Total Demand, Use and Unmet Need for Modern Contraceptives Among Women Living in Informal Settlements in Kira Municipality, Wakiso District, Uganda. Implications for Urban Health

Background: Update and utilization of modern contraceptives has public health benefits including reduction of unintended pregnancies, unsafe abortions, and related maternal mortality. However, paucity of evidence on key indicators of family planning in the informal settlements abounds. Data are usually collapsed within the larger urban communities that tend to mask peculiarities of informal settlements. This study determined the proportion of women using modern contraceptives, the unmet need for modern contraceptives and the total demand in informal settlements of an urban municipality.Methods: A cross-sectional study conducted among 626 women in the reproductive age (15–49 years) in the informal settlements of Kira municipality (part of metropolitan Kampala). Multi-stage sampling was applied in the selection of the respondents. Descriptive and log-binomial regression analysis were conducted to determine percentage of women using modern contraceptives, unmet need, and total demand with their associated factors. All analyses were conducted using STATA version 15.0.Results: The total demand for modern contraceptives was 84.9%, modern contraceptive prevalence was 47.4% nearly meeting the national target of 50%, however the unmet need was 37.3%, which much higher than the national target of 10%. Lower total demand for contraceptives was associated with higher women's education status and preference to have another child, while higher total demand was associated with having at least one living child. Higher modern contraceptives use was associated with older age, having at least one living child and high decision-making power, while lower modern contraceptives use was associated with higher education and undetermined fertility preference. Lower unmet need for modern contraceptives was associated with older age (PR 0.68, 95% CI: 0.48–0.97) and high decision-making power (PR 0.64, 95% CI: 0.50–0.81), while higher unmet need was found among those who having at least one living child (PR 1.40, 95% CI: 1.01–1.93) and undetermined fertility preference (PR 1.70, 95% CI: 1.24–2.34).Conclusions: Total demand and contraceptive use were found to be higher in the informal settlements of Kira municipality, however, the unmet need was much higher among this population as compared to the national urban estimates. This indicates a much higher demand for contraceptives and the need to consider the diverse socio-demographic characteristics of urban spaces. Development of Interventions need to critically consider the diverse urban space, associated explanatory variables and a collaborative systems lens to achieve sustained improvements.

A child's grief after the death of a sibling – a review of selected theoretical and empirical aspects

The aim of the article is to review selected theoretical and empirical aspects concerning the death of a sibling as well as its psychological and social consequences for a living child. This topic has not been of interest to researchers so far. This fact may pose an obstacle in searching for effective forms of social and educational support for families who have been orphaned in this way, especially for children. The article illustrates the importance of selected factors that determine the grief experience of children in connection with the loss of a sibling, such as: gender and age, type and cause of sibling death, features of the family environment. Considering the practical implications, it may be emphasized that the ability of the living child to cope with the loss may depend on the willingness of parents to discuss the death of a sibling. Moreover, in order to plan the care and educational impact, gender, age, type and cause of sibling death should be taken into account.

Dr. James Murphy. — Abdominal Section during Pregnancy .— (Lancet., 1895, 19 / i, p. 148). - Gluttony during pregnancy.

A 22-year-old woman with a left ovarian cyst, which caused her considerable pain, considering herself to be 2 months pregnant, turned to Dr. Murphy for advice; he did not find a reason for the immediate production of the operation. After a short time, the patient suddenly developed a collapse, a liquid was felt in the abdomen. Murphy immediately made a cut in the abdomen with chloroform, at which up to 20 ounces of liquid blood had escaped from the last day, and rinsed the peritoneal cavity with boron solution. The uterus turned out to be enlarged, the tubes and ovaries were healthy, but near the right ovary, a bleeding place was found in the ruptured pseudo-membrane, by which the ovary was attached to the Douglas space. When the pregnant uterus was lifted up, the membrane ruptured and gave profuse bleeding, probably not long before the operation. After bandaging the bleeding membrane, the operation is over; recovery is smooth. Pregnancy continued and the patient was destroyed in time by a living child.

Dr. Cullingworth. - A case of advanced Extra-Uterine Gestation in wich a living Child was removed, the placenta left, and the Abdominal Wound entirely closed. (British med. Journ., 22 / XII 94, p. 1422). A case of extrauterine pregnancy in 8 months; extraction of a living child by gastrointestinal tract, leaving after and complete closure of the abdominal cavity

A 33-year-old, emaciated worker was sent by one doctor to the hospital with the diagnosis of an extrauterine pregnancy, 25 / ix 93. She had a previous birth 13 years ago, 3 years ago she had a 5 month miscarriage, the last regulations in April 93 she had pains in the abdomen with light bleeding; then she had morning sickness, swelling of her breasts. In August - the second attack of pain, lay for about a week in bed. Cullingworth, denying that she had an extrauterine pregnancy, kept her in the hospital until the pains soothed and for the 18th sent her home. 5 / I 94 she developed pain during labor with vomiting. The uterus was palpated not enlarged, without any discharge from her, a tumor in the abdomen with clear movements and heartbeats of the fetus. 13 / I the patient was again admitted to the hospital.

F.F.Kutlinskiy. To the question of the operation of taking away the dropped handle. (Protocol of the meeting of obstetrician-gynecological society in Kiev. God 5, volume 5, issues 9 and 10)

The author describes a case in which, in his opinion, the removal of the handle was shown and necessary. This case is: a woman with a narrow pelvis, conj. ext. = 15 ctm; diagonalis = 10.5; gives birth to the 3rd connector; the first childbirth ended prematurely with a living child, the second - due to the failure of the fetus.

Inversio vesicae urinariae per fissuram abdominis cum atresia vaginae in a newborn girl.

On March 17, 1894, a well-built, full-term, living child, female, was delivered to me, 27 hours after his birth, with the above developmental defect.

A case of a preserving caesarean section

Ms. Ch., 26 years old; poor health; started to walk at the age of 6; the first menstruation - at the age of 12, got married on the 19th and immediately became pregnant. The first birth, which lasted 46 hours, ended with a craniotomy at the Obstetric Aid in Moscow; the second pregnancy was artificially terminated by the author at the end of the 24th week, - a living child was born, died after 7 weeks from congenital weakness; The author interrupted the third pregnancy at the 36th week, and the labor was completed by the difficult imposition of forceps on the head moving above the entrance to the pelvis, - the girl was born in asphyxiation, revived. The present, fourth, pregnancy proceeded as follows: the last regulations between March 7 and 10, 1891; first fetal movement - July 24; only on 30 November (i.e. at the end of the 38th week) did the pregnant woman turn to the author.

THE CASE OF ABORTION AT THE 5TH MONTH WITH A LIVING CHILD

On October 3, 1891, at 5 o'clock in the afternoon, a pregnant L.G., 24 years old, was admitted to the maternity hospital at the Hospital of the Society of Kremenchug Physicians, with complaints of pulling pains, as well as minor bloody expirations for 2 weeks. L. G. married 21/2 years, pregnant for the 3rd time: the 1st pregnancy ended in miscarriage in the 3rd month, 2nd urgent delivery 1 year and 3 months ago. The last regulations were in early May; L. G. felt fetal movement 5 days before admission to the clinic. Throughout her last pregnancy, L. G. suffered from time to time puffy pains and leucorrhoea, the latter, however, even before pregnancy. A pregnant woman is of good build, nutrition is not entirely satisfactory, thin, anemic, when listening to the heart, a noise is heard instead of the first tone. The abdomen is soft, the uterus is hard, sensitive to pressure, the bottom of it is 2 transverse fingers below the navel; the neck is soft, passes a finger; a little blood is shown from the genital tract.

The King and the Two Prostitutes (1 Kgs 3:16–27): A Case for the Relevance of Narratorial Comment in Biblical Narratives

The narrative of the King and the Two Prostitutes (1 Kgs 3:16–27) presents the reader with a riddle to identify the true mother of the living child. While the king knows and sees the true mother, the reader is to discover the same through the literary indications within the narrative. However, some translations of the bible explicitly affirm that the first woman is the mother of the living child. Such identification is seen in the Septuagint (LXX) and some modern English translations (NRSV, NEB, RSV). This essay, however, takes a different stand from the popular opinion expressed in these translations. The essay argues that paying attention to narratorial comment and its implications for reading the entire narrative leads the reader to conclude that the second woman could have been the true mother of the living child.

Factors Contributing to Older Adults Living Alone and Thereby at Risk of Poor Health and Adverse Health Outcomes

Introduction: Extensive research demonstrates that older adults living alone tend to be less healthy, have poorer health outcomes and are at greater risk of dying. While many investigators have explored various aspects of aging, there has been limited work assessing factors that increase the chances of an older adult to live alone. This study examines the association between demographic characteristics; current health status; and social, cultural, and environmental factors among older adults (65 years of age and older) and the likelihood they will live alone Methods: Secondary analyses is conducted of survey data from the Americans' Changing Lives (ACL) cohort study initiated in 1986 (Wave 1) and continued through 2012, with four follow-up surveys conducted in 1989 (Wave II), 1994 (Wave III), 2001/02 (Wave IV), and 2011/12 (Wave V). All ACL participants 65 years and older at time of survey (Wave I – V) are included for this study (N=7,020). An analysis of variance (ANOVA) that included demographics, health status, and social support factors is employed to determine the relationship of these variables to an older adult reporting living alone. Additionally, the Cox proportional hazards model is used for survival analysis to predict the expected age at onset of living alone. Results: Four critical factors reduce the probability of an older adult living alone: 1) marital status (married), 2) gender (male), 3) presence of at least one living child, and 4) willingness to spend time in the garden (physical activity). An older female adult who is currently single and without a living child is most likely to report living alone (p<.001). Conclusions: Older adults living alone are at higher risk of poor health and health outcomes. The influx of baby boomers whose life expectancy is longer than the past, will cause a dramatic increase in senior adults living alone. This research suggests a guideline to public health professionals for identifying those at risk of being negatively impacted by living alone so that they can intervene and provide alternative living arrangements and support services, as necessary. Keywords: living alone, older adults, health outcomes