RESUMO
PURPOSE: Identification of trends in the ability of young single women to protect themselves from unwelcome pregnancy is essential for evaluation and development of policies and programs. We document trends over a 15-year period in sexual activity, contraceptive use, and reproductive outcomes in four countries for single women aged 15-24 years. METHODS: Using retrospective month-by-month reproductive and contraceptive calendars, we constructed annual sexual, contraceptive, and reproductive profiles. The analysis was applied to all four countries (Colombia, Kenya, Peru, and Zimbabwe) that had collected complete reproductive calendars in three consecutive Demographic and Health Surveys. Women-years were classified as sexually inexperienced (i.e., virgin), sexually experienced but using contraception, and sexually experienced without contraception. Conception rates were calculated and those ending in live births were classified as wanted or unwanted. RESULTS: While virginity decreased over time in the Latin American countries, it increased in the African settings. The contribution of condom to the sexually active time protected by contraception use increased in all countries. While the percentage of conceptions ending in spontaneous or induced abortion increased in Colombia and Peru to around 15% of the total pregnancy outcomes, it decreased in the African countries to less than 6%. CONCLUSIONS: Delayed sexual debut remains the major restraint on pregnancy in these four countries with the result that conception rates are very low. Condoms remain the most common method of contraception even in the two countries without severe HIV risks and efforts to displace condoms by nonbarrier methods should be pursued with caution.
Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Comportamento Sexual/estatística & dados numéricos , Adolescente , Adulto , Colômbia/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Quênia/epidemiologia , Nascido Vivo/epidemiologia , Estudos Longitudinais , Peru/epidemiologia , Gravidez , Estudos Retrospectivos , Adulto Jovem , Zimbábue/epidemiologiaRESUMO
BACKGROUND: Around 1.5 million annual neonatal deaths occur in the first week of life, and infections represent one of the major causes in developing countries. Neonatal sepsis is often strictly connected to infection of the maternal genital tract during labour. METHODS: The association between signs suggestive of puerperal infection and early neonatal mortality (<7 days of life) was performed using Demographic and Health Surveys (DHS) data of six countries, conducted between 2010 and 2013. The population attributable fraction (PAF) was generated using the estimates on early neonatal mortality of a 1990-2013 systematic analysis for the Global Burden of Disease Study. RESULTS: Signs of puerperal infection ranged from 0.7% in the Philippines to 16.4% in Honduras. Infection was associated with a 2.1 adjusted Risk Ratio (95% CI: 1.4-3.2) of early neonatal mortality. Around five percent of all deaths in the first week of life were attributable to signs suggestive of puerperal infections and varied from 13.9% (95% CI: 1.0-26.6) in Honduras to 3.6% (95% CI: 1.0-8.5) in Indonesia. CONCLUSIONS: Targeted interventions should be addressed to contain the burden of puerperal infections on early neonatal mortality. Consideration of the PAF will help in the discussion of the benefits of antenatal and perinatal measures.