Browsing by Subject "Reproductive health"

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    A prospective cohort study of school-going children investigating reproductive and neurobehavioral health effects due to environmental pesticide exposure in the Western Cape, South Africa: study protocol
    (BioMed Central, 2018-07-11) Chetty-Mhlanga, Shala; Basera, Wisdom; Fuhrimann, Samuel; Probst-Hensch, Nicole; Delport, Steven; Mugari, Mufaro; Van Wyk, Jennifer; Röösli, Martin; Dalvie, Mohamed A
    Abstract Background Research on reproductive health effects on children from low-level, long-term exposure to pesticides currently used in the agricultural industry is limited and those on neurobehavioral effects have produced conflicting evidence. We aim at investigating the association between pesticide exposure on the reproductive health and neurobehavior of children in South Africa, by including potential relevant co-exposures from the use of electronic media and maternal alcohol consumption. Methods The design entails a prospective cohort study with a follow-up duration of 2 years starting in 2017, including 1000 school going children between the ages of 9 to 16 years old. Children are enrolled with equal distribution in sex and residence on farms and non-farms in three different agricultural areas (mainly apple, table grapes and wheat farming systems) in the Western Cape, South Africa. The neurobehavior primary health outcome of cognitive functioning was measured through the iPad-based CAmbridge Neuropsychological Test Automated Battery (CANTAB) including domains for attention, memory, and processing speed. The reproductive health outcomes include testicular size in boys and breast size in girls assessed in a physical examination, and blood samples to detect hormone levels and anthropometric measurements. Information on pesticide exposure, co-exposures and relevant confounders are obtained through structured questionnaire interviews with the children and their guardians. Environmental occurrence of pesticides will be determined while using a structured interview with farm owners and review of spraying records and collection of passive water and air samples in all three areas. Pesticide metabolites will be analysed in urine and hair samples collected from the study subjects every 4 months starting at baseline. Discussion The inclusion of three different agricultural areas will yield a wide range of pesticide exposure situations. The prospective longitudinal design is a further strength of this study to evaluate the reproductive and neurobehavioural effects of different pesticides on children. This research will inform relevant policies and regulatory bodies to improve the health, safety and learning environments for children and families in agricultural settings.
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    The economics of school-based sexual and reproductive health education interventions
    (2025) Bango, Funeka; Cleary, Susan; Bekker, Linda-Gail
    Background: Promoting the sexual and reproductive health (SRH) of adolescent girls remains central to enabling their health, education, and economic prospects. Comprehensive school-based sexual and reproductive health education (SBSHE) has been recognised as a key strategy for promoting adolescent SRH. However, there is little evidence on the cost and cost- effectiveness of such programmes, limiting investment and priority-setting decisions. Methods: The thesis aimed to understand the economic costs of adolescent sexual and reproductive health services and to evaluate the potential value of a school-based sexual and reproductive health education intervention targeted at adolescent girls in South Africa. A critical review was conducted to understand the methods for conducting community-based health promotion interventions similar to SBSHE interventions. The economic data was collected within a cluster randomised trial. The Goals for Girls trial assessed a sports-based comprehensive SBSHE intervention targeting adolescent girls aged 14 to 17 compared to usual practice. Intervention costs were estimated from a Department of Education provider perspective, using a mixed-method costing approach. The costs of averted basic and emergency intrapartum care were estimated at two levels of care from a Department of Health provider perspective. Subsequently, the economic burden of adolescent girl SRH services was described from a Department of Health provider perspective. In addition, the value of the intervention was assessed via a modelled cost-consequence analysis from a multi-sector perspective across a range of intermediate (% time in school, % pregnant, and % giving birth by five years) and final outcomes (life years and quality-adjusted life years) Results: The results of the critical review showed that the methodological quality of the included studies was good overall. However, the methods applied did not adequately address the methodological issues of conducting economic evaluation in community-based health promotion. The costs of a sports-based SBSHE intervention were $ 9.9 per learner per session and $69.43 per learner graduating (seven of ten sessions). Sensitivity analysis indicated that these costs were sensitive to learner participation rates. The mean cost per patient for vaginal delivery at a maternity obstetric unit and obstetric hospital was US$142.47 and US$557.49, respectively, compared to US$943.33 for a c-section. Clinical costs, including personnel, were the leading drivers of costs in both facilities. The estimated undiscounted cost of SRH services per learner over a five-year period was $289.66, with contraceptives and obstetric services accounting for 48% and 47%, respectively. The total societal costs of the comprehensive SBSHE intervention were $447.07, while life years and quality-adjusted life years were estimated at 4.9 and 4.4, respectively. In scenario analysis, increasing levels of abstinence or contraceptives both improved biological outcomes, although the latter generated significantly higher contraceptive costs. One-way sensitivity analyses revealed that changes in the discount rate and the utilisation of the intervention had the most impact on societal costs. Conclusion: The findings from this thesis are significant for promoting ASRH in South Africa. The findings can contribute to decision-making for comprehensive SBSHE interventions. Including a multisector perspective supports transparency and can foster collaboration across sectors.