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BACKGROUND: There is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of coronavirus disease 2019 (COVID-19). To address this gap, our team organized a multicountry, cross-sectional online survey as part of a global consortium. METHODS: Consortium research teams conducted online surveys in 30 countries. Sampling methods included convenience, online panels, and population-representative. Primary outcomes included sexual behaviors, partner violence, and SRH service use, and we compared 3 months prior to and during policy measures to mitigate COVID-19. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence. RESULTS: Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%), and 640 (14.1%) reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063 of 15 144, 7.0%) compared to before COVID-19 measures (1469 of 15 887, 9.3%). COVID-19 measures impeded access to condoms (933 of 10 790, 8.7%), contraceptives (610 of 8175, 7.5%), and human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing (750 of 1965, 30.7%). Pooled estimates from meta-analysis indicate that during COVID-19 measures, 32.3% (95% confidence interval [CI], 23.9%-42.1%) of people needing HIV/STI testing had hindered access, 4.4% (95% CI, 3.4%-5.4%) experienced partner violence, and 5.8% (95% CI, 5.4%-8.2%) decreased casual partner condom use (moderate certainty of evidence for each outcome). Meta-analysis findings were robust in sensitivity analyses that examined country income level, sample size, and sampling strategy. CONCLUSIONS: Open science methods are feasible to organize research studies as part of emergency responses. The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings., SCOPUS: ar.j, info:eu-repo/semantics/published

SCOPUS: ar.j, info:eu-repo/semantics/published

BACKGROUND: There is limited evidence to date about changes to sexual and reproductive health (SRH) during the initial wave of COVID-19 disease. To address this gap, our team organized a multi-country, cross-sectional online survey as part of a global consortium.METHODS: Consortium research teams conducted online surveys in 30 countries. Sampling methods included convenience, online panels, and population-representative. Primary outcomes included sexual behaviors, partner violence, and SRH service utilization, and we compared three months prior to and during policy measures to mitigate COVID-19. We conducted meta-analyses for primary outcomes and graded the certainty of the evidence using Cochrane methods.RESULTS: Among 4546 respondents with casual partners, condom use stayed the same for 3374 (74.4%) people and 640 (14.1%) people reported a decline. Fewer respondents reported physical or sexual partner violence during COVID-19 measures (1063/15144, 7.0%) compared to the period before COVID-19 measures (1469/15887, 9.3%). COVID-19 measures impeded access to condoms (933/10790, 8.7%), contraceptives (610/8175, 7.5%), and HIV/STI testing (750/1965, 30.7%). Pooled estimates from meta-analysis indicate during COVID-19 measures, 32.3% (95% CI 23.9-42.1) of people needing HIV/STI testing had hindered access, 4.4% (95% CI 3.4-5.4) experienced partner violence, and 5.8% (95% CI 5.4-8.2) decreased casual partner condom use (moderate certainty of evidence for each outcome). Meta-analysis findings were robust in sensitivity analyses that examined country income level, sample size, and sampling strategy.CONCLUSIONS: Open science methods are feasible to organize research studies as part of emergency responses. The initial COVID-19 wave impacted SRH behaviors and access to services across diverse global settings.

En 2008, le ministère de la Santé marocain a mis en place une stratégie pour accélérer la réduction de la mortalité maternelle. Le système de surveillance des décès maternels (SSDM) était l’un des leviers de cette stratégie. L’objectif de ma thèse était de mieux comprendre le processus d’implantation et d’utilisation du SSDM afin de tirer des leçons utiles pour améliorer sa performance au Maroc et dans d’autres pays similaires. METHODOLOGIE: Une première étude observationnelle analytique nationale sur la mortalité des femmes en âge de reproduction en 2009 a décrit le processus de développement et d’implantation du SSDM et analysé les causes et les facteurs associés aux décès maternels. Une deuxième étude en 2013-2014 dans une région a mesuré la complétude du SSDM et expliqué les écarts entre le nombre mesuré et celui estimé. Une troisième étude qualitative en 2017 a évalué le niveau d’implantation du SSDM dans l’ensemble des régions du Royaume et a analysé les facteurs qui influençaient sa mise en œuvre et son utilisation pour la prise de décision sur la base du « Consolidated Framework for Implementation Research ». RESULTATS ET DISCUSSION: En 2009, le SSDM a identifié 436 décès liés à la grossesse ;303 cas étaient de cause maternelle. Plus de trois quarts des décès sont survenus dans la période du postpartum, dans un hôpital public ou lors du transfert entre les structures de soins de santé. Les hémorragies étaient la première cause de mortalité maternelle. Plus de la moitié des femmes auraient pu être sauvées si des mesures avaient été prises à l’hôpital. L’étude de 2013-2014 a montré que non seulement la quasi-totalité des décès maternels à domicile et des décès tardifs n’était pas notifiée, mais aussi que la sous-notification concernait des décès de causes obstétricales directes dans les hôpitaux. En 2017, le SSDM n’était plus opérationnel dans quatre régions. Les comités régionaux d’audit confidentiel ne se réunissaient plus dans quatre autres régions. Dans hu, Doctorat en Sciences de la santé Publique, info:eu-repo/semantics/nonPublished

Dans cette thèse de doctorat, les perceptions et les expériences des pères africains pour la première fois concernant leur implication dans la grossesse, l'accouchement et la parentalité précoce ont été explorées dans deux contextes :le sud-est du Nigeria et la Belgique. Les objectifs de l'étude au Nigéria étaient (a) d'examiner les perceptions et les besoins des pères pour la première fois concernant la grossesse et l'accouchement et (b) de mieux comprendre l'implication des pères africains pour la première fois dans la grossesse, l'accouchement et la garde des enfants. Pour faire cela, une étude qualitative descriptive a été menée. Des entretiens semi-structurés avec 50 hommes recrutés sur des lieux de travail ruraux et urbains, des hôpitaux et des marchés ont généré des données qui ont été analysées à l'aide de la technique d'analyse thématique de Braun & Clarke. Ces analyses ont révélé que le manque d'information empêchait les pères d'apporter le soutien dont leur conjointe enceinte avait besoin. De plus, les perceptions culturelles des rôles de genre ont influencé le soutien fourni par les pères pour la première fois à leurs épouses ainsi que le soutien qu'ils ont reçu de leurs réseaux de soutien social. Les nouveaux pères ont identifié le besoin d'être informé et le besoin de connaître le coût des soins dans les établissements de santé comme des besoins primaires. De plus, cette étude explore les « émotions » des pères pour la première fois, ce qui n'est pas un domaine de recherche commun, en particulier dans les études menées dans des contextes patriarcaux. À partir de ce travail, nous pensons que les interventions de santé axées sur l'augmentation des connaissances informationnelles des pères pour la première fois encourageront leur implication et, en fin de compte, amélioreront les résultats des naissances au Nigeria.Lors de la réalisation de cette étude au Nigéria, nous avons rencontré des défis contextuels qui ont eu un impact sur l'exécution en temps opp, In this PhD thesis, the perceptions, and experiences of African first-time fathers regarding their involvement in pregnancy, childbirth and early parenting were explored in two settings: Southeast Nigeria and Belgium.The aims of the study in Nigeria were (a) to examine the perceptions and needs of first-time fathers regarding pregnancy and childbirth and (b) to better understand African first-time fathers’ involvement in pregnancy, childbirth, and childcare. To achieve this, a descriptive qualitative study was conducted. Semi-structured interviews with 50 men recruited from both rural and urban workplaces, hospitals, and markets generated data that were analysed using Braun & Clarke’s thematic analysis technique. These analyses revealed that lack of information hindered the fathers from providing the support their pregnant spouses needed. Furthermore, the cultural perceptions of gender roles influenced the support provided by first-time fathers to their spouses as well as the support they received from their social support networks. First-time fathers identified the need to be informed and the need to know about the cost of care in health settings as primary needs. Additionally, this study explores the ‘emotions’ of first-time fathers, which is not common research area, especially in studies from patriarchal settings. From this work, we believe that health interventions focused on increasing the informational knowledge of first-time fathers will encourage their involvement and ultimately improve birth outcomes in Nigeria.While conducting this study in Nigeria, we experienced contextual challenges that impacted the timely execution of our work in the data collection phase. Therefore, this thesis contains ‘lessons learned’ on male recruitment and interviewing in patriarchal settings. These reflections shed light on the influence of ‘who you know’ in negotiating one’s way while conducting fieldwork in African contexts and highlight the crucial role of gatekeepers in ga, Doctorat en Santé Publique, info:eu-repo/semantics/nonPublished

With cancer accounting for 19% of deaths and projected to rise in the coming years, Ecuador’s inequities in healthcare coverage remain a major concern for the rural, indigenous populations. While the cancer burden among this vulnerable population has been much publicized in the context of the controversial oil extraction in the Amazon, there is contradictory evidence on its occurrence and determinants. This review critically discusses the available literature on cancer among indigenous people in Ecuador and explores the link between oil exploitation and cancer occurrence among indigenous people using a scoping review approach. The results of this review show there is a clear but inconsistent association between oil exposure and cancer risk in indigenous populations of Ecuador. While the environmental magnitude of oil extraction in this region is a topic of debate, our findings point to the interplay with social determinants and other sources of carcinogenic compounds, which exacerbates the risks faced by indigenous communities. Based on these findings, this study puts forward three arguments to contextualize the occurrence of cancer related to oil exploitation in the Amazon, and puts forth key recommendations for public health initiatives embedded within the local community., SCOPUS: re.j, info:eu-repo/semantics/published

Background: HIV services were inevitably disrupted and affected due to COVID-19. There are many challenges in implementing appropriate HIV services, particularly in the provision of health care and the link between people living with HIV/AIDS and retention in care. The study investigated the impact of COVID-19 on HIV services and the anticipated benefit of the COVID-19 vaccination on HIV service restoration in North Shewa, Oromia, Ethiopia. Methods: A qualitative descriptive study approach was used to explore how healthcare delivery evolved during the outbreak of COVID-19 in Ethiopia. Sixteen antiretroviral therapy (ART) clinics were selected from 13 districts and one administrative town in Ethiopia. From them, 32 ART providers were purposively selected based on their experience in ART provision. Data were collected from June to July 2021 using in-depth interviews. A thematic analysis approach was used to analyze the data, based on themes and subthemes emerging from the data. ATLAS.ti software was used for coding. Results: Healthcare for people living with HIV was interrupted due to the COVID-19 pandemic. Medical appointments, HIV testing and counseling services, opportunistic infection treatment, medicine supply, and routine viral load and CD4 T-cell count tests were interrupted. Due to a shortage of healthcare staff, outreach testing services and home index testing were discontinued and HIV testing was limited only to hospitals and health centers. This has substantially affected accessibility to HIV testing and reduced the quality of HIV service delivery. Telehealth and less frequent visits to health facilities were used as alternative ways of delivering HIV services. The COVID-19 vaccination campaign is expected to restore healthcare services. Vaccination may also increase the confidence of healthcare providers by changing their attitudes toward COVID-19. Conclusions: The COVID-19 pandemic has substantially impacted HIV services and reduced the quality of HIV car, SCOPUS: ar.j, info:eu-repo/semantics/published

SCOPUS: no.j, info:eu-repo/semantics/published