Findings from a baseline survey conducted prior to the initiation of organized family planning ef... more Findings from a baseline survey conducted prior to the initiation of organized family planning efforts in one urban and one rural area of Bas Zaire reveal the widespread use of traditional methods and a surprisingly high level of knowledge of modern contraceptives. However, in the absence of a delivery system, use of the latter was extremely limited (4-5 percent of currently married women). The data reflect a deep-seated motivation for birth spacing, which is achieved primarily through withdrawal and abstinence. Of the variables tested as possible correlates, only economic status was related to use of both traditional and modern methods in the same direction. Use of a traditional method was largely determined by age of the youngest child and breastfeeding status. By contrast, use of a modern method was highest among women over 30 with higher levels of education and parity, who were not currently breastfeeding.
Follow-up surveys were carried out in six countries (Bangladesh, Columbia, El Salvador, Guatemala... more Follow-up surveys were carried out in six countries (Bangladesh, Columbia, El Salvador, Guatemala, Indonesia, and Tunisia) between 1984 and 1986 to assess client decision-making regarding sterilization. The results revealed that women made well-informed, voluntary decisions to be sterilized. They were knowledgeable about other family planning methods and made the decision to be sterilized after consulting their partners, friends, relatives, or other sterilized women. Although their decisions were voluntary, other findings revealed areas for improvement such as client information and education about the risks of the procedure. These data were used to improve program services by emphasizing the need for better information, education, and counseling programs.
The purpose of this study was to determine the comparability of two indicators of family planning... more The purpose of this study was to determine the comparability of two indicators of family planning (FP) performance-number of active users (a widely reported statistic) and couple-months-of protection. Both were used to monitor the Guatemalan community- based distribution (CBD) program over a twelve-month period. Discrepancies between the two indicators were observed m monthly statistics but were minimal in trimester data.
This paper contains data from a qualitative study from 218 in-depth interviews with men and women... more This paper contains data from a qualitative study from 218 in-depth interviews with men and women and their partners who decided to have a vasectomy in six countries: Bangladesh, Kenya, Mexico, Rwanda, Sri Lanka and the USA. It examined the key factors that led men to choose vasectomy and what role their partners played in this decision. The reasons for
Page 1. ARTICLES A Comparison of Sterilization Use and Demand From the Demographic and Health Sur... more Page 1. ARTICLES A Comparison of Sterilization Use and Demand From the Demographic and Health Surveys By Naomi Rutenberg and Evelyn Landry Data from 26 countries that participated in the first phase of the Demographic and Health Sur-...
... Mass media. Several country teams in-cluded in their information, education and communication... more ... Mass media. Several country teams in-cluded in their information, education and communications strategy a plan to work directly with the mass media to develop messages for men and women about male reproductive health. ...
Objectives: To present profiles and experiences of women with obstetric fistula. Methods: Data fo... more Objectives: To present profiles and experiences of women with obstetric fistula. Methods: Data for 1,354 women were collected at admission, surgery, discharge, and 3 month follow-up using standardized forms. Results: Median fistula duration was 1 year and median age at fistula development was 20. At time of surgery, median parity was 2, and most women were married and financially supported by husbands or other relatives. Effects of living with fistula result in women being socially isolated : more than 80% reported leaking from the fistula prevented then attending social and religious gatherings and ability to work. Before discharge over 90% were counseled about FP and the importance of antenatal care for the next pregnancy; 54% accepted FP at time of discharge. At the three month follow up more than 70% of women reported improvements in the quality of their lives post-surgerymore were able to eat with others, attend religious and social gatherings and return to work. Conclusions: P...
Duration of bladder catheterisation after female genital fistula repair varies widely. We aimed t... more Duration of bladder catheterisation after female genital fistula repair varies widely. We aimed to establish whether 7 day bladder catheterisation was non-inferior to 14 days in terms of incidence of fistula repair breakdown in women with simple fistula. In this randomised, controlled, open-label, non-inferiority trial, we enrolled patients at eight hospitals in the Democratic Republic of the Congo, Ethiopia, Guinea, Kenya, Niger, Nigeria, Sierra Leone, and Uganda. Consenting patients were eligible if they had a simple fistula that was closed after surgery and remained closed 7 days after surgery, understood study procedures and requirements, and agreed to return for follow-up 3 months after surgery. We excluded women if their fistula was not simple or was radiation-induced, associated with cancer, or due to lymphogranuloma venereum; if they were pregnant; or if they had multiple fistula. A research assistant at each site randomly allocated participants 1:1 (randomly varying block sizes of 4-6; stratified by country) to 7 day or 14 day bladder catheterisation (via a random allocation sequence computer generated centrally by WHO). Outcome assessors were not masked to treatment assignment. The primary outcome was fistula repair breakdown, on the basis of dye test results, any time between 8 days after catheter removal and 3 months after surgery. The non-inferiority margin was 10%, assessed in the per-protocol population. This trial is registered with ClinicalTrials.gov, number NCT01428830. We randomly allocated 524 participants between March 7, 2012, and May 6, 2013; 261 in the 7 day group and 263 in the 14 day group. In the per-protocol analysis, ten (4%) of 250 patients had repair breakdown in the 7 day group (95% CI 2-8) compared with eight (3%) of 251 (2-6) in the 14 day group (risk difference 0·8% [95% CI -2·8 to 4·5]), meeting the criteria for non-inferiority. 7 day bladder catheterisation after repair of simple fistula is non-inferior to 14 day catheterisation and could be used for management of women after repair of simple fistula with no evidence of a significantly increased risk of repair breakdown, urinary retention, or residual incontinence up to 3 months after surgery. US Agency for International Development.
This article presents data from 1354 women from five countries who participated in a prospective ... more This article presents data from 1354 women from five countries who participated in a prospective cohort study conducted between 2007 and 2010. Women undergoing surgery for fistula repair were interviewed at the time of admission, discharge, and at a 3-month follow-up visit. While women's experiences differed across countries, a similar picture emerges across countries: women married young, most were married at the time of admission, had little education, and for many, the fistula occurred after the first pregnancy. Median age at the time of fistula occurrence was 20.0 years (interquartile range 17.3-26.8). Half of the women attended some antenatal care (ANC); among those who attended ANC, less than 50% recalled being told about signs of pregnancy complications. At follow-up, most women (even those who were not dry) reported improvements in many aspects of social life, however, reported improvements varied by repair outcome. Prevention and treatment programmes need to recognise the supportive role that husbands, partners, and families play as women prepare for safe delivery. Effective treatment and support programmes are needed for women who remain incontinent after surgery.
A vaginal fistula is a devastating condition, affecting an estimated 2 million girls and women ac... more 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. 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. 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. ClinicalTrials.gov Identifier NCT01428830.
The field of obstetric fistula has historically lacked common definitions for measuring needs and... more The field of obstetric fistula has historically lacked common definitions for measuring needs and outcomes. This paper recounts the process of developing, refining, and using standardized monitoring indicators as part of a fistula prevention and repair project in fourteen countries—Bangladesh, Benin, Democratic Republic of the Congo, Ethiopia, Ghana, Guinea, Liberia, Mali, Niger, Nigeria, Rwanda, Sierra Leone, Togo, and Uganda. The process included collaborative indicator development, introducing standardized data collection at health facilities, and promoting the integration of fistula indicators into national health management information systems (HMIS) to enable continued measurement and support for fistula treatment services. As monitoring of obstetric fistula continues to become more standardized and routine, the multi-country scope of the project has enabled a wide-ranging effort through which indicators for an emerging maternal health content were introduced and applied.
Findings from a baseline survey conducted prior to the initiation of organized family planning ef... more Findings from a baseline survey conducted prior to the initiation of organized family planning efforts in one urban and one rural area of Bas Zaire reveal the widespread use of traditional methods and a surprisingly high level of knowledge of modern contraceptives. However, in the absence of a delivery system, use of the latter was extremely limited (4-5 percent of currently married women). The data reflect a deep-seated motivation for birth spacing, which is achieved primarily through withdrawal and abstinence. Of the variables tested as possible correlates, only economic status was related to use of both traditional and modern methods in the same direction. Use of a traditional method was largely determined by age of the youngest child and breastfeeding status. By contrast, use of a modern method was highest among women over 30 with higher levels of education and parity, who were not currently breastfeeding.
Follow-up surveys were carried out in six countries (Bangladesh, Columbia, El Salvador, Guatemala... more Follow-up surveys were carried out in six countries (Bangladesh, Columbia, El Salvador, Guatemala, Indonesia, and Tunisia) between 1984 and 1986 to assess client decision-making regarding sterilization. The results revealed that women made well-informed, voluntary decisions to be sterilized. They were knowledgeable about other family planning methods and made the decision to be sterilized after consulting their partners, friends, relatives, or other sterilized women. Although their decisions were voluntary, other findings revealed areas for improvement such as client information and education about the risks of the procedure. These data were used to improve program services by emphasizing the need for better information, education, and counseling programs.
The purpose of this study was to determine the comparability of two indicators of family planning... more The purpose of this study was to determine the comparability of two indicators of family planning (FP) performance-number of active users (a widely reported statistic) and couple-months-of protection. Both were used to monitor the Guatemalan community- based distribution (CBD) program over a twelve-month period. Discrepancies between the two indicators were observed m monthly statistics but were minimal in trimester data.
This paper contains data from a qualitative study from 218 in-depth interviews with men and women... more This paper contains data from a qualitative study from 218 in-depth interviews with men and women and their partners who decided to have a vasectomy in six countries: Bangladesh, Kenya, Mexico, Rwanda, Sri Lanka and the USA. It examined the key factors that led men to choose vasectomy and what role their partners played in this decision. The reasons for
Page 1. ARTICLES A Comparison of Sterilization Use and Demand From the Demographic and Health Sur... more Page 1. ARTICLES A Comparison of Sterilization Use and Demand From the Demographic and Health Surveys By Naomi Rutenberg and Evelyn Landry Data from 26 countries that participated in the first phase of the Demographic and Health Sur-...
... Mass media. Several country teams in-cluded in their information, education and communication... more ... Mass media. Several country teams in-cluded in their information, education and communications strategy a plan to work directly with the mass media to develop messages for men and women about male reproductive health. ...
Objectives: To present profiles and experiences of women with obstetric fistula. Methods: Data fo... more Objectives: To present profiles and experiences of women with obstetric fistula. Methods: Data for 1,354 women were collected at admission, surgery, discharge, and 3 month follow-up using standardized forms. Results: Median fistula duration was 1 year and median age at fistula development was 20. At time of surgery, median parity was 2, and most women were married and financially supported by husbands or other relatives. Effects of living with fistula result in women being socially isolated : more than 80% reported leaking from the fistula prevented then attending social and religious gatherings and ability to work. Before discharge over 90% were counseled about FP and the importance of antenatal care for the next pregnancy; 54% accepted FP at time of discharge. At the three month follow up more than 70% of women reported improvements in the quality of their lives post-surgerymore were able to eat with others, attend religious and social gatherings and return to work. Conclusions: P...
Duration of bladder catheterisation after female genital fistula repair varies widely. We aimed t... more Duration of bladder catheterisation after female genital fistula repair varies widely. We aimed to establish whether 7 day bladder catheterisation was non-inferior to 14 days in terms of incidence of fistula repair breakdown in women with simple fistula. In this randomised, controlled, open-label, non-inferiority trial, we enrolled patients at eight hospitals in the Democratic Republic of the Congo, Ethiopia, Guinea, Kenya, Niger, Nigeria, Sierra Leone, and Uganda. Consenting patients were eligible if they had a simple fistula that was closed after surgery and remained closed 7 days after surgery, understood study procedures and requirements, and agreed to return for follow-up 3 months after surgery. We excluded women if their fistula was not simple or was radiation-induced, associated with cancer, or due to lymphogranuloma venereum; if they were pregnant; or if they had multiple fistula. A research assistant at each site randomly allocated participants 1:1 (randomly varying block sizes of 4-6; stratified by country) to 7 day or 14 day bladder catheterisation (via a random allocation sequence computer generated centrally by WHO). Outcome assessors were not masked to treatment assignment. The primary outcome was fistula repair breakdown, on the basis of dye test results, any time between 8 days after catheter removal and 3 months after surgery. The non-inferiority margin was 10%, assessed in the per-protocol population. This trial is registered with ClinicalTrials.gov, number NCT01428830. We randomly allocated 524 participants between March 7, 2012, and May 6, 2013; 261 in the 7 day group and 263 in the 14 day group. In the per-protocol analysis, ten (4%) of 250 patients had repair breakdown in the 7 day group (95% CI 2-8) compared with eight (3%) of 251 (2-6) in the 14 day group (risk difference 0·8% [95% CI -2·8 to 4·5]), meeting the criteria for non-inferiority. 7 day bladder catheterisation after repair of simple fistula is non-inferior to 14 day catheterisation and could be used for management of women after repair of simple fistula with no evidence of a significantly increased risk of repair breakdown, urinary retention, or residual incontinence up to 3 months after surgery. US Agency for International Development.
This article presents data from 1354 women from five countries who participated in a prospective ... more This article presents data from 1354 women from five countries who participated in a prospective cohort study conducted between 2007 and 2010. Women undergoing surgery for fistula repair were interviewed at the time of admission, discharge, and at a 3-month follow-up visit. While women's experiences differed across countries, a similar picture emerges across countries: women married young, most were married at the time of admission, had little education, and for many, the fistula occurred after the first pregnancy. Median age at the time of fistula occurrence was 20.0 years (interquartile range 17.3-26.8). Half of the women attended some antenatal care (ANC); among those who attended ANC, less than 50% recalled being told about signs of pregnancy complications. At follow-up, most women (even those who were not dry) reported improvements in many aspects of social life, however, reported improvements varied by repair outcome. Prevention and treatment programmes need to recognise the supportive role that husbands, partners, and families play as women prepare for safe delivery. Effective treatment and support programmes are needed for women who remain incontinent after surgery.
A vaginal fistula is a devastating condition, affecting an estimated 2 million girls and women ac... more 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. 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. 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. ClinicalTrials.gov Identifier NCT01428830.
The field of obstetric fistula has historically lacked common definitions for measuring needs and... more The field of obstetric fistula has historically lacked common definitions for measuring needs and outcomes. This paper recounts the process of developing, refining, and using standardized monitoring indicators as part of a fistula prevention and repair project in fourteen countries—Bangladesh, Benin, Democratic Republic of the Congo, Ethiopia, Ghana, Guinea, Liberia, Mali, Niger, Nigeria, Rwanda, Sierra Leone, Togo, and Uganda. The process included collaborative indicator development, introducing standardized data collection at health facilities, and promoting the integration of fistula indicators into national health management information systems (HMIS) to enable continued measurement and support for fistula treatment services. As monitoring of obstetric fistula continues to become more standardized and routine, the multi-country scope of the project has enabled a wide-ranging effort through which indicators for an emerging maternal health content were introduced and applied.
Uploads
Papers by Evelyn Landry