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Abou Coulibaly,1 Tieba Millogo,2 Adama Baguiya,1 Nguyen Toan Tran,3 Blandine Thieba,4 Armando Seuc,5 Asa Cuzin-Kihl,5 Sihem Landoulsi,5 James Kiarie,5 Rachel Yodi,6 Désiré Mashinda,6 Séni Kouanda1 1Institut de Recherche en Sciences de la Santé (IRSS), Département Biomédical et Santé Publique, Ouagadougou, Burkina Faso; 2Institut Africain de Santé Publique, Ouagadougou, Burkina Faso; 3University of Technology, Faculty of Health, Australian Centre for Public and Population Health Research, Sydney, Australia; 4Université Joseph KI-ZERBO, Unité de Formation et de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso; 5World Health Organization, Department of Reproductive Health Research, Geneva, Switzerland; 6Université de Kinshasa, Ecole de Santé Publique, Kinshasa, République Démocratique du CongoCorrespondence: Abou CoulibalyInstitut de Recherche en Sciences de la Santé (IRSS), 03 B.P. 7047, Ouagadougou, 03, Burkina FasoTel +226 71 40 77 89Email samsoncoul@gmail.comPurpose: An earlier adoption of contraceptive methods during the postpartum period could help women to extend the inter-pregnancy interval. This article aimed to determine and compare the timing of long-acting reversible contraceptives (LARC) use (ie, intrauterine device and implant) in Burkina Faso (BF) and DR Congo (DRC) between the intervention and control groups.Patients and Methods: A total of 1120 postpartum women were enrolled and followed up to 12 months postpartum. We used Yam-Daabo trial data which was a multi-intervention, single-blinded, cluster-randomised controlled trial done in primary health-care centres (clusters) in both countries. Centres were randomly allocated to receive the six-component intervention or standard antenatal and postnatal care in matched pairs (1:1). We did a secondary analysis using Royston-Parmar’s semi-parametric model to estimate the effect of the interventions on the median time of LARC uptake.Results: Our analysis included 567 postpartum women in BF (284 in the intervention group and 283 in the control group) and 553 in the DRC (274 in the intervention group and 279 in the control group). After showing an increase in family planning use in these two African countries, Yam Daabo’s interventions showed a reduction of the median time of LARCs adoption in the intervention group compared to the control group in both countries (difference of 39 days in Burkina Faso; difference of 86 days in the DR Congo).Conclusion: The Yam Daabo intervention package resulted in increased and earlier adoption of LARC in rural settings in Burkina Faso and urban settings in DR Congo. Such an intervention could be relevant in similar contexts in Sub-Saharan Africa with very high fertility rates and high unmet needs for contraception.Keywords: family planning, postpartum, long-acting reversible contraceptives, sub-Saharan Africa

Objective: To estimate the national and provincial number of excess deaths due to diabetes across Cuba in 2019. Study design: Cross-sectional design with secondary data. Methods: We used DISMODII, a computerized generic disease model, to assess disease burden by modelling the relationships between incidence, prevalence, and disease-specific mortality. Baseline input data included population structure, total mortality, and age- and sex-specific estimates for diabetes prevalence from the Cuban National Health Survey 2019, and available published estimates of the relative risk of death for people with diabetes compared to people without diabetes. The results were internally validated with DISMODII output for duration of diabetes (years). Results: In 2019, we estimated an excess of mortality attributable to diabetes of 7.5 times the diabetes mortality reported by the National Death Registry, which is equivalent to 16.4 % of all deaths in Cuba. The percentages of all-cause mortality among provinces varied between 10.7 % in Villa Clara and 24.5 % in Ciego de Avila. Conclusions: These are the first estimates of mortality attributable to diabetes in Cuba and its provinces. Diabetes is likely to be a much more prominent leading cause of death than the 9th ranking reported by the Cuban National Death Registry 2019. Disease models similar to DISMODII are important tools to validate the epidemiologic indicators used in the burden of disease calculations.

Se estudiaron independientemente y a ciegas por 2 técnicos, 30 pacientes, a los cuales se les midió la presión arterial sistólica humeral, poplítea, pedia y tibial posterior en el lado derecho; para cuantificar la variabilidad interobservador en la medición de las presiones sistólicas de las extremidades con un velocímetro Doppler. Se encontraron valores de presiones arteriales entre 46 y 250 mmHg. En la arteria poplítea, al igual que en la pedia y la tibial posterior, se observa una recta de regresión con pendiente ligeramente negativa, a diferencia del brazo, donde la pendiente fue ligeramente negativa, con una media y rangos de intervalos de confianza para las diferencias y las medias de las diferencias más elevados en las piernas, que los observados al nivel del brazo. La variabilidad de medición entre los 2 observadores fue pequeña, destacándose la arteria poplítea como la responsable de las mayores diferencias30 patients were independently and blindly studied by 2 technicians. Their humeral systolic, popliteal, pedal and posterior tibial arterial pressures were measured on the right side to quantify the interobserver variability in the measurement of the systolic pressures of the limbs with a Doppler speedometer. Arterial pressure values between 46 mmHg and 250 mmHg were found. In the popliteal artery and in the pedal and the posterior tibial, it was observed a regression straight line with a mildly negative slope, differently from the arm, where the slope was slightly negative, with a mean and confidence interval ranges for the differences and the means of the differences more elevated than the observed at the arm level. The measurement variablity between the 2 observers was small. The popliteal artery was stressed as the responsible for the greatest differences

Background High-quality contraceptive counselling can accelerate global efforts to reduce the unmet need for and suboptimal use of modern contraceptives. This study aims to identify a package of interventions designed to strengthen in Pakistan and Nigeria and determine their effectiveness in increasing client-level decision-making, autonomy and meeting of contraceptive needs.Methods A multisite, two-stage and five-phase intervention design will start with a pre-formative, formative, design, experimental and reflective phase. The pre-formative phase will map potential study sites and establish the sampling frame. The two-part formative phase will first use participatory approaches to identify clients’ perspectives, including young couples and providers, to ensure research contextualisation and address each interest group’s needs and priorities followed by clinical observations of client–provider encounters to document routine care. The design workshop in the third phase will result in the development of a package of contraceptive counselling interventions. In the fourth experimental phase, a multi-intervention, three-arm, single-blinded, parallel cluster randomised-controlled trial will compare routine care (arm 1) with the contraceptive counselling package (arm 2) and the same package combined with wider methods availability (arm 3). The study aims to enrol a total of 7920 participants. The reflective phase aims to identify implementation barriers and enablers. The outcomes are clients’ level of decision-making autonomy and use of modern contraceptives.Ethics and dissemination Ethical approval for this study was obtained from the WHO Scientific and Ethics Review Committee (Protocol ID Pakistan: ERC 006232 and Nigeria ERC: 006523). Each study site is required and has obtained the necessary ethical and regulatory approvals that are required in each specific country. Findings will be presented at local, national and international conferences and disseminated by peer-review publications.Trial registration number NCT06081842.

Objective To identify and summarise the evidence on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detection and persistence in body fluids associated with sexual activity (saliva, semen, vaginal secretion, urine and faeces/rectal secretion).Eligibility All studies that reported detection of SARS-CoV-2 in saliva, semen, vaginal secretion, urine and faeces/rectal swabs.Information sources The WHO COVID-19 database from inception to 20 April 2022.Risk of bias assessment The National Institutes of Health tools.Synthesis of results The proportion of patients with positive results for SARS-CoV-2 and the proportion of patients with a viral duration/persistence of at least 14 days in each fluid was calculated using fixed or random effects models.Included studies A total of 182 studies with 10 023 participants.Results The combined proportion of individuals with detection of SARS-CoV-2 was 82.6% (95% CI: 68.8% to 91.0%) in saliva, 1.6% (95% CI: 0.9% to 2.6%) in semen, 2.7% (95% CI: 1.8% to 4.0%) in vaginal secretion, 3.8% (95% CI: 1.9% to 7.6%) in urine and 31.8% (95% CI: 26.4% to 37.7%) in faeces/rectal swabs. The maximum viral persistence for faeces/rectal secretions was 210 days, followed by semen 121 days, saliva 112 days, urine 77 days and vaginal secretions 13 days. Culturable SARS-CoV-2 was positive for saliva and faeces.Limitations Scarcity of longitudinal studies with follow-up until negative results.Interpretation SARS-CoV-2 RNA was detected in all fluids associated with sexual activity but was rare in semen and vaginal secretions. Ongoing droplet precautions and awareness of the potential risk of contact with faecal matter/rectal mucosa are needed.PROSPERO registration number CRD42020204741.

Abstract Background A vaginal fistula is a devastating condition, affecting an estimated 2 million girls and women across Africa and Asia. There are numerous challenges associated with providing fistula repair services in developing countries, including limited availability of operating rooms, equipment, surgeons with specialized skills, and funding from local or international donors to support surgeries and subsequent post-operative care. Finding ways of providing services in a more efficient and cost-effective manner, without compromising surgical outcomes and the overall health of the patient, is paramount. Shortening the duration of urethral catheterization following fistula repair surgery would increase treatment capacity, lower costs of services, and potentially lower risk of healthcare-associated infections among fistula patients. There is a lack of empirical evidence supporting any particular length of time for urethral catheterization following fistula repair surgery. This study will examine whether short-term (7 day) urethral catheterization is not worse by more than a minimal relevant difference to longer-term (14 day) urethral catheterization in terms of incidence of fistula repair breakdown among women with simple fistula presenting at study sites for fistula repair service. Methods/Design This study is a facility-based, multicenter, non-inferiority randomized controlled trial (RCT) comparing the new proposed short-term (7 day) urethral catheterization to longer-term (14 day) urethral catheterization in terms of predicting fistula repair breakdown. The primary outcome is fistula repair breakdown up to three months following fistula repair surgery as assessed by a urinary dye test. Secondary outcomes will include repair breakdown one week following catheter removal, intermittent catheterization due to urinary retention and the occurrence of septic or febrile episodes, prolonged hospitalization for medical reasons, catheter blockage, and self-reported residual incontinence. This trial will be conducted among 512 women with simple fistula presenting at 8 study sites for fistula repair surgery over the course of 24 months at each site. Discussion If no major safety issues are identified, the data from this trial may facilitate adoption of short-term urethral catheterization following repair of simple fistula in sub-Saharan Africa and Asia. Trial registration ClinicalTrials.gov Identifier NCT01428830.

Background: an analysis of the trend of change in the mortality of cancer of the lip, oral cavity and pharynx and the quantification of the impact on life expectancy in the Cuban population can help researchers and those responsible for formulating health policies. Public to have a comprehensive view of this problem. Objective: to estimate the mortality burden of cancer of the lip, oral cavity and pharynx, by sex, in Cuba in the period 2005-2020. Method: a descriptive, cross-sectional study was carried out in which five-year data series were used. The universe was made up of all deaths from cancer of the lip, oral cavity and pharynx for the years studied. For each year and causes, the number of deaths was used; rates per 100,000 inhabitants and the years of life potentially lost due to mortality were calculated. The average was calculated and the annual percentage change was estimated. Results: mortality rates were between 7.62 and 12.23 in men and 2.60 and 3.74 in women, per 100,000 inhabitants. Regarding the years of life lost early, due to cancer of the lip, oral cavity and pharynx, it was observed that in men the rates rose from 131 in 2005 to 169 in 2020 and from 40 to 52 in women. Conclusions: the burden of cancer of the lip, oral cavity and pharynx in Cuba has increased, it was higher in men, the trend is growing in both sexes, both men and women died at younger ages due to nasopharyngeal cancer than, due to other locations studied, the percentage change was higher for pharyngeal cancer.

Fundamento: la mortalidad excesiva es considerada como un indicador especialmente útil para evaluar el impacto sanitario de la COVID-19; a nivel internacional, su empleo ha ido en aumento durante todo el 2021, pero en la literatura científica nacional su presencia es, hasta donde conocemos, nula.Objetivo: definir el indicador mortalidad excesiva y describir su empleo en el cálculo de la mortalidad excesiva para Cuba en el 2020, comparándola con la de otros países.Métodos: estudio ilustrativo del empleo e interpretación de un indicador de impacto de la COVID-19.Resultados: la mortalidad excesiva en Cuba en 2020 se compara, favorablemente, con la de otros países, en particular del área Latinoamericana.Conclusiones: la incidencia de la enfermedad, junto con las intervenciones no farmacéuticas implementadas por los gobiernos, entre otros factores, influyen en la mortalidad excesiva. En el caso de Cuba, es necesario calcularla para 2021, dado que en ese año se observaron las mayores tasas de incidencia, y de esa manera contribuir a la evaluación de la resiliencia global de nuestro Sistema de Salud en el enfrentamiento a la pandemia.

En el marco de los objetivos planteados en el Programa Nacional de Reducción de Ia Mortalidad Oncológica, llevado a cabo por el Ministério de Salud Pública a partir dei pasado ano, se impone un conocimiento más acucioso sobre Ia tendencia de Ia mortalidad por câncer y Ia formulación de hipótesis etiológicas. El presente trabajo, tomando los datos relativos a Ia mortalidad por cáncer de mama de Ia mujer cubana en el período 1963-1987, estudia mediante un procedimiento de análisis estadístico novedoso que utiliza el modelo lineal generalizado. Ia tendencia de Ia misma, asumiendo Ia influencia de los factores: edad, período y cohorte de nacimiento, sobre Ias tasas de mortalidad. Se observa una importante influencia del factor cohorte, determinândose que el riesgo de mortalidad por cáncer de mama de Ia mujer, es mayor en Ias cohortes más jóvenes del estúdio, se distingue además Ia asociación entre el riesgo de morirpor cáncer de mama y los bajos patrones reproductivos de Ia mujer cubana.

Background: low adherence to pharmacological treatment is considered a Public Health problem. Social, economic and cultural determinants play an essential role in its origin. Objective: to investigate the level of adherence to pharmacological treatment in a subsample of hypertensive people from the Julio Antonio Mella University Polyclinic in the Guanabacoa municipality and to identify the main factors that may be interfering in this process. Methods: a descriptive cross-sectional study was carried out in the previously mentioned area between September and December 2019. Simple random sampling was used. 337 hypertensive people older than 35 years were studied. The variables studied were: sociodemographic (age, sex, skin color, occupation, education, household composition or cohabitation) and variables related to patient care: need for care, follow-up, blood pressure measurement, treatment prescription pharmacological and non-pharmacological and adherence. Categorical variables were presented as frequencies and percentages. Results: adherence was 69.4 %, it was related to feeling the need for care (p≤0.01), being controlled (p≤0.05) and being older than 65 years (p≤0.04). People with a history of cardiac events and stroke followed to treatment. The rest of the sociodemographic variables were not related, nor the follow-up consultation and blood pressure measurement in the last year. Conclusions: achieving adequate therapeutic adherence is a complex process, influencing both individual and organizational aspects. The unavailability of medications in the pharmacy, forgetting to take them and at the established times were the main barriers referred to; these must be taken into account to have a favorable impact on patient control. It is important to implement strategies to improve the level of adherence and knowledge of patients about their disease.

Background: the characterization of the mortality burden is essential information for planning and setting priorities in health, monitoring and evaluating intervention programs and identifying groups of women at higher risk. Objective: to determine the maternal deaths burden from indirect causes in Cuba in the period 2005-2020. Methods: a descriptive cross-sectional study of annual series was carried out. The universe was the total number of indirect maternal deaths registered during the studied years. The variables used in the study were: basic cause of death and age. For each series, the years of life potentially lost due to mortality, their percentage and average, as well as the trend over the years, were calculated. Results: during 2005-2020, 269 women died in Cuba due to indirect causes. Premature deaths quantified 13,972 years of life potentially lost, with an annual average of 874 years, which represented an average of 51 years not lived for each deceased. The indirect causes that generated more years of life lost were the group of other indirect causes, 341 years on average, and diseases of the circulatory system, 247. Conclusion: the causes of death with the greatest impact on life expectancy in the Cuban population coincided with the causes with the highest number of deaths, which shows that there are no great differences in the ages at which one dies between the different causes. The women who died at younger ages were those in the group with other indirect causes, which, together with the circulatory system diseases, showed a tendency to increase over time.

Introducción. Este trabajo resume el aporte del Grupo Técnico de Modelación y Epi- demiología para el enfrentamiento de la COVID-19. El objetivo del trabajo fue generar conocimiento y evidencias científicas en apoyo a la toma de decisiones del Gobierno, el sistema de salud y otros sectores. Método. Se realizó investigación de implementa- ción con un enfoque transdisciplinar, con la epidemiología como guía. Se desarrollaron herramientas que permitieron la identificación de la magnitud y la diseminación de la COVID-19 en el país, el análisis de riesgo de enfermar y de severidad, así como para la evaluación de las medidas implementadas. Resultados. Se realizaron mejoras a los sis- temas de información y se creó la plataforma Covid19CubaData para la estandarización y visualización de los datos. Se desarrollaron modelos matemáticos de pronósticos. Se emplearon los Sistemas de Información Geográfica para identificar grupos poblacio- nales vulnerables y estratificar intervenciones. El impacto de las acciones fue evaluada desde el análisis clínico-epidemiológico, el uso de técnicas de big data de la movilidad y la estimación en tiempo real del número reproductivo efectivo. Modelos multinivel y de inteligencia artificial permitieron la comparación del comportamiento de la pandemia en Cuba y el mundo. Se propusieron indicadores para el des-escalado de las acciones y se evaluó la equidad en la respuesta del país ante la COVID-19. En conclusión, la investigación epidemiológica realizada, con el apoyo de la modelación y los sistemas de información, sirvieron para la toma de decisiones del Gobierno y el Ministerio de Salud Pública en el enfrentamiento efectivo a la COVID-19.

Background: diabetes mellitus is a serious health problem with an upward trend. Every year a considerable number of people die as a result of their complications that derive from poor control, so improving the quality of care constitutes a challenge for health systems. Objective: to evaluate the quality of care by reviewing the medical records and investigating some of the program indicators, in a health area of the Cárdenas municipality during 2016. Method: an investigation of health systems and services was carried out, using a two-stage conglomerate sampling. The variables studied were related to the fulfillment of the main activities established in the patient care process and others with the knowledge, training and satisfaction of the providers. Instruments tested in previous studies were applied. The statistical packages Access 2000 and SPSS 21.0 were used to collect and analyze the results. Results: the evaluation of the process, level of knowledge, training and satisfaction of the suppliers was not adequate in the studied area, as the proposed standards were not reached for any of the criteria. Conclusions: the care received by these patients is not adequate since there were difficulties in the fulfillment of the program, which affected on its follow-up and control.

Objective To develop a global research agenda that will guide investment in effective interventions to satisfy the large unmet need for modern methods of family planning. Methods In a global survey, experts on contraception were invited to identify and rank the types of research that would be needed – and the knowledge gaps that would have to be filled – to reduce the unmet need for family planning in the next decade. The experts were then asked to score the research on a given topic in terms of the likelihood of its leading to an intervention that would: (i) be deliverable, affordable and sustainable; (ii) substantially reduce the unmet need for contraceptives; (iii) be effective and efficient in improving health systems; (iv) be ethically implemented; and (v) improve equity in the target population. The overall scores were then ranked. Findings Most of the topics that received the 15 highest scores fell into three categories: implementation of policies in family planning; the integration of services to address barriers to contraceptive use; and interventions targeted at underserved groups, such as adolescents. Conclusion Experts on contraception gave top priority ranking to research on improving the implementation and integration of health services and on strengthening the health systems supporting family planning services. The results of the exercise may help decision-makers, researchers and funding agencies to develop a clear and focused approach to satisfying the global need for family planning and reach the target set by the Family Planning 2020 initiative.

Objective To examine the effectiveness, safety, and acceptability of nurse provision of early medical abortion compared to physicians at three facilities in Mexico City. Methods We conducted a randomized non-inferiority trial on the provision of medical abortion and contraceptive counselling by physicians or nurses. The participants were pregnant women seeking abortion at a gestational duration of 70 days or less. The medical abortion regimen was 200 mg of oral mifepristone taken on-site followed by 800 µg of misoprostol self-administered buccally at home 24 hours later. Women were instructed to return to the clinic for follow-up 7-15 days later. We did an intention-to-treat analysis for risk differences between physicians' and nurses' provision for completion and the need for surgical intervention. Findings Of 1017 eligible women, 884 women were included in the intention-to-treat analysis, 450 in the physician- provision arm and 434 in the nurse-provision arm. Women who completed medical abortion, without the need for surgical intervention, were 98.4% (443/450) for physicians' provision and 97.9% (425/434) for nurses' provision. The risk difference between the group was 0.5% (95% confidence interval, CI: -1.2% to 2.3%). There were no differences between providers for examined gestational duration or women's contraceptive method uptake. Both types of providers were rated by the women as highly acceptable. Conclusion Nurses' provision of medical abortion is as safe, acceptable and effective as provision by physicians in this setting. Authorizing nurses to provide medical abortion can help to meet the demand for safe abortion services. Objectif Examiner l'efficacite, la securite et l'acceptabilite de l'avortement medical precoce pratique par un(e) infirmier(iere) par rapport au meme acte realise par un medecin dans trois etablissements de la ville de Mexico. Methodes Nous avons mene un essai de non-inferiorite randomise sur l'avortement medical et le conseil en matiere de contraception pratiques par des medecins ou des infirmiers. Les participantes etaient des femmes enceintes souhaitant avorter a un terme de grossesse de 70 jours ou moins. Le protocole de l'avortement medical etait de 200 mg de mifepristone administres sur place par voie orale, suivis de 800 µg de misoprostol auto-administres par voie orale a la maison 24 heures plus tard. Les femmes avaient recu comme consigne de revenir a la clinique pour y etre suivies 7 a 15 jours plus tard. Nous avons effectue une analyse en intention de traiter pour les differences de risque entre l'avortement medical pratique par les medecins et par les infirmiers et le besoin d'une intervention chirurgicale. Resultats Parmi les 1 017 femmes eligibles, 884 femmes etaient incluses dans l'analyse en intention de traiter, 450 dans l'acte d'avortement pratique par un medecin et 434 dans l'acte d'avortement pratique par un(e) infirmier(iere). Les femmes qui ont subi un avortement medical sans avoir eu besoin d'une intervention chirurgicale etaient de 98,4% (443/450) pour l'avortement pratique par un medecin et de 97,9% (425/434) pour l'avortement pratique par un(e) infirmier(iere). La difference de risque entre les groupes etait de 0,5% (intervalle de confiance a 95%: de 1,2% a 2,3%). Il n'y avait pas de difference entre les professionnels de sante pour les termes de la grossesse examines ou la prise de methode contraceptive des femmes. Par ailleurs, les femmes acceptaient completement les deux types de professionnels de sante. Conclusion Dans ce contexte, l'avortement medical pratique par les infirmiers est aussi s-r, acceptable et efficace que celui pratique par les medecins. Autoriser les infirmiers a pratiquer l'avortement medical peut aider a repondre a la demande en matiere de services d'avortement securises. Objetivo Examinar la eficacia, seguridad y aceptabilidad de la actuacion de los enfermeros en los abortos con medicamentos en fases tempranas de la gestacion en tres centros de Ciudad de Mexico en comparacion con la actuacion los medicos. Metodos Se llevo a cabo un ensayo de no inferioridad aleatorio sobre la realizacion de abortos medicos y asesoramiento anticonceptivo por parte de medicos o enfermeros. Las participantes fueron mujeres embarazadas que buscaban interrumpir una gestacion de 70 dias o menos. El regimen para el aborto con medicamentos consistio en 200 mg demifeprlstona por via oral, administrados en el centro, seguidos de 800 µg de misoprostol autoadministrados por via oral en casa 24 horas mas tarde. Se indico a las mujeres que acudieran a la clinica para realizar un seguimiento entre 7y 15 dias mas tarde. Se realizo un analisis por intencion de tratar de las diferencias de riesgo entre la asistencia de los medicos y los enfermeros para el termino y la necesidad de una intervencion quirurgica. Resultados De 1017 mujeres elegibles, se incluyeron 884 en el analisis por intencion de tratar, 450 en el brazo atendido por medicos y 434 en el grupo atendido por enfermeros. De las mujeres que se sometieron al aborto con medicamentos, el 98,4 % (443/450) de las atendidas por medicos y el 97,9 % (425/434) de las atendidas por enfermeras no requirieron ninguna intervencion quirurgica. La diferencia de riesgo entre el grupo fue de 0,5 % (intervalo de confianza del 95 %: -1,2 % al 2,3 %). No hubo diferencias entre los proveedores para la duracion de la gestacion examinada o metodo anticonceptivo de las mujeres. Las mujeres calificaron ambos proveedores como muy aceptables. Conclusion Los enfermeros son tan seguros, aceptables y eficaces como los medicos a la hora de asistir un aborto con medicamentos. Autorizar a las enfermeras a realizar abortos con medicamentos puede ayudar a satisfacer la demanda de servicios para un aborto seguro., Introduction In Mexico City, early elective abortion to terminate pregnancy was legalized in April 2007. (1-3) Up to June 2013,100 000 abortions have been provided by trained physicians in Ministry [...]

Objective To develop a global research agenda that will guide investment in effective interventions to satisfy the large unmet need for modern methods of family planning. Methods In a global survey, experts on contraception were invited to identify and rank the types of research that would be needed--and the knowledge gaps that would have to be filled--to reduce the unmet need for family planning in the next decade. The experts were then asked to score the research on a given topic in terms of the likelihood of its leading to an intervention that would: (i) be deliverable, affordable and sustainable; (ii) substantially reduce the unmet need for contraceptives; (iii) be effective and efficient in improving health systems; (iv) be ethically implemented; and (v) improve equity in the target population. The overall scores were then ranked. Findings Most of the topics that received the 15 highest scores fell into three categories: implementation of policies in family planning; the integration of services to address barriers to contraceptive use; and interventions targeted at underserved groups, such as adolescents. Conclusion Experts on contraception gave top priority ranking to research on improving the implementation and integration of health services and on strengthening the health systems supporting family planning services. The results of the exercise may- help decision-makers, researchers and funding agencies to develop a clear and focused approach to satisfying the global need for family planning and reach the target set by the Family Planning 2020 initiative. Objectif Developper un agenda de recherche mondial qui guidera les investissements dans les interventions efficaces pour repondre aux grands besoins non satisfaits en methodes modernes de planification familiale. Methodes Dans une enquete mondiale, les experts dans le domaine de la contraception ont ete invites a identifier et classer les types de recherche qui seraient necessaires--et les lacunes en fermes de connaissances qui devront etre comblees--pour reduire le besoin non satisfait de planification familiale dans la prochaine decennie. Les experts ont ensuite ete invites a noter la recherche dans un domaine particulier et a evaluer ses chances de deboucher sur une intervention qui: (i) serait livrable, abordable et durable; (ii) reduirait substantiellement le besoin non satisfait de moyens contraceptifs; (iii) serait efficace et efficiente dans l'amelioration des systemes de sante; (iv) serait mise en oeuvre de maniere ethique; et (v) ameliorerait l'equite dans la population cible. Les notes globales ont ensuite ete classees. Resultats La plupart des sujets qui ont recu les 15 meilleures notes appartiennent a trois categories: la mise en oeuvre de politiques en matiere de planification familiale; l'integration de services pour surmonter les obstacles a l'utilisation des moyens contraceptifs; et les interventions ciblees vers des groupes mal desservis, comine les adolescents. Conclusion Les experts dans le domaine de la contraception ont classe comme hautement prioritaire: l'amelioration de la mise en oeuvre et de l'integration des services de sante et le renforcement des systemes de sante qui soutiennent les services de planification familiale. Les resultats de l'exercice peuvent aider les decideurs, les chercheurs et les organismes de financement a developper une approche claire et ciblee pour satisfaire les besoins mondiaux en matiere de planification familiale et pour atteindre l'objectif fixe par l'initiative de la Planification Familiale 2020. Objetivo Desarrollar una agenda global de investigacion que guie la inversion en intervenciones efectivas para cubrir la gran necesidad insatisfecha de metodos modernos de planificacion familiar. Metodos En una encuesta mundial, se invito a expertos en anticoncepcion a identificar y clasificar los tipos de investigacion que serian necesarios, asi como las lagunas de conocimientos que deben colmarse para reducir la necesidad insatisfecha de planificacion familiar en la proxima decada. A continuacion, se pidio a los expertos que puntuaran la investigacion de una materia concreta en terminos de la probabilidad de que condujera a una intervencion que: (i) fuera viable, asequible y sostenible; (ii) redujera sustancialmente la necesidad insatisfecha de a nticonceptivos; (iii) fuera eficaz y eficiente en la mejora de los sistemas sanitarios; (iv) pudiera aplicarse con etica; y (v) mejorara la equidad en la poblacion meta. A continuacion, se clasificaron las puntuaciones generales. Resultados La mayoria de los temas que recibieron las 15 calificaciones mas altas se dividieron en tres categorias: la aplicacion de las politicas de planificacion familiar, la integracion de servicios para abordar las barreras al uso de anticonceptivos y las intervenciones dirigidas a grupos desatendidos, como los adolescentes. Conclusion Los expertos en anticoncepcion dieron maxima prioridad a la investigacion destinada a mejorar la aplicacion e integracion de los servicios sanitarios y al fortalecimiento de los sistemas sanitarios que apoyan los servicios de planificacion familiar. Los resultados del ejercicio pueden ayudar a los gobernantes, investigadores y organismos de financiacion a desarrollar un enfoque claro y a satisfacer la necesidad internacional de planificacion familiar, asi como a alcanzar el objetivo fijado por la iniciativa Planificacion Familiar 2020., Introduction By protecting women from the risk of pregnancy and its associated complications, family planning can play a vital role in the reduction of infant, child and maternal morbidity and [...]