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OBJECTIVE: Evidence on the association between client-provider interaction (CPI) and contraceptive continuation has been mixed. This paper attempts to unravel the puzzle by examining various factors that may have contributed to the mixed results. METHODS: This paper critically reviews key studies that examined the association between CPI and contraceptive continuation. A scan of peer reviewed publications and project reports was undertaken with a focus on CPI and contraceptive continuation. In addition, a review of key studies that examined the impact of interventions to improve CPI in compliance with medical regimens was carried out. RESULTS: The inconsistency of results may be attributed to methodological factors, characteristics of interventions to improve CPI, or conceptual factors related to the complexity of the issue of contraceptive continuation. CONCLUSION: More rigorous research is needed to understand the role played by CPI in contraceptive continuation as well as socio-demographic, behavioral and contextual factors that moderate the relationship between CPI and contraceptive continuation. PRACTICE IMPLICATIONS: Counseling services should be expanded to address physical, social and emotional needs of continuing clients. Moreover, interventions to improve CPI should also address contextual and health system factors that prevent clients from using family planning consistently and effectively. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has been noted to decrease access to maternal health and family planning services globally. However, evidence from the Middle East and North Africa region is very scarce and limited. We qualitatively explored women's experiences in accessing maternal health and family planning services during the COVID-19 lockdown months in the two Egyptian governorates of Port Said and Souhag., Methods: Using a case study design, semi-structured phone interviews were conducted with a total of 40 women aged 18-35 years from Port Said and Souhag governorates in Egypt. Interviews explored women's experiences in accessing maternal health and family planning services during COVID-19 lockdown months, their coping strategies, and impact of challenges and/or coping strategies on participants and their families. The collected data was analyzed manually using qualitative thematic analysis., Results: Many participants were unable to access maternal health and family planning services during COVID-19 lockdown due to fear of contracting the virus, closure of health facilities, changing service hours, family planning method or drug stock-outs, and/or financial constraints. The above challenges in accessing services along with coping strategies that some women and their families used exposed women to additional health risks, including unintended pregnancies, and posed several social, emotional, and financial burdens to many., Conclusions: The COVID-19 pandemic and associated lockdown measures undermined women's access to maternal and family planning services and interfered with their ability to achieve their reproductive goals. The paper concludes with a number of recommendations to ensure access to maternal and family planning services at times of crisis. Those recommendations include: (1) adapting reliable guidelines from humanitarian settings, (2) providing adequate guidance to healthcare providers and the public to tackle fears and misinformation, (3) making self-care products available such as oral contraceptive pills, vaginal rings and self- administered injectables, (4) involving other health professionals in the provision of maternal and family planning services through task-sharing/shifting, (5) expanding the use of telemedicine and/or digital health services especially to those living in remote areas and (6) raising policymakers' awareness of the centrality of reproductive rights and the importance of protecting them at all times., (© 2024. The Author(s).)

Background: Caesarean section (CS) is an important lifesaving intervention that can reduce maternal and newborn morbidity and mortality. The dramatic increase in CS rates globally has prompted concerns that the procedure may be overused or used for inappropriate indications. In Egypt, CS rates are alarmingly high, accounting for 52% of all deliveries. This study sought to (1) explore indications and risk factors for CS in public hospitals in four governorates in Egypt and (2) examine health care provider factors impacting the decision to perform a CS., Methods: We reviewed medical records for all deliveries that took place during April 2016 in 13 public hospitals situated in four governorates in Egypt (Cairo, Alexandria, Assiut and Behera), and extracted information pertaining to medical indications and women's obstetric characteristics. We also interviewed obstetricians in the study hospitals to explore factors associated with the decision to perform CS., Results: A total of 4357 deliveries took place in the study hospitals during that period. The most common medical indications were previous CS (50%), an "other" category (13%), and fetal distress (9%). Multilevel analysis revealed that several obstetric risk factors were associated with increased odds of CS mode of delivery - including previous CS, older maternal age, and nulliparity - while factors such as partograph completion and oxytocin use were associated with reduced odds of CS. Interviews with obstetricians highlighted non-medical factors implicated in the high CS rates, including a convenience incentive, lack of supervision and training in public hospitals, as well as absence of or lack of familiarity with clinical guidelines., Conclusion: A combination of both medical and non-medical factors drives the increase in CS rates. Our analysis however suggests that a substantial number of CS deliveries took place in the absence of strong medical justification. Health care provider factors seem to be powerful factors influencing CS rates in the study hospitals.

Objective: To assess supply and demand of family planning services from a reproductive rights perspective among young married women (YMW) in Egypt., Methods: Data sources related to family planning included structured interviews with service providers (n=216); an inventory of equipment and supplies (n=40); exit interviews with YMW (n=147); and focus group discussions (n=12) with YMW, husbands, and mothers and/or mothers in law. YMW, husbands and mothers in law were not necessarily related., Results: Although family planning services were readily available and affordable, YMW had limited access to information and services. Shortfalls were noted regarding respect for privacy, choice of family planning method, access to fertility services, and premarital counseling. Few YMW had sufficient autonomy to make informed reproductive decisions. Effective accountability mechanisms and processes for redress were also lacking., Conclusion: Implementation of a rights-based approach and structural changes to family planning service delivery are recommended to empower YMW in Egypt to demand and exercise their reproductive rights., (Copyright © 2015. Published by Elsevier Ireland Ltd.)

Concern for client's rights in the provision of reproductive health services in the developing world has prompted intense efforts by international experts to promote client-centered models of communication as a replacement for more provider-centered approaches. Nonetheless, the usefulness or feasibility of cross-cultural transplantation of client-centered models of communication has not been examined. The present study examines the feasibility, acceptability, and effectiveness of client-centered models of communication in 31 family planning clinics in Egypt. Consultations between 34 physicians and 112 clients requesting family planning methods were audio-taped and analyzed for physician communication style. Client satisfaction was measured through exit interviews. Method continuation was determined through home interviews at 3 and 7 months from the index visit. Based on audio-tape analysis, two-thirds of physician consultations were characterized as physician-centered and one-third as client-centered. Client-centered consultations were only one minute longer than physician-centered consultations. A client-centered consultation was associated with a three-fold increase in the likelihood of client satisfaction and method continuation at 7 months. A high proportion of solidarity statements (positive talk) by the physician was predictive of client satisfaction whereas a high proportion of disagreement statements and directive instructions by the physician were predictive of method discontinuation. The study findings suggest that in Egypt, as in more developed countries, client-centered models of communication are likely to produce better client outcomes than provider-centered models, with no substantial changes in the structure of services.

Percutaneous exposure of outbred Swiss mice to 500 Schistosoma mansoni (Egyptian strain) cercariae attenuated by 25,000 rad gamma radiation, twice at a 4-week interval, led to 80% protection against challenge with 100 live unattenuated cercariae compared to unimmunized control mice. The S. mansoni molecules that induce protective immunity in this model are not as yet identified. The capacity of an immunogen to induce efficient protective immunity depends largely on its T-cell-activating potential, as T cells are required both for eliciting long-lasting antibody formation and for antibody-independent cell-mediated immunity. To define such T cell antigen in S. mansoni, soluble adult worm antigens (SAWA) were separated by SDS-PAGE and electrotransferred onto nitrocellulose paper. Thirteen bands, identified by their M(r) were tested in T cell Western assays for their ability to stimulate proliferation of lymph node cells from 23 mice immunized with irradiated cercariae for the second time 2-5 weeks earlier. Lymphocytes from all mice responded to only a few (maximum of 6) bands. The response rate for the 13 SAWA bands tested ranged from 0-43%. These findings suggest a heterogeneity in T cell responses of individual mice to each of the SAWA bands and have implications that should be considered in the selection of immunogens to be assayed for anti-Schistosomiasis mansoni protective capacity. A highly significant protection against S. mansoni challenge in outbred Swiss mice was obtained exclusively following vaccination with a cocktail of soluble adult worm T cell immunogens that are recognized by 30-40% of individuals.