Intrauterine device self-removal practices during the COVID-19 pandemic among family planning clinics
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ABSTRACT: Objectives
To explore the prevalence of intrauterine device self-removal practices before and during the COVID-19 pandemic among family planning clinics. Study Design
This is a secondary analysis of data from a descriptive, longitudinal study using a clinic-based convenience sample from the Abortion Clinical Research Network assessing baseline and pandemic-adaptive family planning practices. Results
Of the 63 sites that provided contraception, five (7.9%) reported providing guidance on intrauterine device self-removal at baseline. Sixteen sites (25.4%) provided guidance on self-removal by the end of the study period. Self-removal counseling was associated with being an academic center and reporting a median lower number of monthly contraceptive encounters. Conclusions
Endorsement of IUD self-removal increased to one-quarter of sites by the final timepoint.
SUBMITTER: Fay K
PROVIDER: S-EPMC9554323 | biostudies-literature | 2022 Oct
REPOSITORIES: biostudies-literature
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Project description:BackgroundIntrauterine devices (IUDs) are commonly used as contraceptives worldwide. However, pregnancies in patients carrying this kind of device may occur. IUD removal when the woman wishes to continue their pregnancy may be very challenging. Only 9 manuscripts in literature reported such similar procedure.Case presentationWe report the case of an hysteroscopic removal of IUD in a young woman at 6 weeks of gestation.DiscussionThe case reported highlights safety and efficacy of operative hysteroscopy as a method of IUD removal in early pregnancy, although other different methods have been reported in literature. In our opinion, maintaining a low infusion pressure during the procedure may help avoiding potential gestational sac damage and IUD displacement for better grasping.
| S-EPMC9609195 | biostudies-literature
Project description:BackgroundWe describe how High Impact Practices (HIPs) in family planning (FP) were adapted across Kenya, Nigeria, and Zimbabwe to maintain access to services in response to the coronavirus disease (COVID-19) pandemic.MethodsUsing a qualitative data collection tool structured around 3 HIP categories (service delivery, demand creation, and enabling environment), adaptations in FP programs during the pandemic were documented. We describe adaptations made to 3 specific HIPs: mobile outreach, community health workers, and digital health for social and behavior change.Program experiencesIn Zimbabwe, the Mhuri/Imuli project adapted its mobile outreach model integrating community-based outreach with facility-based outreach. The number of outreach clients served per week peaked at 1,759 (July 2020) from a low of 203 (May 2020). Clients choosing long-acting reversible methods increased from 22% to 59% during the 3 months before and after lockdown, respectively.In Kenya, a program addressed youth's hesitation to visit health facilities through youth community health volunteers, who provided counseling, community dialogues, contraceptive pills, and condoms. Over 6 months, the program reached 1,048 youth with community dialogues, and 4,656 youth received FP services. In Nigeria, peer mobilizers provided services through a socially distanced community-based program to help adolescent girls access contraceptive self-injection when movement restrictions limited youth's ability to travel to facilities.In Nigeria, Adolescents 360 adapted sexual and reproductive health information programs for virtual delivery through WhatsApp. A contraceptive education Facebook campaign gained more than 80,000 followers, reached 5.9 million adolescents, and linked 330 adolescents to program-supported facilities from January to March 2021. In Kenya, the Kibera-based project used WhatsApp to reach youth with discussion groups and health workers with skills strengthening.ConclusionMonitoring how projects adapt HIPs to ensure continuity of care during the COVID-19 pandemic can help inform the implementation of successful adaptations in the face of present and future challenges.
| S-EPMC9426984 | biostudies-literature
Project description:AimTo describe the use of a new protective device to reduce aerosol dispersion in dental clinics during the COVID-19 pandemic.MethodologyThe device consists of a rigid translucent acrylic structure (methyl polymethacrylate), adjusted to the dental chair, involving the patient's head, neck and chest. There is also a piping system to generate negative pressure, for aspiration and filtering of the air inside the device chamber. The operator works through small holes in the acrylic structure, to reduce contact with the microparticles arising from aerosols during dental procedures. Simulated dental procedures using a fluorescent dye in the water of the dental equipment were carried out, with and without the use of the device. The presence of the dye was analysed at various locations, such as on personal protective equipment (PPE), the dental chair and on the clinic floor.ResultsIn the simulated dental procedure without the device, the dye was obvious on surgical gloves, aprons (waist, chest, legs, fists) and face shields, as well as on the dental chair (backrest, light reflector) and clinic floor. In the simulated dental procedure using the device, the dye was observed only on surgical gloves, apron (fists), inside the pipe system and internal walls of the acrylic chamber. There was a certain limitation of movement and visualization by the dentist whilst using the device.ConclusionsThe present device is a low-cost complementary resource for use in conjunction with standard PPE, to reduce the transmission of SARS-CoV-2 in the dental setting. Further clinical trials should be carried out to test the efficacy of this device to reduce aerosol dispersion and the consequent vector of contamination, as well as the ergonomic impacts related to its use.
| S-EPMC7436703 | biostudies-literature
Project description:Introduction Rwanda has high unmet need for family planning (FP), especially in the postpartum period when women are advised to space pregnancies at least two years for improved maternal-child health. Despite interest in the copper intrauterine device (IUD), a highly cost-effective method, access and uptake remain low. This study aimed to determine factors associated with postpartum IUD (PPIUD) uptake after postpartum family planning (PPFP) counseling as well as provider perceptions of facilitators and barriers to clients’ PPIUD uptake. Methods Postpartum women who received PPFP counseling and were less than 6 weeks postpartum were recruited for a case-control study in Kigali, Rwanda in 2018. We recruited n = 74 women who had accepted and n = 91 women who had declined the PPIUD. Multivariate logistic regression analyses evaluated associations between women’s socio-demographics, FP knowledge and decision-making, and the outcome of PPIUD uptake. Six focus groups (FGs) were conducted with FP providers (n = 24) and community health workers (n = 17) trained to deliver PPFP counseling to assess perceptions of PPFP counseling and facilitators and barriers to PPIUD uptake. FG discussions were recorded, translated, and analyzed for themes. Results Factors associated (P<0.1) with PPIUD uptake included citing its non-hormonal nature, effectiveness, and duration of protection against pregnancy as advantages. Exclusive male partner control over FP decisions (relative to women’s control or joint decision-making) was associated with non-use. Overall, limited knowledge about some aspects of the PPIUD persisted among clients even after counseling. Provider FGs highlighted client concerns, inconsistent FP messaging, and lack of male partner involvement as factors influencing non-use. Conclusions Knowledge of the IUD and its benefits was associated with PPIUD uptake. There is need to refine PPFP counseling messages to address remaining knowledge gaps and concerns. Additionally, male partner involvement in FP counseling and decisions with their partners could be a key strategy to increase both PPIUD and FP uptake in Rwanda.
| S-EPMC9632907 | biostudies-literature
Project description:ObjectiveThe COVID-19 pandemic and the measures implemented to stop the pandemic had a broad impact on our daily lives. Besides work and social life, health care is affected on many levels. In particular, there is concern that attendance in health care programs will drop or hospital admissions will be delayed due to COVID-19-related anxieties, especially in children. Therefore, we compared the number of weekly visits to 78 German pediatric institutions between 2019 and 2020.ResultsWe found no significant differences during the first 10 weeks of the year. However, and importantly, from April, the weekly number of visits was more than 35% lower in 2020 than in 2019 (p = 0.005). In conclusion, the COVID-19 pandemic seems to relate to families´ utilization of outpatient well-child clinics and pediatric practice attendance in Germany.
| S-EPMC8050987 | biostudies-literature
Project description:BackgroundThe World Health Organization recommends postpartum family planning (PPFP) for healthy birth spacing. This study is an evaluation of an intervention that sought to improve women's access to PPFP in Tanzania. The intervention included counseling on PPFP during antenatal and delivery care and introducing postpartum intrauterine device (PPIUD) insertion as an integrated part of delivery services for women electing PPIUD in the immediate postpartum period.MethodsThis cluster-randomized controlled trial recruited 15,264 postpartum Tanzanian women aged 18 or older who delivered in one of five study hospitals between January and September 2016. We present the effectiveness of the intervention using a difference-in-differences approach to compare outcomes, receipt of PPIUD counseling and choice of PPIUD after delivery, between the pre- and post-intervention period in the treatment and control group. We also present an intervention adherence-adjusted analysis using an instrumental variables estimation.ResultsWe estimate linear probability models to obtain effect sizes in percentage points (pp). The intervention increased PPIUD counseling by 19.8 pp (95% CI: 9.1 - 22.6 pp) and choice of PPIUD by 6.3 pp (95% CI: 2.3 - 8.0 pp). The adherence-adjusted estimates demonstrate that if all women had been counseled, we would have observed a 31.6 pp increase in choice of PPIUD (95% CI: 24.3 - 35.8 pp). Among women counseled, determinants of choosing PPIUD included receiving an informational leaflet during counseling and being counseled after admission for delivery services.ConclusionsThe intervention modestly increased the rate of PPIUD counseling and choice of PPIUD, primarily due to low coverage of PPIUD counseling among women delivering in study facilities. With universal PPIUD counseling, large increases in choice of PPIUD would have been observed. Giving women informational materials on PPIUD and counseling after admission for delivery are likely to increase the proportion of women choosing PPIUD.Trial registrationRegistered with clinicaltrials.gov (NCT02718222) on March 24, 2016, retrospectively registered.
| S-EPMC7218519 | biostudies-literature
Project description:IntroductionFederal recommendations for providing quality family planning services were published in 2014 and included preconception care (PCC). This paper aims to describe the prevalence of PCC delivery among publicly funded clinics, prior to the recommendations.MethodsPrevalence of providing occasional or frequent PCC in the last 3 months and having written protocols for recommended PCC screenings were estimated in 2015 using survey data collected from a nationally representative sample of publicly funded clinic administrators (2013-2014, N=1,615). Analyses included examination of differential distributions of outcomes by clinic characteristics (p<0.05) and multivariable regression.ResultsPrevalence of occasional or frequent PCC delivery was 81% for women and 38% for men. The percentage of clinics with written protocols for specific PCC screenings ranged from 74% to 88% (women) and 66% to 83% (men). Prevalence of having written protocols for all PCC screenings was 29% for women and 22% for men. Characteristics negatively associated with having written protocols for all PCC screenings for women and men (respectively) were as follows: not receiving Title X funding (adjusted prevalence ratio [APR]=0.6, 95% CI=0.50, 0.76; APR=0.6, 95% CI=0.47, 0.77) and being a community health center (APR=0.5, 95% CI=0.37, 0.72; APR=0.5, 95% CI=0.30, 0.67); health department (APR=0.7, 95% CI=0.61, 0.87; APR=0.6, 95% CI=0.49, 0.76); or hospital/other (APR=0.6, 95% CI=0.50, 0.79; APR=0.6, 95% CI=0.43, 0.75) (versus Planned Parenthood).ConclusionsProvision of PCC appears to differ by clinic characteristics and by interpretation of the phrase "preconception care," suggesting opportunities for education and improvement.
| S-EPMC5379123 | biostudies-literature
Project description:A female patient presented with episodes of fever and pain in the lower right abdomen after hysteroscopic removal of an intrauterine device 2 months earlier. Pelvic actinomycosis originating from a tubo-ovarian abscess was diagnosed with Propionibacterium propionicum, formerly known as Arachnia propionica, as causative agent.
| S-EPMC3020428 | biostudies-literature
Project description:BackgroundAnnual chlamydia screening is recommended for all sexually active women aged <25 years. Substantial limitations exist in ascertaining chlamydia trends. Reported case rates have increased likely due to increased screening and improved test technology. Other data suggest that prevalence has decreased.MethodsData from the Infertility Prevention Project (IPP), a national chlamydia screening program, were used to assess trends in chlamydia positivity from 2004 to 2008 among women aged 15 to 24 years who were tested in family planning clinics reporting data to IPP. Using the clinic as the unit of analysis, a correlated, longitudinal data analysis with a random intercept was conducted among clinics reporting ≥3 years of data during the analysis timeframe. Sensitivity analyses were performed to address the impact of various clinic participation levels in addition to the assessment of various correlation structures.ResultsOver 5 million chlamydia tests were reported to IPP family planning clinics from 2004 to 2008. A majority of tests were conducted among white women (clinic-specific mean: 63.2%, interquartile range: 37.6%-91.5%); the clinic-specific mean percent of tests conducted among black women was 17.9% (interquartile range: 0.8%-25.7%). Overall chlamydia positivity from 2004 to 2008 was 7.0%. The odds ratio associated with a single year change (1.00; 95% confidence interval: 0.99, 1.00) suggested that chlamydia positivity did not change from 2004 to 2008, after controlling for clinic-specific population factors (age, race, test usage, and geography).ConclusionsFindings support previous analyses suggesting that chlamydia prevalence is not increasing despite apparent increasing rates based on case reports.
| S-EPMC4041131 | biostudies-literature
Project description:BackgroundSelf-medication association with an ongoing pandemic is evident in the studies conducted throughout the world. To summarize the findings of previous papers, we carried out a systematic review to observe the current scenario of self-medication during COVID-19.MethodologyScopus, Embase, Web of Science, PubMed, MedRxiv preprints, SciELO Preprints, google, and google scholar were searched using keywords related to the topic. Studies reporting original data and assessing the self-medication practices during Covid-19 were included.ResultsA total of 660 papers were collected and 14 cross-sectional studies among them were finalized from 12 different countries after apposite screening processes. Our study measured that during the COVID-19 pandemic, there was a 44.786% prevalence of self-medication. Analgesics, antibiotics, and nutritional supplements were commonly practiced drugs. Pharmacy and hospital outlets were the main sources of the drugs. Fever, sore throat, body ache (muscle pain), and flu or cough were among the most frequently recorded illnesses; treatment and prevention of COVID-19 were the main culprit behind self-medication. During COVID-19, the major factors associated with self-medication were fear, anxiety, and perception regarding COVID-19. Thus, in this pandemic, fear, anxiety, and rumors regarding immunity boosters, nutritional supplements, financial burden, and easy accessibility to even non-OTC drugs; all have their fair share in self-medication practices.ConclusionAs there was heterogeneity regarding COVID-19 and self-medication found among the assessed studies, educating general people about safe self-medication practices, hazards of superfluous drug usage, and provision of an affordable quality-health system should become a priority, especially in low and middle-income countries.
| S-EPMC9419440 | biostudies-literature