This document discusses variation in the prevalence and provision of intrauterine contraception (IUC) worldwide. It finds wide variation between continents, regions, and countries. Prevalence is highest in Asia, at 83% of global users, with nearly two-thirds of users located in China. Prevalence varies greatly within regions, with some countries having rates above 40% while others have rates below 2%. Variation is influenced by the types of providers authorized to place IUC, locations where it can be accessed, funding models, medico-legal environments, and availability of trained providers. Expanding provider types and locations, as seen in the example of authorizing midwives in Turkey, can increase IUC utilization and uptake.
Mother-to-child transmission of HIV (MTCT) is the main route by which infants acquire HIV infection globally. In 2010, children living with HIV in Nigeria contributed 15.3% to the 370,000 infected children worldwide, thus, the region with the highest number of unprotected childhood infection. This accounts for about 90% of HIV infection in children below 15 years of age.Most children below 15 years living with HIV contract diseases through MTCT (FMoH, 2010)
Overall incidence of MTCT without intervention is 20%-45% distributed over
-Antenatal period
-Labour & Delivery
-Breastfeeding
Without intervention,
About 30% of infants of HIV infected mothers will be infected during pregnancy and delivery
An additional 5-20% will also be infected through breastfeeding practices.
Sorry this presentation is not great, because all the animations just stockpiled. If you want to see a better version, please go to http://tinyurl.com/pat48ks
Thanks!
Mother-to-child transmission of HIV (MTCT) is the main route by which infants acquire HIV infection globally. In 2010, children living with HIV in Nigeria contributed 15.3% to the 370,000 infected children worldwide, thus, the region with the highest number of unprotected childhood infection. This accounts for about 90% of HIV infection in children below 15 years of age.Most children below 15 years living with HIV contract diseases through MTCT (FMoH, 2010)
Overall incidence of MTCT without intervention is 20%-45% distributed over
-Antenatal period
-Labour & Delivery
-Breastfeeding
Without intervention,
About 30% of infants of HIV infected mothers will be infected during pregnancy and delivery
An additional 5-20% will also be infected through breastfeeding practices.
Sorry this presentation is not great, because all the animations just stockpiled. If you want to see a better version, please go to http://tinyurl.com/pat48ks
Thanks!
Everything you need to know about the feminine health market in one easy infographic - available only here
http://www.almalasers.com/us/wp-content/uploads/2017/03/FE02221701-Rev.-A FemiLift-Infographic-v11.pdf
October 7, 2019
On October 7, 2019, the Harvard Global Health Institute will host a one-day symposium to explore what enabled this visionary program, and to showcase how it has transformed not just the worldwide HIV/AIDS response but global health delivery more broadly.
There are many lessons learned in PEPFAR’s story - from what it took to build a supply chain where there was none, to establishing the use of generic antiretroviral therapies (ARTs) and leveraging human capacity. This event convened the early architects of PEPFAR as well as experts and implementers currently leading the charge. We took a historically informed look at what it will take to stop global transmission, and shared tools useful for others hoping to move the needle on vexing problems in global health.
For more information, visit our website at https://petrieflom.law.harvard.edu/events/details/15-years-of-pepfar
Poster presentation at the AIDS 2018 conference in Amsterdam.
By: Adam Bourne1, Beatrice Alba1, Alex Garner2, Gianfranco Spiteri3, Anastasia Pharris3, Teymur Noori3
1. Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia; 2. Hornet Gay Social Network, California, USA; 3. European Centre for Disease Prevention and Control, ECDC, Sweden
PANEL DISCUSSION
MODERATOR: DR. RUPAM ARORA / Dr. Sharda Jain
PANELISTS:
DR. ARUNA SAXENA
DR. DEEPTI NABH
DR. ILA GUPTA
DR. JYOTI AGARWAL
DR. RAJ BOKADIA
DR. RENU CHAWLA
Is cervical cancer common
Progress, Challenges and Opportunities for Vaccines to Reduce Under-5 Childho...Sara Berlanda
In this slideset, Professor Shabir Madhi, WAidid board member, analyses the trends in global and sub-Saharan Africa under-5 childhood mortality, to then demonstrate the contribution of new childhood vaccines in reducing under-5/neonatal morbidity and mortality by vaccination.
To learn more, visit www.waidid.org!
Washington Global Health Alliance Discovery Series
Catherine Wilfert, MD [
December 1, 2008
'Global Prevention of Mother to Child Transmission of HIV-1'
World Gold Council | Mining Indaba 2014 | Gold for Health presentationWorld Gold Council
Supporting slide deck following Dr. Trevor Keel's panel discussion exploring gold’s role in medical technology and community healthcare.
Panellists included:
Dr Trevor Keel, Head of Technology, World Gold Council
Dr Brian Chicksen, Vice President Sustainability: Health and EVP Support, AngloGold Ashanti
Dr Brian Brink, Group Chief Medical Officer, Anglo American and Board Member, The Global Fund
Dr Alexis Nang-Beifubah, Regional Director of Health Services in Ghana
Dr Devanand (Patrick) Moonasar, Director Malaria, National Department of Health, South Africa
Speaking at the 2015 CCIH Annual Conference, Dr. Douglas Huber discusses injectable contraceptives and addresses common misunderstandings and misperceptions about how they work and side effects.
Everything you need to know about the feminine health market in one easy infographic - available only here
http://www.almalasers.com/us/wp-content/uploads/2017/03/FE02221701-Rev.-A FemiLift-Infographic-v11.pdf
October 7, 2019
On October 7, 2019, the Harvard Global Health Institute will host a one-day symposium to explore what enabled this visionary program, and to showcase how it has transformed not just the worldwide HIV/AIDS response but global health delivery more broadly.
There are many lessons learned in PEPFAR’s story - from what it took to build a supply chain where there was none, to establishing the use of generic antiretroviral therapies (ARTs) and leveraging human capacity. This event convened the early architects of PEPFAR as well as experts and implementers currently leading the charge. We took a historically informed look at what it will take to stop global transmission, and shared tools useful for others hoping to move the needle on vexing problems in global health.
For more information, visit our website at https://petrieflom.law.harvard.edu/events/details/15-years-of-pepfar
Poster presentation at the AIDS 2018 conference in Amsterdam.
By: Adam Bourne1, Beatrice Alba1, Alex Garner2, Gianfranco Spiteri3, Anastasia Pharris3, Teymur Noori3
1. Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia; 2. Hornet Gay Social Network, California, USA; 3. European Centre for Disease Prevention and Control, ECDC, Sweden
PANEL DISCUSSION
MODERATOR: DR. RUPAM ARORA / Dr. Sharda Jain
PANELISTS:
DR. ARUNA SAXENA
DR. DEEPTI NABH
DR. ILA GUPTA
DR. JYOTI AGARWAL
DR. RAJ BOKADIA
DR. RENU CHAWLA
Is cervical cancer common
Progress, Challenges and Opportunities for Vaccines to Reduce Under-5 Childho...Sara Berlanda
In this slideset, Professor Shabir Madhi, WAidid board member, analyses the trends in global and sub-Saharan Africa under-5 childhood mortality, to then demonstrate the contribution of new childhood vaccines in reducing under-5/neonatal morbidity and mortality by vaccination.
To learn more, visit www.waidid.org!
Washington Global Health Alliance Discovery Series
Catherine Wilfert, MD [
December 1, 2008
'Global Prevention of Mother to Child Transmission of HIV-1'
World Gold Council | Mining Indaba 2014 | Gold for Health presentationWorld Gold Council
Supporting slide deck following Dr. Trevor Keel's panel discussion exploring gold’s role in medical technology and community healthcare.
Panellists included:
Dr Trevor Keel, Head of Technology, World Gold Council
Dr Brian Chicksen, Vice President Sustainability: Health and EVP Support, AngloGold Ashanti
Dr Brian Brink, Group Chief Medical Officer, Anglo American and Board Member, The Global Fund
Dr Alexis Nang-Beifubah, Regional Director of Health Services in Ghana
Dr Devanand (Patrick) Moonasar, Director Malaria, National Department of Health, South Africa
Speaking at the 2015 CCIH Annual Conference, Dr. Douglas Huber discusses injectable contraceptives and addresses common misunderstandings and misperceptions about how they work and side effects.
Newborn survival and perinatal health in resource-constrained settings in Asia and the Pacific: Applying Global Evidence to Priorities Beyond 2015
12 April 2013
A protocol for the management of breast cancer developed by the multidisciplinary oncology team at University of Nigeria Teaching Hospital, fully adapted to our environment
AIDSTAR-One WHO's 2010 Recommendations for HIV Treatment: National Guideline ...AIDSTAROne
In 2010, the World Health Organization released revised recommendations for adult and adolescent HIV treatment. This technical brief provides HIV policy makers and program managers with a point of reference as they adapt and implement revised national HIV treatment guidelines. Approaches that worked well, challenges and lessons learned from Sub-Saharan Africa, Latin America, and South-East Asia are highlighted. Links to key resources for countries revising guidelines and implementing revisions are also provided.
www.aidstar-one.com/focus_areas/treatment/resources/technical_briefs/who_2010_guidelines
FINAL-Advocacy-Module 6 Research for advocatesCforCourage
Cancer is a disease in which some of the body’s cells grow uncontrollably and spread to other parts of the body.
Cancer can start almost anywhere in the human body, which is made up of trillions of cells. Normally, human cells grow and multiply (through a process called cell division) to form new cells as the body needs them. When cells grow old or become damaged, they die, and new cells take their place.
Sometimes this orderly process breaks down, and abnormal or damaged cells grow and multiply when they shouldn’t. These cells may form tumors, which are lumps of tissue. Tumors can be cancerous or not cancerous (benign).
Cancerous tumors spread into, or invade, nearby tissues and can travel to distant places in the body to form new tumors (a process called metastasis). Cancerous tumors may also be called malignant tumors. Many cancers form solid tumors, but cancers of the blood, such as leukemias, generally do not.
Benign tumors do not spread into, or invade, nearby tissues. When removed, benign tumors usually don’t grow back, whereas cancerous tumors sometimes do. Benign tumors can sometimes be quite large, however. Some can cause serious symptoms or be life threatening, such as benign tumors in the brain.
Differences between Cancer Cells and Normal Cells
How Does Cancer Develop?
Types of Genes that Cause Cancer
When Cancer Spreads
Tissue Changes that Are Not Cancer
Types of Cancer
Related Resources
Updated: October 11, 2021
If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions. In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., “What Is Cancer? was originally published by the National Cancer Institute.”
Dr. Laura Guay, the Foundation’s Vice President of Research, also conducted a journalist training today sponsored by the National Press Foundation, teaching reporters about some of the most misunderstood issues concerning HIV and children
Say no to cervical cancer-PUBLIC Awareness-Life Care Centre_Dr.Sharda JainLifecare Centre
Cervical Cancer in INDIA
Say no to cervical cancer
Dr.Sharda Jain
Life Care Centre
PUBLIC Awareness_Dr.Sharda Jain
HPV Infection
HPV Vaccination
Cervical Screening
SEE & TREAT Programme tp Prevent Cervical Cancer
Similar to Intra module-1-global-diversity-in-iuc-use (20)
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
1. Series 1
Diversity of practice: provision and
uptake of intrauterine contraception
(IUC) worldwide
2. INTRA group: Intrauterine coNtraception:
Translating Research into Action
A panel of independent physicians with expert interest in
intrauterine contraception
– Formation of the INTRA group and its ongoing work is supported
by Bayer Pharma
Purpose:
– To encourage more widespread use of IUC methods in a broad
range of women through medical education
3. Core Slide Kit: Terms of use
If any adjustments are made to the originals, neither Bayer Pharma nor the
INTRA Group can accept responsibility whatsoever for their content.
– If you make changes you should not use the INTRA slide template.
When using any of these slides, even if you modify them in some way, please
acknowledge to your audience that the original slides were provided by the
INTRA Group:
– “The global INTRA group is a panel of independent physicians with expert interest
in intrauterine contraception. Formation of the INTRA group and its ongoing work is
supported by Bayer Pharma”.
You may select any combination of slides to present on to others; however,
the context of the slides should be maintained wherever possible.
Please be aware that recommendations and regulations around
communications on contraception as well as product labels vary globally, and
ensure that the content and recommendations included in the slides are
aligned to the local regulations and product labels of the country where you
are presenting.
4. In this series:
Variation in prevalence of IUC use
Practitioner variation
Variation in the numbers of providers with the appropriate
skill set
Local variation in practices
6. Wide global variation in prevalence of IUC use
14.3
9.2
15.1
17.9
12.4
7
4.8 4.4
1.1
22.8
12.7
24.7
27
17.1
9.6
6.1
15.4
1.8
0
10
20
30 Women using IUC (%)
Contraceptors using IUC (%)
Women(%)
1. United Nations, 2011
2. Bühling et al 2014
Prevalence of IUC use among women aged 15–49 years, married or in
union*: variation between continents1,2
Contraceptors: women using any form of contraception
*Prevalence of IUC use among women aged 15−49 years, married or in union. IUC is also suitable for single women,
but this group of users is not captured in available data.
7. Variation in prevalence of IUC use* within Africa1
Area of Africa Women aged 15–49 years, married or in union (%)
Using any
method of
contraception
Using any
modern method
of contraception
Using IUC
Sub-Saharan 21.8 15.7 0.5
Northern (excl. Sudan) 60.5 54.0 22.3
Eastern 28.4 22.9 0.5
Middle 18.6 6.6 0.2
Northern 50.4 44.8 18.1
Southern 58.4 58.1 1.1
Western 14.4 8.7 0.7
*Prevalence of IUC use among women aged 15−49 years, married or in union. IUC is also suitable for single
women, but this group of users is not captured in available data.
1. Bühling et al 2014
8. Prevalence of IUC use* within Asia
Extremely wide regional variation in prevalence of
IUC use:
– Lowest prevalence in Southern Asia (2.0%)1
– Highest prevalence in Central Asia (41.5%)1
With regard to individual Asian countries2:
– Highest prevalence: China (40.6%), Democratic People’s
Republic of Korea (42.8%) and Vietnam (43.7%)
– Lowest prevalence: Nepal (0.7%), the Maldives (0.8%),
Bangladesh (0.9%), Afghanistan (1.0%), Myanmar (1.8%) and
Cambodia (1.8%)
*Prevalence of IUC use among women aged 15−49 years, married or in union. IUC is also suitable for single women, but
this group of users is not captured in available data.
1. Bühling et al 2014
2. United Nations, 2011
9. Variation in prevalence of IUC use* within
Europe1,2
Area of Europe Women aged 15–49 years, married or in union (%)
Using any
method of
contraception
Using any
modern method
of contraception
Using IUC
Eastern 74.9 54.3 16.3
Northern 80.1 77.2 11.9
Southern 63.8 46.3 5.7
Western 71.9 68.6 11.4
*Prevalence of IUC use among women aged 15−49 years, married or in union. IUC is also suitable for single women, but
this group of users is not captured in available data.
1. Bühling et al 2014
2. United Nations, 2011
10. Prevalence of IUC use* within Europe1
France
22.7%
Northern Europe
Germany
5.3%
Estonia
35.9%
Latvia
28.0%
Finland
25.8%Norway
23.3%
Sweden
16.2%
Ireland
8.4%
Belarus
25.7%
Moldova
25.2%
Romania
6.7%
Slovenia
22.9%
Macedonia
0.4%
Eastern Europe
Southern Europe
Western Europe
Netherlands
8.0%
Switzerland
6.0%
Portugal
7.3%
Spain
6.4%
Italy
5.8% Greece
3.6%
UK
10.0%
Poland
8.4%
Czech
Republic
13.9%
• Highest prevalence: Eastern Europe (16.3%)
• Lowest prevalence: Southern Europe (5.7%)
*Prevalence of IUC use among women aged 15−49 years, married or in union. IUC is also suitable for single
women, but this group of users is not captured in available data.
1. United Nations, 2011
11. Prevalence of IUC use* within North America
Prevalence of IUC use has increased over recent years1
– 5.3% in the US
– 1.0% in Canada
Rates of IUC use in the US are influenced by ethnicity
– Hispanic women are more likely to use IUC than Caucasians2
1. United Nations, 2011;
2. Mosher, 2010
*Prevalence of IUC use among women aged 15−49 years, married or in union. IUC is also suitable for single
women, but this group of users is not captured in available data.
12. Variation in prevalence of IUC use* within Latin
America and Caribbean
Area of Latin
America and
Caribbean
Women aged 15–49 years, married or in union (%)
Using any
method of
contraception
Using any
modern method
of contraception
Using IUC
Caribbean 61.6 57.0 11.3
Central America 68.2 63.0 9.6
South America 76.1 69.6 5.5
*Prevalence of IUC use among women aged 15−49 years, married or in union. IUC is also suitable for single
women, but this group of users is not captured in available data.
1. Bühling et al 2014
13. Variation in prevalence of IUC use* within
Latin America
*Prevalence of IUC use among women aged 15−49 years, married or in union. IUC is also suitable for single
women, but this group of users is not captured in available data.
Argentina
9.5%
Bolivia
8.4%
Brazil
1.9%
Chile
18.9%
Colombia
11.2%
Ecuador
10.1%
Guyana
7.3%
Paraguay
12.3%
Uruguay
12.3%
Peru
3.8%
Suriname
1.5%
Venezuela
9.5%
Mexico
11.6%
1. United Nations, 2011
14. Prevalence of IUC use* within Latin America
Higher prevalence in Central America (9.6%) versus
South America (5.5%)
Central America
– Highest prevalence: Mexico (11.6%), Costa Rica (6.9%),
Honduras (6.6%) and Panama (6.0%)
– Lowest prevalence: El Salvador (0.8%), Guatemala (1.9%) and
Nicaragua (3.4%)
South America
– Highest prevalence: Chile (18.9%), Paraguay (12.3%) and
Uruguay (12.3%)
– Lowest prevalence: Suriname (1.5%), Brazil (1.9%) and
Peru (3.8%)
*Prevalence of IUC use among women aged 15−49 years, married or in union. IUC is also suitable for single
women, but this group of users is not captured in available data.
1. United Nations, 2011
15. Worldwide distribution of IUC users is not uniform1
83% of the world’s users
of IUC are in Asia1,2
Almost two-thirds (64%)
of the world’s IUC users
are in China alone1
– The majority of women
in Asia use non-
hormonal methods
(stainless steel and
copper IUDs)3
Asia
83%
Europe
8%
Africa
4%
Latin America
& Caribbean
4%
North
America
1%
Oceania
0.03%
Europe
8%
Africa
4%
Oceania
0.03%
North
America
1%
Asia
83%
Latin America &
Caribbean
4%
1. Bühling et al 2014
2. United Nations, 2011
3. Cheung, 2010
16. Reasons for geographical variation in IUC use1
Positive or
negative
influence on IUC
uptake
Types of providers
authorised and the
locations at which
women can access IUC
Funding models
and variation in
cost (to women)
Medico-legal
environment
Differences in
clinical practices
Availability of HCPs with
the appropriate skill set
(availability of practical
training for HCPs)
The types of
devices that are
available in
different countries
1. Bühling et al 2014
18. Providers of IUC services, by country1
Provider
Country OB/GYN
FP physician
or GP
Nurse, midwife
or other provider
Europe
Germany
UK
France
Sweden
The Netherlands
North America
USA
Canada
1. Bühling et al 2014
19. Providers of IUC services, by country1
Provider
Country OB/GYN
FP physician
or GP
Nurse, midwife
or other provider
Latin America
Mexico
Costa Rica
Colombia
Argentina
Brazil
Asia/Asia-Pacific
China
India
Australia
1. Bühling et al 2014
20. Locations for IUC services, by country1
Location
Country
Provider’s
office
Sexual health,
contraception or
youth clinic
Abortion
clinic
Hospital-
based
community
clinic
Europe
Germany
UK
France
Sweden
The Netherlands
North America
USA
Canada
1. Bühling et al 2014
21. Locations for IUC services, by country1
Location
Country
Provider’s
office
Sexual health,
contraception or
youth clinic
Abortion
clinic
Hospital-
based
community
clinic
Latin America
Mexico
Costa Rica
Colombia
Argentina
Brazil
Asia/Asia-Pacific
China
India
Australia
1. Bühling et al 2014
22. Providers and locations of IUC services
influence uptake
Germany France
Providers: OB/GYN only1
Locations: Providers office only1
Providers: OB/GYN, FP physicians,
GPs, nurses, midwives1
Locations: Providers office, sexual
health, contraception or youth clinic,
abortion clinic, hospital-based
community clinic1
IUC utilisation: 5.3%2 IUC utilisation: 22.7%2
Expanding the types of HCPs and range of
locations increases utilisation
1. Bühling et al 2014
2. United Nations, 2011
23. Case study 1: impact of authorising midwives on
IUC uptake in Turkey1
Initial attempts to extend access to IUC to rural areas via mobile clinics failed
owing to difficulties in providing adequate post-placement follow-up care
Turkish government conducted a study to assess whether local midwives
could safely place and remove IUC devices
Based on the results of this study, local midwives were authorised to offer
IUC services
A steady and sustained increase in IUC uptake was achieved over the
following decade
1. d’Arcangues, 2007
24. Case study 2: impact of authorising GPs on IUC
uptake in Egypt1
IUC services used to be provided only by OB/GYNs
Since the mid-1980s, a steady increase in IUC use has
been achieved
This was in part due to the following:
– Authorising GPs to perform placements and removals
– Careful attention to the training and certification of the
new providers
1. d’Arcangues, 2007
25. VARIATION IN THE NUMBERS OF
PROVIDERS WITH THE APPROPRIATE
SKILL SET
26. A paucity of adequately trained providers limits
IUC uptake1
Not enough expert providers offer placement training
(long waiting lists for training places in some countries)
Insufficient providers with the necessary skill set to offer an IUC
placement service
Women may face long waiting lists for IUC placements
Women who would otherwise have chosen IUC opt for other more
immediately available methods
1. Black et al. 2012
27. Factors limiting the number of trained providers
Both scenarios lead to shortages of providers with the necessary
skills to perform IUC placements
Scenario 1: paucity of
trainers: experienced
providers may be reluctant to
offer training to others for fear
that they may lose an
important source of income1
Scenario 2: some healthcare
systems indirectly discourage
HCPs from developing IUC
placement skills: referral
systems may make it
advantageous for providers to
refer rather than provide a
placement service themselves1
1. Black et al. 2012
29. Types of devices available globally
Country LNG-IUS
Copper IUDs
(number of devices) Stainless
steel IUD
1 2–10 10+
Argentina
Australia
Brazil
Canada
China
Colombia
France
Germany
Mexico
The Netherlands
New Zealand
Sweden
UK
USA
1. Bühling et al 2014
30. Reimbursement for IUC varies globally (1)
Reimbursement for IUC either by government or private insurance varies
between countries
– In some countries, for example the UK, both copper IUDs and Mirena are fully
reimbursed and are free to women
– In some countries, only copper IUDs are free to women
In Colombia and Mexico, copper IUDs are free of charge in public clinics1
In New Zealand, copper IUDs are free to women but Mirena is not1,2
– In some countries, Mirena is reimbursed and is free to women
In Australia, Mirena is partially subsidised by the government1,2
– In some countries, certain subsets of women receive reimbursement for IUC
In France, for women <18 years of age, IUD cost and the placement procedure can be
free in family planning clinics2
In Germany, IUC is reimbursed by public and private insurances for women with HMB
and those with certain illnesses that contraindicate use of COCs and POPs2
In Sweden, Mirena can be subsidised for young women and in two counties all
contraceptive methods are free for women under the age of 23 or 25 years2
1. Black et al 2012;
2. Bühling et al 2014
31. Reimbursement for IUC varies globally (2)
Reimbursement for the IUC placement procedure either
by government or private insurance varies between
countries
– In some countries, women do not have to pay for the IUC
placement procedure
In France, IUC placement is reimbursed up to 65% by public
insurance and 35% by private insurance (approximately 90% of the
French population receive complementary private insurance)
1. Bühling et al 2014
32. Other intrauterine devices available in Asia1
Frameless copper device
GyneFix
Combined stainless steel
and copper devices
Uterine-shaped IUDGamma Cu 380 IUD
Framed copper devices
Flexi T CuAiMu Mcu
Stainless steel rings
Single ring Double ring
1. Cheung 2010
34. Product labelling in certain countries is more
restrictive than international Medical Eligibility
Criteria1–4
The Mirena package insert is more restrictive than
supported by evidence
German product labelling
is as a ‘second choice for
nulliparae’
Recommended patient
profile: a parous woman in
a stable, long-term
relationship
Extensive list of
contraindications
HCPs infrequently recommend IUC to women, particularly those who are
nulliparous or adolescent
1. WHO MEC, 2010;
2. US MEC, 2010;
3. UK MEC, 2009
4. Lyus, 2009;
35. Guidelines: variation in pre-insertion screening
requirements may influence IUC uptake accordingly
STI screeningCervical cancer screening
UK
Pre-placement
Pap smears
are not
mandated1
US
Can screen for
STIs and place
IUC on the
same day and
treat any
positive result
in situ4
UK
High-risk women
should be tested
for STIs prior to
placement, but if
not possible,
antibiotic
prophylaxis should
be given1
Australia
Screening
recommended
in higher risk
groups e.g
sexually active
women younger
than 25 years
old3
Germany
Pap smear
within
6 months of
placement is
mandatory2
1. NICE 2005
2. German guidelines 1985
3. Family Planning NSW 2011
4. ACOG 2011
36. Conclusion
There is a wide variation in continental, regional and
global IUC use
– Global distribution of use is uneven with highest use in Asia (83%)
EU (8%), Africa (4%), Oceania (0.03%), North America (1%),
Latin America and Carribean (4%)
– Factors influencing this wide variation includes:
The types of devices available
Access to treatment
Differences in funding methods
Differences in clinical practice and lack of skillset
Medico-legal environment
– Subsequently, there is a local variation in product labelling and
pre-insertion screening recommendations which might influence
IUC uptake accordingly
Editor's Notes
Speaker notes:
This slide summarises the agreed terms of use of the Educational Slide Kit contents.
References
1. United Nations. World Contraceptive Use, 2011. Available at: http://www.un.org/esa/population/publications/contraceptive2011/contraceptive2011.htm (accessed March 2016)
2. Bühling KJ et al. Worldwide use of intrauterine contraception: a review. Contraception 2014;89(3):162-173
Reference
1. Bühling KJ et al. Worldwide use of intrauterine contraception: a review. Contraception 2014;89(3):162-173
References
Bühling KJ et al. Worldwide use of intrauterine contraception: a review. Contraception 2014;89(3):162-173
United Nations. World Contraceptive Use, 2011. Available at: http://www.un.org/esa/population/publications/contraceptive2011/contraceptive2011.htm (accessed March 2016)
Reference
Bühling KJ et al. Worldwide use of intrauterine contraception: a review. Contraception 2014;89(3):162-173
United Nations. World Contraceptive Use, 2011. Available at: http://www.un.org/esa/population/publications/contraceptive2011/contraceptive2011.htm (accessed March 2016)
Reference
1. United Nations. World Contraceptive Use, 2011. Available at: http://www.un.org/esa/population/publications/contraceptive2011/contraceptive2011.htm (accessed March 2016)
References
1. United Nations. World Contraceptive Use, 2011. Available at: http://www.un.org/esa/population/publications/contraceptive2011/contraceptive2011.htm (accessed March 2016)
2. Mosher WD and Jones J. Use of contraception in the United States: 1982-2008. Vital Health Stat 2010; series 23:1-44.
Reference
1. Bühling KJ et al. Worldwide use of intrauterine contraception: a review. Contraception 2014;89(3):162-173
Reference
1. United Nations. World Contraceptive Use, 2011. Available at: http://www.un.org/esa/population/publications/contraceptive2011/contraceptive2011.htm (accessed March 2016)
Reference
1. United Nations. World Contraceptive Use, 2011. Available at: http://www.un.org/esa/population/publications/contraceptive2011/contraceptive2011.htm (accessed March 2016)
15
1. Bühling KJ et al. Worldwide use of intrauterine contraception: a review. Contraception 2014;89(3):162-173
Reference
Bühling KJ et al. Worldwide use of intrauterine contraception: a review. Contraception 2014;89(3):162-173
Reference
Bühling KJ et al. Worldwide use of intrauterine contraception: a review. Contraception 2014;89(3):162-173
Reference
Bühling KJ et al. Worldwide use of intrauterine contraception: a review. Contraception 2014;89(3):162-173
Reference
Bühling KJ et al. Worldwide use of intrauterine contraception: a review. Contraception 2014;89(3):162-173
References
Bühling KJ et al. Worldwide use of intrauterine contraception: a review. Contraception 2014;89(3):162-173
United Nations. World Contraceptive Use, 2011. Available at: http://www.un.org/esa/population/publications/contraceptive2011/contraceptive2011.htm (accessed November 2012)
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Reference
1. Black et al. A review of barriers and myths preventing the more widespread use of intrauterine contraception in nulliparous women. Eur J Contracept Reprod Health Care 2012;17(5):340-50.
Reference:
1. Bühling KJ et al. Worldwide use of intrauterine contraception: a review. Contraception 2014;89(3):162-173
References
Black et al. A review of barriers and myths preventing the more widespread use of intrauterine contraception in nulliparous women. Eur J Contracept Reprod Health Care 2012;17(5):340-50.
Bühling KJ et al. Worldwide use of intrauterine contraception: a review. Contraception 2014;89(3):162-173
Reference:
1. Bühling KJ et al. Worldwide use of intrauterine contraception: a review. Contraception 2014;89(3):162-173
Reference
1. Cheung V. Sonographic appearances of Chinese intrauterine devices. JUM 2010;29:1093−1101.
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World Health Organization. Medical eligibility for contraceptive use, 5th edition 2015. Available online at: http://apps.who.int/iris/bitstream/10665/181468/1/9789241549158_eng.pdf?ua=1 (Accessed March 2016)
US medical eligibility criteria for contraceptive use, 2010. Available at:http://www.cdc.gov/mmwr/pdf/rr/rr59e0528.pdf
UK Medical eligibility criteria for contraceptive use, 2009. Available at:http://www.fsrh.org/pdfs/ukmec2009.pdf
Lyus R et al. on behalf of the Board of the Society of Family Planning. Use of the Mirena LNG-IUS and Paragard CuT380A intrauterine devices in nulliparous women. Contraception 2009;81:367-371.
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National Collaborating Centre for Women's and Children's Health, National Institute for Health and Clinical Excellence. Long-acting reversible contraception: The effective and appropriate use of long-acting reversible contraception. 2005.
Gemeinsamen Bundesausschusses. Richtlinie des Gemeinsamen Bundesausschusses zur Empfängnisregelung und zum Schwangerschaftsabbruch. Bundesanzeiger Nr. 60a . 1985. Available at: http://www.g-ba.de/informationen/richtlinien/9/.
Reproductive and Sexual Health, an Australian Clinical Practice Handbook, 2nd edition, 2011, Family Planning NSW, Australia
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