Thoai D. Ngo

Comparative effectiveness, safety and acceptability of medical abortion at home and in a clinic: a systematic review

OBJECTIVE To compare medical abortion practised at home and in clinics in terms of effectiveness, safety and acceptability. METHODS A systematic search for randomized controlled trials and prospective cohort studies comparing home-based and clinic-based medical abortion was conducted. The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE and Popline were searched. Failure to abort completely, side-effects and acceptability were the main outcomes of interest. Odds ratios and their 95% confidence intervals (CIs) were calculated. Estimates were pooled using a random-effects model. FINDINGS Nine studies met the inclusion criteria (n = 4522 participants). All were prospective cohort studies that used mifepristone and misoprostol to induce abortion. Complete abortion was achieved by 86-97% of the women who underwent home-based abortion (n = 3478) and by 80-99% of those who underwent clinic-based abortion (n = 1044). Pooled analyses from all studies revealed no difference in complete abortion rates between groups (odds ratio = 0.8; 95% CI: 0.5-1.5). Serious complications from abortion were rare. Pain and vomiting lasted 0.3 days longer among women who took misoprostol at home rather than in clinic. Women who chose home-based medical abortion were more likely to be satisfied, to choose the method again and to recommend it to a friend than women who opted for medical abortion in a clinic. CONCLUSION Home-based abortion is safe under the conditions in place in the included studies. Prospective cohort studies have shown no differences in effectiveness or acceptability between home-based and clinic-based medical abortion across countries.

Mobile Technology for Improved Family Planning (MOTIF): the development of a mobile phone-based (mHealth) intervention to support post-abortion family planning (PAFP) in Cambodia.

BackgroundThe objective of this paper is to outline the formative research process used to develop the MOTIF mobile phone-based (mHealth) intervention to support post-abortion family planning in Cambodia.MethodsThe formative research process involved literature reviews, interviews and focus group discussions with clients, and consultation with clinicians and organisations implementing mHealth activities in Cambodia. This process led to the development of a conceptual framework and the intervention.ResultsKey findings from the formative research included identification of the main reasons for non-use of contraception and patterns of mobile phone use in Cambodia. We drew on components of existing interventions and behaviour change theory to develop a conceptual framework. A multi-faceted voice-based intervention was designed to address health concerns and other key determinants of contraception use.ConclusionsFormative research was essential in order to develop an appropriate mHealth intervention to support post-abortion contraception in Cambodia. Each component of the formative research contributed to the final intervention design.

Herpes Simplex Virus Type 2 Infection among Commercial Sex Workers in Kunming, Yunnan Province, China

A cross-sectional survey was conducted to determine the sociodemographic correlates of herpes simplex virus type 2 (HSV-2) infection among male and female commercial sex workers in Kunming, Yunnan Province of China. HSV-2 prevalence was 33.0%, human immunodeficiency virus (HIV) infection was 2.4% and hepatitis C virus (HCV) infection was 6.8%. Subjects who were positive for HSV-2 had a significantly higher prevalence of HIV infection (5.5% versus 0.9%, P = 0.002; odds ratio [OR]: 6.4, P = 0.006) and HCV infection (18.7% versus 2.4%, P < 0.001; OR: 7.6, P < 0.001) compared with HSV-2-negative individuals. Risk factors that increased the odds of HSV-2 infection were HIV infection, HCV infection, being female, and having a steady sex partner within the last six months (P ≤ 0.01). In a multivariate analysis, being female (OR: 6.6, P < 0.001), having HCV infection (OR: 5.9, P < 0.001) and having a sex partner within the last six months (OR: 2.2, P < 0.05) showed greater odds of being infected with HSV-2. A strong relationship was found between HSV-2, HIV and HCV infections.

Safety and effectiveness of termination services performed by doctors versus midlevel providers: a systematic review and analysis.

Objective Training midlevel providers (MLPs) to conduct surgical abortions and manage medical abortions has been proposed as a way to increase women’s access to safe abortion. This paper reviews the evidence that compares the effectiveness and safety of abortion procedures administered by MLPs versus doctors. Methods A systematic search was conducted of published trials and comparison studies assessing the effectiveness and/or safety of abortion provided by MLPs compared to doctors. The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, and Popline were searched. The primary outcomes of interest were: (1) incomplete or failed abortion; and (2) measures of safety (adverse events and complications) of abortion procedures administered by MLPs and doctors. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated for each study. Data were synthesized in a narrative fashion. Findings Five studies were included in this review (n = 8539 women), comprising two randomized controlled trials (RCTs) (n = 3821) and three prospective cohort studies (n = 4718). In total, 4198 women underwent a procedure administered by an MLP, and 4341 women underwent a physician-administered procedure. Studies took place in the US, Nepal, South Africa, Vietnam, and India. Four studies used surgical abortion with maximum gestational ages ranging from 10 to 16+ weeks, while a medical abortion study had gestational ages up to 9 weeks. In RCTs, the effect estimates for incomplete or failed abortion for procedures performed by MLPs compared with doctors were OR = 2.00 (95% CI 0.85–4.68) for surgical abortion, and OR = 0.69 (95% CI 0.34–1.37) for medical abortion. Complications were rare among both provider types (1.2%–3.1%; OR = 1.80, 95% CI 0.83–3.90 for surgical abortions), and no deaths were reported. Conclusion There were no statistical differences in incomplete abortion and complications for first trimester surgical and medical abortion up to 9 weeks performed by MLPs compared with physicians. Further studies are required to establish more precise effect estimates.

Levels and determinants of switching following intrauterine device discontinuation in 14 developing countries

OBJECTIVE To examine the levels and determinants of switching to any reversible modern contraceptive method following intrauterine device (IUD) discontinuation due to method-related reasons among women in developing countries. STUDY DESIGN We analysed 5-year contraceptive calendar data from 14 Demographic and Health Surveys, conducted in 1993-2008 (n=218,092 women; 17,151 women contributed a total of 18,485 IUD episodes). Life-table methods were used to determine overall and cause-specific probabilities of IUD discontinuation at 12 months of use. For IUD episodes discontinued due to method-related reasons, the probability of switching to another reversible modern method within 3 months was estimated, overall and by place of residence, education level, motivation for use, age category and wealth tertiles. Country-specific rate ratios (RR) were estimated using generalized linear models, and pooled RRs using meta-analyses. RESULTS The median duration of uninterrupted IUD use was 37 months. At 12 months, median probability of discontinuation was 13.2% and median probability of discontinuation due to method-related reasons was 8.9%. Within 3 months of discontinuation due to method-related reasons, half of the women had switched to another reversible modern method, 12% switched to traditional methods, 12% became pregnant, and 25% remained at risk for pregnancy. More educated women were more likely to switch to another reversible modern method than women with primary education or less (pooled RR 1.47; 95% CI 1.10-1.96), as were women in the highest wealth tertile (pooled RR 1.38; 95% CI 1.04-1.83) and women who were limiting births (pooled RR 1.35; 95% CI 1.08-1.68). CONCLUSION Delays to switching and switching to less reliable methods following IUD discontinuation remain a problem, exposing women to the risk of unwanted pregnancy. Family planning programmes should aim to improve quality of services through strengthening of counselling and follow-up services to support womens continuation of effective methods. IMPLICATIONS The risk of unintended pregnancy following IUD discontinuation remains high in developing countries. The quality of family planning services may be an important factor in switching to alternative modern contraceptive methods. Service providers should focus on counselling services and follow-up of women to support the continued use of effective methods.

Availability and provision of misoprostol and other medicines for menstrual regulation among pharmacies in Bangladesh via mystery client survey

To explore the availability and provision of misoprostol and other medicines for menstrual regulation (MR) among pharmacies in Bangladesh.

Male circumcision uptake, postoperative complications, and satisfaction associated with mid-level providers in rural Kenya

Objective The purpose of this study was to assess postoperative complications and patient satisfaction associated with mid-level provision of male circumcision in rural Kenya. Methods A prospective cohort study was conducted among children, adolescents, and adult men undergoing male circumcision from September 1, 2008 to December 4, 2008 at Marie Stopes International Kenya mobile outreach sites located in eight districts in the Nyanza and Western Provinces, Kenya. Male circumcision procedures were performed by registered nurses, surgical technicians, or nurse aides. Postoperative follow-up visits took place on the day of the procedure and at postoperative days 3, 7, and 30, with additional visits as necessary. Data on adverse events, healing conditions, satisfaction level, and resumption of activities were assessed at each follow-up visit. Results A total of 285 individuals were screened, and 240 underwent male circumcision procedures. All procedures were performed using the guided forceps technique by mid-level providers. At the first follow-up visit (postoperative day 3), 5.8% (n = 14) individuals did not return for post-surgical assessment. Retention rates at the second (day 7) and third (day 30) follow-up visits were 91.3% (n = 219) and 84.6% (n = 203), respectively. The prevalence of complications (moderate and severe adverse events) was 1.3% (3/240). At the first and second follow-up visits, 91.7% of patients (n = 220) were capable of resuming their daily activities, and 100% by day 30. The majority of patients (>99%) were satisfied with the procedure, counseling, and information received. Conclusion Male circumcisions can be delivered safely and successfully by mid-level providers in rural settings with high client satisfaction, thereby increasing access to human immunodeficiency virus prevention services in Kenya.

Vouchers for family planning and sexual and reproductive health services: A review of voucher programs involving Marie Stopes International among 11 Asian and African countries

To evaluate provision of vouchers for family planning and sexual and reproductive health (SRH) services.

Pharmacy workers’ knowledge and provision of abortifacients in Ho Chi Minh City, Vietnam

⁎ Corresponding author at: Research and Metrics Team Health System Department, Marie Stopes International, 1 Conway Street, London, W1T 6LP, UK. Tel.: +44 20 7034 2352; fax: +44 20 7034 2372. E-mail address: Thoai.Ngo@mariestopes.org (T.D. Ngo). Table 1 Details from the records of 52 rape survivors attending the gynecological emergency department of North Bengal Medical College, Darjeeling, India, between 2005 and 2010.

Use of Commercial Enzyme Immunoassays To Detect Antibodies to the Herpes Simplex Virus Type 2 Glycoprotein G in a Low-Risk Population in Hanoi, Vietnam

ABSTRACT Sera from 1,238 Vietnamese women in Hanoi were tested for herpes simplex virus type 2 (HSV-2). HSV-2 prevalence was 2.0%. The Kalon and Biokit assays showed significantly higher concordance to Western blotting data than did the Focus assay (P < 0.01). Screening by Focus and then retesting with Kalon/Biokit of positive samples can reduce falsely positive results significantly (P < 0.01).