Thesis (M.S.)--University of Michigan, 1989.

Thesis (M.S.)--University of Michigan, 1989.

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ABSTRACT This study is the first of a series of community-based surveys that the City of Tshwane Metropolitan Municipality (CTMM) has planned to conduct in the next 15 years to fulfill its provincial mandate (being the provider of primary health care services) in accordance with the Gauteng District Health Services Act (Act No 8 of 2000)1. The study determined the prevalence rate of contraceptive use and method choice, and the effects of the availability of reproductive health services on contraceptive use and method choice in the CTMM in 2004. The study used a descriptive cross-sectional population-based study design and a sample of 3, 547 women of childbearing age (15-49 years) using a multi-stage cluster sampling with probability proportional to size to determine these effects. A modified 1998 SADHS questionnaire helped to collect information on selected individuals, programmes and district explanatory variables from women living in the four health sub-districts and data were used in three B (4 variables), C (six variables) and D (eight variables) unconditional binary logistic regression models and a multinomial logistic model to estimate their effects (odds ratios and pvalue at 5% level) on contraceptive use and method choice. The selection of these variables is based on the conceptual framework that recognizes that contraceptive use or method choice is the consequence of service utilization, which, in turn, is influenced by individual, service/programme and community factors2,3. The availability of reproductive health services was measured by the presence or absence of the supply source of contraceptive methods in a district. After controlling for the effects of individual (social and demographic) variables, none of the programmatic variables was independently associated with contraceptive use. By contrast, district/place of residence predictor was associated with reduced odds of contraceptive use and with reduced odds of condom, injection and IUD’s choice against pill in all the models and districts, respectively. In terms of the source of first information on contraceptive methods and the differences between IUD and injection, the study shows that nurses (odds ratio, 1.80, p<0.05) are more likely than mothers to be the providers of information on IUD while physicians (odds ratio, 0.65, p<0.05) are shown to be less likely than mothers to be the providers of information on injection as opposed to the pill. The private sector ( odds ratio, 2.12, p<0.01) is shown to be more likely than the public sector to be the supply source of IUD methods rather than the pill, and also more likely (odds ratio, 1.97, p<0.01) than the public sector to be the supply source of IUD instead of injection. Private pharmacies (odds ratio, 2.25, p<0.05) are more likely than the public sector to supply condoms rather than the pill. The presence or absence of reproductive health services in a district was significantly associated with reduced odds of both contraceptive use and choice of condom, injection and IUD methods against pill. This may be attributable to women’s willingness to travel outside their place of residence to get their preferred method. Thus availability of reproductive health services in the district seems not to have an important effect on use and choice of modern contraception in the City of Tshwane in 2004.

Background Religion is widely known to affect the acceptance of modern contraception among people, thus affecting their reproductive behavioural outcomes in sub-Saharan Africa. The significance of religion on the use of contraceptives has been currently neglected in SSA. Fertility transitions have been widely attributed to the increased use of contraceptives among women worldwide. Given that religion plays an important role in post-colonial Kenya, this study examined the differentials in contraceptive use by religious affiliation as well as the demographic and socio-economic factors that affect the use of contraceptives in Kenya. Methodology The study obtained data from the Kenyan Demographic and Health Survey (KDHS, 2008-2009) that uses a national cross sectional study design. The study population was women of reproductive ages (15-49 years) who were sexually active and the sample size was 4, 207. This study made use of descriptive statistics, chi-square tests and logistic regression. Results Religious affiliation is a significant predictor of contraceptive use in Kenya. Muslims were 51% less likely to use modern methods of contraceptives compared to Christians. There was no significant difference in the use of contraceptives among Roman Catholics and Protestants. Demographic and socio-economic factors - specifically age, education, number of living children, fertility intention, wealth and marital status - were significantly associated with the use of modern methods of contraceptives. Conclusion Religious affiliation affects the use of contraceptives and plays a vital role in the reproductive behaviours of women in Kenya. The low levels of contraceptive use among Muslims are accounted for by their low socio-economic characteristics in addition to Islam’s pro-natal doctrine. The lack of contraceptive use differentials among Roman Catholics and Protestants is as a result of their similar socio-economic characteristics, regardless of Roman Catholics pro-natal doctrine. Thus, a frontier for further study is to examine how religious involvement affects contraceptive use in addition to religious affiliation.

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No description available.

Background Adult females recently diagnosed HIV positive fall pregnant soon after diagnosis in John Taolo Gaetsewe Health District. They usually claim ignorant of or say they forgot to take their pills and that lead to their getting pregnant. Considering the health implication of pregnancy on the general health outlook of HIV positive females and risk of mother to child transmission of HIV, that motivated this study. Aim and Objectives To study the contraceptive knowledge, attitude and practices amongst adult HIV positive females in John Taolo Gaetsewe Health District. The objectives are; 1. To evaluate contraceptive knowledge, perceptions and practices amongst patients presenting for contraception 2. To find out the reasons for use and non use of contraceptives by patients 3. To determine choices of contraceptive methods, use of emmergency contraception and barrier contraception such as condoms. Methods Study design: A cross sectional descriptive study focused on determining the contraceptive knowldge, attitude and practices of adult HIV positive females between the ages of 18 and 49 were selected for the study. Approval for the study was obtained from the Ethics Committee University of Stellenbosch with reference number N11/04/123, and the Northern Cape Department of Health. The study was carried out between June 2011 and July 2011. The questionnaire was designed based on a publication cited on contraceptive practices of women in Northern Tshwane. Setting: The study was conducted in the ARV clinics of the Kuruman and Tshwaragano districts hospitals and the four community health centres in the John Taolo Gaetsewe Health District. This district is a predominantly rural district. Results: Data was provided by 224 participants who fullfiled the inclusion criteria. The knowledge about condom ranked highest(100%) followed by injectibles(94%), oral contraceptive pills(87%), female sterilization(66%) and emmergency contraception(51%). IUCD is the method that is least known(3%).Nurses are the major source of information about contraceptives(89%) while the educator give the least information to participants on contraceptives(40%). 100% of participants had access to oral contraceptive pills and injectibles at their local clinics while the method that was least accessible are IUCD(2%) and hormonal implants(0%). There was a 100% positive perception of injectibles, 74% to female sterilization 67% for morning after pill and 61% to oral contarecptive pills while male sterilization had a positive perception of 12% and IUCD (8%). Availability of contraceptives influenced choice of contraceptives as participants used available methods at the clinic which were condoms, injectibles, oral contraceptives and female sterilization. Partners of participants and tradition also influenced use while non use was mainly because participant wanted to fall pregnant(22%), side effects(6%) and tuberculosis(1%). Conclusion This study revealed that participants had very good knowledge and positive perception about the readily available contraceptive methods at the local clinics. This was true as 100% were well informed about condoms, 94% about injectibles and 87% about oral contracetive pills. At clinics in John Taolo Gaetsewe health District the three methods of contraceptive mentioned above were what you find readily available. 51% of partcipants were also well informed about emmergency contraception this showed the level of awareness in this area on emmergency contraception despite their low level of education . The study revealed that partners of participants and traditional healer had impact on contraceptive use, while getting pregnant topped the list on reasons why contraceptive was discontinued. Parents, teachers and the media should get more involved in the enlightenment campaign about contraceptive as it will help protect women from unplanned pregnancies.

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PhD,School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand / Tissue specific regulation of the progesterone receptor is central to female health. The synthetic steroid, RU486 is a partial progesterone and oestrogen receptor antagonist, functioning to actively silence progesterone receptor gene associated transcription. For this reason, it has been used both as a contraceptive and quite controversially as an abortive agent. In this study, both cellular and gene specific effects of RU486 were investigated in a rat model of early pregnancy, this including the key phases of the plasma membrane transformation, the window of receptivity and early implantation. As all of these stages are hormonally regulated by progesterone and oestrogen, the focus here was to elucidate the mechanisms of action of a single dose of RU486, used as a postcoital contraceptive, at day 3.0 of pregnancy, to successfully prevent implantation of a viable blastocyst and subsequent pregnancy. In association with the cellular preparation of uterine epithelial cells for implantation, selected molecular targets and events were investigated at a protein and gene expression level, both prior to and after RU486 treatment, to assess the effects of either a deficit or excessive expression of these gene products on uterine preparation and eventual implantation. Factors here included the progesterone receptor, markers of apoptosis (Bax and Bcl2), mediators of angiogenesis (VEGF, bFGF and PDGF) and biomarkers of endometrial implantation (LIF, Calcitonin and Muc-1). Together, an ultrastructural and light microscopy analysis showed RU486 to morphologically alter the uterine endometrial cells and to disrupt the plasma membrane transformation of early pregnancy, predisposing these cells towards apoptosis. In association with this, progesterone receptor gene and protein expression was ubiquitously decreased throughout pregnancy. With regards to the implantation process of early pregnancy, the luminal epithelial cells undergo apoptosis to allow the hatching blastocyst to penetrate and implant within the uterine wall. This is partially mediated by the ratio of the expression of the apoptotic factors Bax and Bcl-2. Surprisingly here, RU486 caused an overall anti-apoptotic environment, despite previously observed high levels of apoptotic activity. This indicates that factors other than Bax and Bcl-2 influence the RU486-induced apoptosis. A crucial event of early pregnancy is the establishment of an adequate blood supply to sustain and nourish the implanting blastocyst. There was a decided reduction in the angiogenic response of early pregnancy, as a direct consequence of RU486 treatment; the normally high levels of VEGF and bFGF during early pregnancy, were markedly decreased at all three days of pregnancy. This was reflected in the lack of increased vascularisation as normally signalled by the indicator dye, Pontamine Sky blue. In contrast to the overall increase in VEGF and bFGF at the time of blastocyst implantation during early pregnancy, increased PDGF expression was localised to the implantation sites, strongly suggesting a role for this angiogenic factor in endothelial cell proliferation. v The endometrial biomarkers are indicative of implantation, their expression patterns varying around the phase of implantation. These markers are essential to implantation, as when LIF and Calcitonin are deregulated and Muc-1 persists on the apical surface of the endometrium, implantation fails. These events are precisely what occur following RU486 treatment. In summary, the overall effects of RU486 in the rat model of early pregnancy, when used as a postcoital contraceptive, indicate highly effective inhibition of progesterone and oestrogen effects on the endometrium, mediated by their receptors. More specifically, the structural and molecular events mirror those described in ovariectomised animal models, suggesting a hormonally under-stimulated endometrium. Clearly from the present study, the precise priming of the endometrium in preparation for blastocyst implantation is severely impaired by RU486 through a number of signalling pathways, thus predisposing the uterus to pregnancy failure.