Need for the Treatment of Pregnant Women Diagnosed with Syphilis during Antenatal Care in High-Morbidity Countries

et al. 2016

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BackgroundCongenital syphilis continues to be a preventable cause of global stillbirth and neonatal morbidity and mortality. Shortages of injectable penicillin, the only recommended treatment for pregnant women and infants with syphilis, have been reported by high-morbidity countries. We sought to estimate current and projected annual needs for benzathine penicillin in antenatal care settings for 30 high morbidity countries that account for approximately 33% of the global burden of congenital syphilis.MethodsProportions of antenatal care attendance, syphilis screening coverage in pregnancy, syphilis prevalence among pregnant women, and adverse pregnancy outcomes due to untreated maternal syphilis reported to WHO were applied to 2012 birth estimates for 30 high syphilis burden countries to estimate current and projected benzathine penicillin need for prevention of congenital syphilis.ResultsUsing current antenatal care syphilis screening coverage and seroprevalence, we estimated the total number of women requiring treatment with at least one injection of 2.4 MU of benzathine penicillin in these 30 countries to be 351,016. Syphilis screening coverage at or above 95% for all 30 countries would increase the number of women requiring treatment with benzathine penicillin to 712,030. Based on WHO management guidelines, 351,016 doses of weight-based benzathine penicillin would also be needed for the live-born infants of mothers who test positive and are treated for syphilis in pregnancy. Assuming availability of penicillin and provision of treatment for all mothers diagnosed with syphilis, an estimated 95,938 adverse birth outcomes overall would be prevented including 37,822 stillbirths, 15,814 neonatal deaths, and 34,088 other congenital syphilis cases.ConclusionPenicillin need for maternal and infant syphilis treatment is high among this group of syphilis burdened countries. Initiatives to ensure a stable and adequate supply of benzathine penicillin for treatment of maternal syphilis are important for congenital syphilis prevention, and will be increasingly critical in the future as more countries move toward elimination targets.

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“…Benzathine penicillin G (BPG) is the only recommended treatment for syphilis in pregnant women to prevent MTCT, as other drugs are contraindicated, do not cross the placenta to treat the fetus, or are less effective than BPG [ 5 ]. Treatment of syphilis-infected pregnant women with 2.4 million international units (IU) of intramuscular of BPG given at least 28 days prior to delivery can result in an 82% reduced risk of stillbirth and 80% reduction in neonatal mortality [ 6 ]. In recognition of this, WHO published The Global Elimination of Congenital Syphilis : Rationale and Strategy for Action [ 7 ] and set country targets for the elimination of MTCT of HIV and syphilis, which will bring BPG shortages into sharp focus.…”

Section: Introductionmentioning

confidence: 99%

Shortages of benzathine penicillin for prevention of mother-to-child transmission of syphilis: An evaluation from multi-country surveys and stakeholder interviews

et al. 2017

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BackgroundBenzathine penicillin G (BPG) is the only recommended treatment to prevent mother-to-child transmission of syphilis. Due to recent reports of country-level shortages of BPG, an evaluation was undertaken to quantify countries that have experienced shortages in the past 2 years and to describe factors contributing to these shortages.Methods and findingsCountry-level data about BPG shortages were collected using 3 survey approaches. First, a survey designed by the WHO Department of Reproductive Health and Research was distributed to 41 countries and territories in the Americas and 41 more in Africa. Second, WHO conducted an email survey of 28 US Centers for Disease Control and Prevention country directors. An additional 13 countries were in contact with WHO for related congenital syphilis prevention activities and also reported on BPG shortages. Third, the Clinton Health Access Initiative (CHAI) collected data from 14 countries (where it has active operations) to understand the extent of stock-outs, in-country purchasing, usage behavior, and breadth of available purchasing options to identify stock-outs worldwide. CHAI also conducted in-person interviews in the same 14 countries to understand the extent of stock-outs, in-country purchasing and usage behavior, and available purchasing options. CHAI also completed a desk review of 10 additional high-income countries, which were also included. BPG shortages were attributable to shortfalls in supply, demand, and procurement in the countries assessed. This assessment should not be considered globally representative as countries not surveyed may also have experienced BPG shortages. Country contacts may not have been aware of BPG shortages when surveyed or may have underreported medication substitutions due to desirability bias. Funding for the purchase of BPG by countries was not evaluated. In all, 114 countries and territories were approached to provide information on BPG shortages occurring during 2014–2016. Of unique countries and territories, 95 (83%) responded or had information evaluable from public records. Of these 95 countries and territories, 39 (41%) reported a BPG shortage, and 56 (59%) reported no BPG shortage; 10 (12%) countries with and without BPG shortages reported use of antibiotic alternatives to BPG for treatment of maternal syphilis. Market exits, inflexible production cycles, and minimum order quantities affect BPG supply. On the demand side, inaccurate forecasts and sole sourcing lead to under-procurement. Clinicians may also incorrectly prescribe BPG substitutes due to misperceptions of quality or of the likelihood of adverse outcomes.ConclusionsTargets for improvement include drug forecasting and procurement, and addressing provider reluctance to use BPG. Opportunities to improve global supply, demand, and use of BPG should be prioritized alongside congenital syphilis elimination efforts.

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Caregiver awareness of reproductive health issues for women with intellectual disabilities

Cited by 18 publications

References 24 publications

Systematic review of menstrual hygiene management requirements, its barriers and strategies for disabled people

Systematic review of menstrual hygiene management requirements, its barriers and strategies for disabled people

Estimating Benzathine Penicillin Need for the Treatment of Pregnant Women Diagnosed with Syphilis during Antenatal Care in High-Morbidity Countries

Shortages of benzathine penicillin for prevention of mother-to-child transmission of syphilis: An evaluation from multi-country surveys and stakeholder interviews

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