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Thesis (M.Sc. (Biostatistics))--Mahidol University, 1983.

Thesis (M.A.)--Georgia State University, 2006. / Title from title screen. Michael Bruner, committee chair; Merrill Morris, Marian Meyers, committee members. Electronic text (138 p.) : digital, PDF file. Description based on contents viewed July 19, 2007. Includes bibliographical references (p. 112-128).

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A hansenÃase acomete, principalmente, pessoas jovens em plena capacidade reprodutiva, que necessitam de cuidados no campo da anticoncepÃÃo, uma vez que a gestaÃÃo e a lactaÃÃo podem agravar o quadro clÃnico de mulheres e representar riscos para o bebÃ. Estabeleceu-se como objetivos descrever o perfil reprodutivo e o perfil da hansenÃase em um grupo de mulheres em idade fÃrtil; conhecer a prÃtica anticonceptiva do grupo pesquisado e sua adequabilidade com relaÃÃo à presenÃa da hansenÃase; avaliar o conhecimento de mulheres com hansenÃase sobre as particularidades do uso de MÃtodos Anticoncepcionais (MAC) relacionadas à patologia e sobre os riscos maternos e fetais associados à mesma; e verificar associaÃÃo estatÃstica entre o intervalo de tempo atà o diagnÃstico de hansenÃase e o Grau de Incapacidade FÃsica (GIF) apresentado pelas mulheres no momento do diagnÃstico; surgimento do diagnÃstico da hansenÃase com o perÃodo da gravidez e/ou lactaÃÃo e pÃs-parto imediato; e ser usuÃria de Anticoncepcional Hormonal Combinado e apresentar reaÃÃo hansÃnica. Tratou-se de estudo avaliativo, transversal, realizado com 200 mulheres com hansenÃase, em idade fÃrtil, acompanhadas no Centro de ReferÃncia Nacional em Dermatologia SanitÃria Dona LibÃnia de Fortaleza-CE. Os dados foram coletados de marÃo a outubro de 2011, por meio de entrevista e revisÃo de prontuÃrios. Para avaliar o conhecimento foram utilizadas escalas Likert. Foi realizada anÃlise estatÃstica descritiva utilizando freqÃÃncia absoluta e relativa, mÃdia, desvio padrÃo e intervalo de confianÃa, e anÃlise estatÃstica bivariada, sendo as associaÃÃes entre as variÃveis categÃricas verificadas por meio dos testes de Qui-Quadrado, Qui-Quadrado com correÃÃo de continuidade e Qui-Quadrado de tendÃncia. Para todas as anÃlises foram consideradas como estatisticamente significantes aquelas com p=0,05. O projeto de pesquisa foi submetido ao Comità de Ãtica em Pesquisa do local do estudo, segundo ResoluÃÃo n 196/96, aprovado conforme protocolo 012/2011, e as participantes assinaram o Termo de Consentimento Livre e Esclarecido. As mulheres apresentaram mÃdia de idade de 39 anos, predomÃnio de relacionamento com parceiro fixo, e renda per capita de R$ 170,74. Predominou a forma clÃnica dimorfa (86 â 43%), a poliquimioterapia multibacilar (111 â 55,5%) e o GIF zero no diagnÃstico (160 â 80%). O surgimento e/ou diagnÃstico de hansenÃase durante a gravidez ou lactaÃÃo dÃi afirmada por 50 (25%) mulheres, sendo que no perÃodo de fertilidade Ãtima (16 a 35 anos) foi afirmada por 31 (40,2%). Quanto à prÃtica anticoncepcional, 163 (81,5%) mulheres usavam algum MAC, sendo os mais citados laqueadura (71 â 43,5%), o anticoncepcional oral combinado (41 â 25,1%) e o preservativo masculino (30 â 18,4%); 58 (35,3%) faziam uso de MAC contra-indicado para sua condiÃÃo clÃnica. Predominou o nÃvel de conhecimento limitado (114 â 57%) na avaliaÃÃo sobre os riscos para o bebÃ, moderado (95 â 47,5%) na avaliaÃÃo sobre os risco para a mÃe, e limitado (107 â 53,5%) na avaliaÃÃo sobre o uso de MAC seguros. NÃo foi encontrada associaÃÃo estatÃstica significante entre o tempo atà o diagnÃstico e o GIF (p=0,0461), entre surgimento dos sinais e sintomas da hansenÃase ou diagnÃstico com gestaÃÃo/lactaÃÃo, sendo os valores de p= 0,335 e 0,871, respectivamente; e entre o uso de MAC hormonal combinado e o surgimento ou diagnÃstico de reaÃÃo hansÃnica (p=0,156). Concluiu-se que mulheres com hansenÃase necessitam de atenÃÃo anticoncepcional, com orientaÃÃo eficaz para os MAC indicados para sua condiÃÃo clÃnica, de modo a contribuir para o alcance do nÃvel de conhecimento extenso. Apesar do estudo nÃo ter revelado associaÃÃo estatÃstica significante entre gravidez/lactaÃÃo com o surgimento/diagnÃstico da hansenÃase, a busca de casos suspeitos em consultas de prÃ-natal, especialmente em Ãreas hiperendÃmicas, deve ser rotina na atenÃÃo bÃsica. / Leprosy affects mainly young people in their reproductive capacity, requiring care in the Field of contraception, as pregnancy and lactation may aggravate the clinical presentation of women and pose risks to the baby. The main objective was to describe the reproductive and leprosy profile in a group of women at childbearing age, to know the practice of contraceptive research group and the suitability for the presence of leprosy; to assess the knowledge of women with leprosy on the specifics of the use of Contraceptive Method (CM), and on maternal and fetal risks associated with it, and verifying statistical association between the interval until the diagnosis of leprosy and the Degree of Disability(DD) at diagnosis, onset/diagnosis of leprosy with the period of pregnancy/lactation and the immediate postpartum period, and be combined hormonal contraceptive user and present leprosy reaction. It was an evaluative study, cross-sectional, conducted with 220 women with leprosy at childbearing age, accompanied by the Center of Dermatology Dona LibÃnia, in Fortaleza, CearÃ. Data were collected from March to October 2011, through interview and records review. To assess the knowledge Likert scales were used. Descriptive statistical analysis was performed using absolute and relative frequency, mean, standard deviation and confidence intervals, and bivariate statistical analysis, and the associations between categorical variables were verified by the chi-square, chi-square with continuity correction and chi square trend. For all tests were considered statistically significant p =0.05. The research was submitted to the Ethics Committee of Center of Dermatology Dona LibÃnia, according to Resolution nÂ196/96, approved according to the protocol 012/2011 and participants signed a consent form. Women had a mean age of 39 years, predominantly in stable relationships, and per capita income of R$ 170.74. Boderline clinical forms predominated (86 â 43%), multibacilary multidrug therapy (111 â 55.5%) and zero degree of disability at diagnosis (160 â 80%). The onset/diagnosis of leprosy during pregnancy/lactation was affirmed by 50 (25%) women, and in the period of optimum fertility (16 to 35 years) was affirmed by 31 (40.2%). As to the contraceptionâs practice 163 (81.5%) women used a CM, the most cited was tubal ligation (71 â 43.5%), the combined oral contraceptive (41 â 25.1%) and male condom (30 â 18.4%), and 58 (35.3%) women were using a contraindicated CM for their condition. Limited knowledge level was predominated (114 â 57%) in the assessment of risks to the baby, moderate (95% - 47.5%) in the assessment of risks to the mother, and limited (107 â 53.5%) in assessment of safe use of CM. There was no statistically significant association between time to diagnosis and DD (p = 0.0461) between appearance of signs and symptoms of leprosy diagnosis with pregnancy or lactation, the values of p= 0.335 and 0.871, respectively, and between the use of combined hormonal contraceptive and the onset/diagnosis of leprosy reaction (p = 0.156). It was concluded that women with leprosy requires contraceptive care with effective guidance for the CM indicated for their condition to contribute to achieving the level of extensive knowledge. Although the study doesnât establish a statistically significant association between pregnancy/lactation with the onset/diagnosis of leprosy, the search for suspects in cases in prenatal consultations, especially in hyperendemic areas, should be a routine in primary care.

M.A. / In 1994 a landmark conference, the International Conference on Population and Development, took place during which the importance of family planning was clearly underlined. In spite of the importance with which this issue is viewed by health departments around the world seventy-five million unintended pregnancies occur around the world every year. Several factors may contribute to this multi-faceted problem. The difference between clients’ expected family planning services and the extent to which these clients’ expectations are met is one such factor. Improving family planning service delivery in line with clients’ expectations is essential to putting clients first. To do so, clients’ perspectives on family planning service delivery should be assessed. Whilst accompanying family planning students at the Johannesburg Metropolitan Health Department, the researcher encountered clients who expressed dissatisfaction with the lack of interpersonal skills and information provided by service providers. Despite the Department of Health’s policies that are in place for the provision of family planning services the researcher became aware of women who considered becoming family planning clients and would then discontinue utilising services because their expectations of the service delivery were not met.

Master of Public Health - MPH

M.Med. in Community Health, Faculty of Health Sciences, University of the Witwatersrand, 2011 / Introduction Three public health interventions well known to decrease the risks associated with pregnancy and child birth are access to maternity care, family planning and contraception, and safe abortion. Worldwide, the African region has the highest case fatality rate associated with unsafe abortion 750 per 100 000, largely as a result of restrictive abortion laws. South Africa (SA) legalised abortion in 1996 with the “Choice on Termination of Pregnancy” (CTOP) Act. It sought to improve the quality and access to termination of pregnancy (TOP) services in SA. Since its enactment there has been a 91% decrease in deaths due to unsafe abortions. There have been some experienced challenges associated with the implementation of the Act, limited number of functional TOP facilities, prolonged waiting times, and negative attitudes of TOP providers to clients. After more than a decade of liberalised law in SA, what are TOP providers’ perceptions, clients’ experiences and the overall quality of TOP services? Main Aim The evaluation of TOP services in the urban Johannesburg Metropolitan Municipality (JHB), Gauteng Province, and two rural municipalities Bela-Bela Municipality, Limpopo Province and Mangaung Municipality, Free State Province. Methodology A mixed methods approach was adopted; both quantitative and qualitative data were collected in three sections. Included were all primary health care facilities offering first trimester TOPs in the Johannesburg Metropolitan, Mangaung, and Bela-Bela Municipalities. Section I the analysis of district health information management system (DHIS) data for JHB. Section II, TOP providers and TOP clients completed self-administered questionnaires. Section III the TOP clients from JHB were questioned again after eighteen months. Various parametric and non-parametric tests were conducted on the data, based on the data distribution. The statistical software used for quantitative data analyses was Stata release 10.0 and qualitative data MAXQDA release 10.0. Results The DHIS showed a 61% increase in TOP requests from 2006 to 2009 (Chi-square for trend; P=0.08). The number of first trimester procedures performed only addressed 40% of total requests in 2006 and 33% of total requests in 2009. Section II demonstrated that all the TOP providers reported not coping with their duties, only two (15%) providers were comfortable with administering TOPs. One hundred and fifty-two TOP clients were recruited into the study. The mean age was 26.00 (±6.03) years. One hundred and sixteen (76%) women were not using contraception. Clients from JHB had prolonged waiting times 14 days (IQR; 6-28) compared to Bela-Bela clients’ 3 days (IQR; 1-6) (Post-hoc Wilcoxon- Ranksum; P<0.0001). Hence clients from JHB had TOPs at later median gestational ages of 9 weeks (IQR; 8-11) and Bela-Bela clients at 7.5 weeks (IQR;4-8) (Post-hoc Wilcoxon Ranksum; P<0.0001). Knowledge of the CTOP Act exceeded seventy percent across all three municipalities (Pearson Chi-square; P=0.83). Section III identified that 39% (n=9) of interviewed clients experienced a TOP-related complication. The odds of experiencing a complication was decreased if client received a follow-up appointment (OR 0.12; 95% CI 0.02-1.51; P=0.02), if client was aware of the CTOP Act (OR 0.11; 95% CI 0.01-2.08; P=0.06), and clients that had attended Lenasia South CHC had odds of complication 8 times higher than clients who had presented to Bophelong clinic (OR 8.68; 95% CI 3.47 -21.7; P<0.0001). The qualitative analysis identified themes of an association with intra-procedural pain and perceived inadequate counselling with those reporting emotional distress. Discussion The prevalence of contraceptive use during the month of conception was low, and the majority of clients were unaware of the correct gestational age for termination of pregnancy according to the CTOP Act. This suggests that the pre-TOP services required strengthening. The TOP services in the public sector may not to be addressing the number of TOP requests; this affects the availability of the service. TOP providers in different South African settings report similar challenges associated with delivering TOP services. The clients from JHB are waiting longer for the TOP and hence having the abortion at later gestational ages which are associated with increased complications rates. The study estimated a complication rate of approximately 26 per 100 abortion clients, higher than acceptable global rates which approximate 3 per 100. The improvement of pre and post-TOP counselling was highlighted. Conclusion This study introduces the importance of passive surveillance in improving the quality of service delivery. Though this is only achieved when data collected are analysed and used to inform policy and service. The studies conducted in South Africa since the CTOP Act enactment has demonstrated various challenges and areas for improvement. These findings have ensured that issues of public health importance continue to be studied and relevant findings disseminated to stakeholders for and consideration and action where appropriate.

Fertility awareness-based methods or natural family planning methods are an effective means of family planning that is seldom recommended by the medical community. After a review of literature it is concluded that such methods empower women and couples, that there is a need for a referral system and natural family planning clinics, and a need for a standardized fertility consultant license. Furthermore, such methods have been highly effective family planning tools in third world countries with limited access to contraceptives. Research on provider attitudes is scarce and further study is required, considering some women cannot or will not utilize mechanical or barrier methods of contraception.

The purpose of this research was to examine the implementation of Georgia's Medicaid family planning program, known as Planning for Healthy Babies or P4HB. This program is the first such program to provide both family planning services and inter-pregnancy care services through a Medicaid expansion to low-income, uninsured women. An evaluative case study design was employed using mixed methods. These methods incorporated process measures to study the implementation of P4HB and to assess whether P4HB was implemented as planned We incorporated theory from the policy implementation and health care access literatures to understand what served as facilitators or barriers to successful implementation. Findings suggest that despite precise goals and objectives, formal guidance about the program did not incorporate clear implementation planning. Many stakeholders, including advocates, providers, and representatives from implementing agencies felt left out of the implementation process and did not feel invested in the program. Considerable confusion existed among eligible clients and providers about the nature and scope of the P4HB program. This lack of awareness and understanding about P4HB likely contributed to the program's low enrollment and participation in the first year of its implementation. As many states prepare to expand their Medicaid programs under the Patient Protection and Affordable Care Act (ACA), this study provides important lessons for policy planning and implementation.