Knowledge of University Students in Szeged, Hungary About Reliable Contraception Methods & Sexually Transmitted Diseases

INTRODUCTION:

Promiscuity and lack of use of reliable contraceptive methods increase the probability of sexually transmitted diseases and the risk of unwanted pregnancies, which are quite common among university students.

AIM:

The aim of the study was to assess the knowledge of university students about reliable contraceptive methods and sexually transmitted diseases, and to assess the effectiveness of the sexual health education in secondary schools, with specific focus on the education held by peers.

METHOD:

An anonymous, self-administered questionnaire survey was carried out in a randomized sample of students at the University of Szeged (n = 472, 298 women and 174 men, average age 21 years) between 2009 and 2011.

RESULTS:

62.1% of the respondents declared that reproductive health education lessons in high schools held by peers were reliable and authentic source of information, 12.3% considered as a less reliable source, and 25.6% defined the school health education as irrelevant source. Among those, who considered the health education held by peers as a reliable source, there were significantly more females (69.3% vs. 46.6%, p = 0.001), significantly fewer lived in cities (83.6% vs. 94.8%, p = 0.025), and significantly more responders knew that Candida infection can be transmitted through sexual intercourse (79.5% versus 63.9%, p = 0.02) as compared to those who did not consider health education held by peers as a reliable source. The majority of respondents obtained knowledge about sexual issues from the mass media.

CONCLUSIONS:

Young people who considered health educating programs reliable were significantly better informed about Candida disease

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By:  Devosa I1,2, Kozinszky Z1,3, Vanya M1,4,5, Szili K1,4,5, Fáyné Dombi A1,2,6, Barabás K7.

• 1Egészségtudományi és Egészségfejlesztő Kutató Csoport, Kecskeméti Főiskola, Tanítóképző Főiskolai Kar Kecskemét.
• 2Szegedi Akadémiai Bizottság Oktatáselméleti Munkabizottság, Magyar Tudományos Akadémia Szeged.
• 3Department of Obstetrics and Gynecology, Blekinge Hospital Karlskrona, Svédország.
• 4Szent-Györgyi Albert Klinikai Központ, Szülészeti és Nőgyógyászai Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged.
• 5Mediteam Zrt. Szeged.
• 6Tanító- és Óvóképző Intézet, Alkalmazott Pedagógia és Pszichológia Tanszék, Szegedi Tudományegyetem, Juhász Gyula Pedagógusképző Kar Szeged.
• 7Magatartástudományi Intézet, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged.
• Orv Hetil. 2016 Apr;157(14):539-46. doi: 10.1556/650.2015.30356.

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Contraceptive Failure Rates in the Developing World

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Trends in Contraceptive Use Worldwide, 2015

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Do Reports of Age and Circumstances of First Intercourse Differ in a Birth Cohort When Asked Seventeen Years Apart?

Conclusions about temporal changes in age and circumstances of first intercourse are generally derived from retrospective reports by people of various ages in cross-sectional studies, with an inherent assumption of no bias stemming from time since the event. We examined this assumption through repeated questions on age and circumstances of first heterosexual intercourse (FHI) at ages 21 and 38 in a birth cohort. 

Despite considerable movement in individual reports, there was no bias in reported age of FHI. However, a greater proportion of both men and women stated at the later assessment both partners had been equally willing (versus persuading or persuaded). The distribution of current views of the appropriateness of the timing did not differ markedly between assessments, although there were many individual changes. 

Reports of contraceptive usage were similar at the two assessments for men but differed among women, mainly through more reporting that they could not remember. T

hese findings imply that among cohorts born in the 1970s, there is no bias in reports of age of FHI many years after the event, and views on the appropriateness of timing persist. However, time biases reports in favor of a more mutual willingness.

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By:  Dickson NP1, Righarts A1, van Roode T1, Cameron C1, Connor J1.

• 1 Department of Preventive and Social Medicine , University of Otago.
• J Sex Res. 2016 Mar-Apr;53(3):321-30. doi: 10.1080/00224499.2015.1058891. Epub 2015 Oct 12. 

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Oral Contraceptives and Multiple Sclerosis/Clinically Isolated Syndrome Susceptibility

Background

The incidence of multiple sclerosis (MS) is rising in women.

Objective

To determine whether the use of combined oral contraceptives (COCs) are associated with MS risk and whether this varies by progestin content.

Methods

We conducted a nested case-control study of females ages 14–48 years with incident MS or clinically isolated syndrome (CIS) 2008–2011 from the membership of Kaiser Permanente Southern California. Controls were matched on age, race/ethnicity and membership characteristics. COC use up to ten years prior to symptom onset was obtained from the complete electronic health record.

Results

We identified 400 women with incident MS/CIS and 3904 matched controls. Forty- percent of cases and 32% of controls had used COCs prior to symptom onset. The use of COCs was associated with a slightly increased risk of MS/CIS (adjusted OR = 1.52, 95%CI = 1.21–1.91; p<0.001). This risk did not vary by duration of COC use. The association varied by progestin content being more pronounced for levenorgestrol (adjusted OR = 1.75, 95%CI = 1.29–2.37; p<0.001) than norethindrone (adjusted OR = 1.57, 95%CI = 1.16–2.12; p = 0.003) and absent for the newest progestin, drospirenone (p = 0.95).

Conclusions

Our findings should be interpreted cautiously. While the use of some combination oral contraceptives may contribute to the rising incidence of MS in women, an unmeasured confounder associated with the modern woman’s lifestyle is a more likely explanation for this weak association.

Below:  Association between combined oral contraceptive use and multiple sclerosis/clinically isolated syndrome

Full article at:   http://goo.gl/jcjccp

By:  

Kerstin Hellwig 
St. Josef University Hospital, Bochum, Neuroimmunological Ward and Outpatient Clinic, Bochum, Germany

Kerstin Hellwig, Lie H. Chen, Annette M. Langer-Gould 

Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, California, United States of America

Frank Z. Stancyzk 

University of Southern California, Keck School of Medicine, Los Angeles, California, United States of America

Annette M. Langer-Gould 

Kaiser Permanente, Southern California Los Angeles Medical Center, Neurology Department, Los Angeles, California, United States of America

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The Relationship Between Contraceptive Use & Maternal & Infant Health Outcomes in Tajikistan

OBJECTIVE:

There has been no evaluation of the association between contraceptive use and maternal and child health (MCH) in Tajikistan, though the government has made concerted efforts to improve accessibility to family planning methods. The aim of this study is to understand the relationship between current contraceptive utilization and specific MCH outcomes in Tajikistan.

STUDY DESIGN:

Using data from the 2012 Tajikistan Demographic and Health Survey, a total weighted sample of 6716 women aged 15 to 49 years who had at least one child at the time of interview was analyzed. Logistic regression analyses were performed to assess the relationship between current contraceptive utilization and birth spacing, birth limiting and infant mortality.

RESULTS:

Modern contraceptive use was low among women studied (27.1%). Modern contraceptive users were more likely to present with a longer birth interval [adjusted odds ratio (aOR) = 2.4, 95% confidence interval (CI) = 2.0-2.8] than traditional or nonusers. Women who used modern contraceptives were half as likely to limit births to three or fewer children compared to traditional or nonusers (aOR = 0.5, 95% CI = 0.4-0.6). Among women whose most recent live birth resulted in death, modern contraceptive use was not associated with lower levels of infant mortality.

CONCLUSION:

Efforts made by the Tajik government to increase utilization of family planning have had mixed effects on overall uptake and the MCH outcomes analyzed in this study. These findings can help to inform the government's policy on family planning.

IMPLICATIONS:

Contraceptive utilization has not yet translated into beneficial MCH outcomes. Policy makers in Tajikistan might consider placing more emphasis on family planning education, while maximizing accessibility of contraceptive methods.

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By:  Merali S1.

• 1Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA. 
• Contraception. 2016 Mar;93(3):216-21. doi: 10.1016/j.contraception.2015.11.009. Epub 2015 Nov 24.

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Non-Barrier Contraceptive Use & Relation to Condom Use Behavior by Partner Type among Female Sex Workers in Andhra Pradesh, India

OBJECTIVE:

The study assessed non-barrier contraceptive use among female sex workers (FSW) in Andhra Pradesh, India and relation to inconsistent condom use among commercial and non-commercial male sexual partners.

METHODS:

FSW at least 18 years of age (n=2338) were recruited through respondent-driven sampling for an HIV risk survey. Analysis was restricted to women of childbearing age (n=2197). Crude and adjusted logistic regression models were used to assess non-barrier contraceptive use and relation to inconsistent condom use with husbands or regular male partners (i.e. non-clients), regular clients and occasional clients.

RESULTS:

Non-barrier methods of contraception included contraceptive pills (3.8%) and sterilisation (68.4%). In logistic regression models adjusted for relevant demographics, FSW using contraceptive pills were more likely to report inconsistent condom use with a regular client (past week) and with an occasional client (past week), as well as accepting more money for sex without a condom (past 30 days). No significant associations were found between pill use and inconsistent condom use among women's non-client partners, potentially related to small sample sizes within these subgroups. Reporting sterilisation, which was more common among FSW who were older in age, was not associated with inconsistent condom use with client or non-client sexual partners.

CONCLUSIONS:

Findings document potential unmet need for modern, spacing contraceptives (i.e. pill, intrauterine device), but also indicate the importance for family planning services, particularly those promoting modern contraceptive methods to be provided alongside HIV prevention among FSW in Andhra Pradesh, India.

Full article at:   http://goo.gl/jiQFHl

By:  Reed E1, Erausquin JT2, Biradavolu M3, Servin AE4, Blankenship KM5.

• 1Assistant Professor, Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA.
• 2Assistant Professor, Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, NC, USA.
• 3Scholar in Residence, Department of Sociology, American University, Washington, DC, USA.
• 4Postdoctoral Fellow, Division of Global Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, USA.
• 5Professor and Chair, Department of Sociology, American University, Washington, DC, USA. 
• J Fam Plann Reprod Health Care. 2015 Dec 23. pii: jfprhc-2014-100918. doi: 10.1136/jfprhc-2014-100918.

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Effects of Intensive Longitudinal Data Collection on Pregnancy & Contraceptive Use

We use an experiment based on the Relationship Dynamics and Social Life (RDSL) study of sexual behavior, pregnancy, and contraceptive use to investigate whether participation in weekly self-reports over one year result in differential effects on related behaviors and attitudes, compared to participation in a one-time follow-up interview requiring retrospective self-reporting for the prior year. 

We randomly assigned 200 subjects to either a control group or a journal group. All subjects were interviewed at the beginning of the study (baseline interview) and 12 months later (closeout interview). Subjects in the journal group also completed a five-minute web- or phone-based survey every week during the 12-month study period. 

We found no statistically significant difference in pregnancy rates across the two groups at closeout. Contrary to our expectation, the control group experienced a slightly larger increase in having ever used a contraceptive method, although this was mainly due to increases in the least effective methods, such as condoms and withdrawal. 

Respondents in the weekly interview group became slightly more positive toward childbearing in terms of one specific attitude measure, but not for the vast majority of measures. 

We conclude that intensive longitudinal data collection does not appear to have a large or consistent impact on respondents' pregnancy, contraceptive use, or related attitudes, relative to the more standard longitudinal approach.

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By:  Barber JS1, Gatny HH1, Kusunoki Y1, Schulz P1.

• 1Institute for Social Research (http://home.isr.umich.edu/), University of Michigan, Ann Arbor, MI USA. 
• Int J Soc Res Methodol. 2016 Mar 1;19(2):205-222. Epub 2014 Dec 1.

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Unintended Pregnancy, Contraceptive Use & Childbearing Desires among HIV-Infected & HIV-Uninfected Women in Botswana

Background

Little is known about the impact of knowledge of HIV serostatus on pregnancy intention and contraceptive use in high-HIV-burden southern African settings in the era of widespread antiretroviral treatment availability.

Methods

We analyzed interview data collected among 473 HIV-uninfected and 468 HIV-infected pregnant and recently postpartum women at two sites in southern Botswana. Participants were interviewed about their knowledge of their HIV status prior to pregnancy, intendedness of the pregnancy, contraceptive use, and future childbearing desires.

Results

The median age of the 941 women was 27 years, median lifetime pregnancies was 2, and 416 (44 %) of pregnancies were unintended. Among women reporting unintended pregnancy, 36 % were not using a contraceptive method prior to conception. Among contraception users, 81 % used condoms, 13 % oral contraceptives and 5 % an injectable contraceptive. In univariable analysis, women with unintended pregnancy had a higher number of previous pregnancies (P = <0.0001), were less educated (P = 0.0002), and less likely to be married or living with a partner (P < 0.0001). Thirty-percent reported knowing that they were HIV-infected, 48 % reported knowing they were HIV-uninfected, and 22 % reported not knowing their HIV status prior to conception. In multivariable analysis, women who did not know their HIV status pre-conception were more likely to report their pregnancy as unintended compared to women who knew that they were HIV-uninfected (aOR = 1.7; 95%CI: 1.2-2.5). After controlling for other factors, unintended pregnancy was not associated with knowing one’s HIV positive status prior to conception (compared with knowing one’s negative HIV status prior to conception). Among women with unintended pregnancy, there was no association between knowing their HIV status and contraceptive use prior to pregnancy in adjusted analyses. Sixty-one percent of women reported not wanting any more children after this pregnancy, with HIV-infected women significantly more likely to report not wanting any more children compared to HIV-uninfected women (aOR = 3.9; 95%CI: 2.6-5.8).

Conclusions

The high rates of reported unintended pregnancy and contraceptive failure/misuse underscore an urgent need for better access to effective contraceptive methods for HIV-uninfected and HIV -infected women in Botswana. Lower socioeconomic status and lack of pre-conception HIV testing may indicate higher risk for unintended pregnancy in this setting.

Full article at:   http://goo.gl/kSzvbg

By:  Mayondi GK1, Wirth K2, Morroni C3,4,5, Moyo S6, Ajibola G7, Diseko M8, Sakoi M9, Magetse JD10, Moabi K11, Leidner J12, Makhema J13,14, Kammerer B15,16,Lockman S17,18,19.

• 1Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. gmayondi@bhp.org.bw.
• 2Harvard School of Public Health (http://www.hsph.harvard.edu/), Boston, MA, USA. kwirth@hsph.harvard.edu.
• 3EGA Institute for Women's Health/Institute for Global Health, University College London, 74 Huntley Street, WC1E 6AU, London, UK. chelseaamorroni@gmail.com.
• 4University of Botswana, Department of Public Health Medicine, University of Botswana Main Campus, Block 246, Gaborone, Botswana. chelseaamorroni@gmail.com.
• 5Botswana-UPenn Partnership, University of Botswana Main Campus, 244G, Gaborone, Botswana. chelseaamorroni@gmail.com.
• 6Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. smoyo@bhp.org.bw.
• 7Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. gajibola@bhp.org.bw.
• 8Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. mdiseko@bhp.org.bw.
• 9Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. msakoi@bhp.org.bw.
• 10Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. jmagetse@bhp.org.bw.
• 11Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. kmoabi@bhp.org.bw.
• 12Goodtables Data Consulting, 3101 Tisbury Rd., Norman, 73071, OK, USA. jeanleid@gmail.com.
• 13Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. jmakhema@bhp.org.bw.
• 14Harvard School of Public Health, Boston, MA, USA. jmakhema@bhp.org.bw.
• 15Boston Children's Hospital, Boston, MA, USA. Betsy.Kammerer@childrens.harvard.edu.
• 16Harvard Medical School, Boston, MA, USA. Betsy.Kammerer@childrens.harvard.edu.
• 17Botswana-Harvard AIDS Institute Partnership, Private Bag Bo 320, Gaborone, Botswana. slockman@hsph.harvard.edu.
• 18Harvard School of Public Health, Boston, MA, USA. slockman@hsph.harvard.edu.
• 19Brigham and Women's Hospital, 15 Francis Street, PBB 4A, Boston, 02115, MA, USA. slockman@hsph.harvard.edu. 
• BMC Public Health. 2016 Jan 16;16(1):44. doi: 10.1186/s12889-015-2498-3.

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Contraceptive Use in Women with Hypertension & Diabetes: Cross-Sectional Study in Northwest Ethiopia

Purpose

Women with diabetes and hypertension are at increased risk of pregnancy complications, including those from surgical delivery and their offspring are at risk for congenital anomalies. Thus, diabetic and hypertensive women of reproductive age are advised to use valid contraceptive methods for reducing unwanted pregnancy and its complications. However, contraceptive use among these segments of the population had not been previously assessed in Ethiopia. Hence, the aim of this study was to assess contraceptive use and associated factors among diabetic and hypertensive women of reproductive age on chronic follow-up care at University of Gondar and Felege Hiwot Hospitals.

Methods

Hospital-based cross-sectional study was conducted from April to May 2012 among diabetic and hypertensive women on follow-up at the chronic illness care center. The sample size calculated was 403. Structured and pretested questionnaire was used for data collection. Data were collected using interview supplemented by chart review. The data were entered using EPI info Version 2000 and analyzed using SPSS Version 16. Frequencies, proportion, and summary statistics were used to describe the study population in relation to relevant variables. Both bivariate and multivariate analyses were run to see the association of each independent variable with contraceptive practice.

Results

A total of 392 married women on chronic follow-up care were interviewed making the response rate of 93.3%. The contraceptive prevalence rate was found to be 53.8%. Factors such as age 25–34 years (adjusted odds ratio, AOR [95% confidence interval, CI] =3.60 [1.05–12.36]), (AOR [95% CI] =2.29 [1.15–4.53]), having middle- and high-level incomes (AOR [95% CI] =2.12 [1.19–3.77]), (AOR [95% CI] =5.03 [2.19–11.54]), receiving provider counseling (AOR [95% CI] =9.02 [4.40–18.49]), and controlled disease condition (AOR [95% CI] =4.13 [2.35–7.28]) were significantly associated with contraceptive practice.

Conclusion

The contraceptive utilization of women on diabetes and hypertension follow-up care was found to be low. Hence, strengthening counseling and education about family planning and controlling their medical conditions would help increase the contraceptive uptake of women on chronic follow-up.

Full article at:   http://goo.gl/tg64gS

By:   Tensae Tadesse Mekonnen,1 Solomon Meseret Woldeyohannes,2 and Tegbar Yigzaw3

¹Department of Midwifery, Tseda Health Science College, University of Gondar, Gondar, Ethiopia

²Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia

³Jhpiego-Ethiopia, Addis Ababa, Ethiopia

Correspondence: Tensae Tadesse Mekonnen, Department of Midwifery, Tseda Health Science College, PO Box 102, Gondar, Ethiopia, Tel/fax +251 5 8111 6221, Email moc.liamg@edatzamla

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