STRATA Skin Sciences (United States)

Abstract Background Sub-Saharan Africa (SSA) faces a high maternal and child health burden, partly due to low contraceptive use and high fertility rates, with many women having unmet family planning needs. Current measures of unmet need for family planning, based on stated fertility intentions, may overlook women with high-risk fertility due to subjective biases, underestimating contraceptive needs. This study introduces the High-Risk Fertility Contraceptive Gap (HRFCG), a complementary risk-based metric of contraceptive gap. This study assesses HRFCG prevalence, its relationship to current unmet-need measures, and its potential for integration into standard unmet need assessments. Methods This is a secondary analysis of pooled Demographic and Health Survey (DHS) data from 28 sub-Saharan African countries, covering 266,923 married women aged 15–49. High-Risk Fertility (HRF) characteristics were defined as attempting pregnancy or giving birth before age 18, after age 35, after four or more children, or within 24 months of a prior birth. The HRFCG refers to non-use of contraception among women with HRF characteristics. Result Three-quarter of women had at least one high-risk fertility characteristic. Among those with high-risk characteristics, 37% expressed no desire to space or limit births. HRFCG prevalence was 28.5%, exceeding conventional unmet need for family planning (20.9%). On average, 15.3% of women had HRFCG but did not meet conventional unmet need criteria. Integrating HRFCG with the unmet need metric increased the overall estimate from 20.9% to 36.2%, capturing women needing contraception due to fertility desires or high-risk characteristics. Conclusions The HRFCG provides a vital risk-based metric to identify women needing family planning, complementing fertility intention-based unmet need measures for a more comprehensive assessment. Its integration with conventional unmet need indicators is practical, leveraging routinely collected DHS and other similar survey data. This approach enhances equity-focused monitoring and guides targeted strategies to address unmet needs effectively.

Abstract Background Sub-Saharan Africa’s fertility transition has lagged behind other regions despite rapid urbanization, resulting in persistently high fertility rates. Studies on fertility transitions in African cities remain scarce. This study examines the stages of fertility transition across major sub-Saharan African cities and analyzes the impact of key proximate determinants on fertility rate differences among these major cities. Methods This analysis used Demographic and Health Survey (DHS) data from 19 cities with populations over 1 million, classifying cities into four fertility transition stages: post-transition (TFR < 2.1), late-transition (TFR 2.1–2.99), mid-transition (TFR 3.0–3.99), and upper mid-transition (TFR ≥ 4.0). The Bongaarts’ Proximate Determinants model was applied to examine the contributions of marriage, contraception, Postpartum Infecundability (PPI), and abortion to fertility differences across these stages. Results Among the 19 cities studied, only one city falls into the post-transition stage, six in the late-transition, eight in the mid-transition, and four in the upper mid-transition. Marriage rates are lowest in post-transition cities (34.3%) compared to 52–56% in the other stages. Contraceptive use is highest in post-transition at 50.1% and lower at 45.2%, 38.4%, and 21.3% in late-transition, mid-transition, and upper mid-transition cities, respectively. Marriage rates account for the largest portion of the TFR difference between post-transition and late-transition cities (38%), while contraceptive use explains only 2.8% of this gap. Together, marriage and contraceptive use account for 45–60% of the TFR difference between post-transition cities and those in the mid- and upper mid-transition stages. Between late-transition and mid/upper mid-transition cities, contraceptive use explains up to 32% of the TFR difference. Abortion has minimal impact, while PPI slightly offsets fertility differences across the transition groups. Conclusion Most cities in this study were in mid- or late-transition stages, with contraceptive use and marriage rates central to fertility differences. In earlier stages, increased contraceptive use significantly reduces fertility, advancing cities through initial transition phases. However, as cities shift from late to post-transition stages, contraceptive influence declines, and lower marriage rates become dominant, illustrating that a complex interplay between family planning services and cultural shifts around marriage drives fertility transition in the region.

Taranabant, an orally active, potent, and highly selective CB-1 receptor inverse agonist, is being developed for the treatment of obesity. This randomized, placebo-controlled, multiple-dose, crossover study evaluated the effect of taranabant on the pharmacokinetics of ethinyl estradiol and norelgestromin in healthy women receiving > or =3 months of therapy with oral contraceptives. Nineteen participants with normal menstrual cycles received oral contraceptives on days 1 to 21 during 2 consecutive contraceptive cycles. Participants received taranabant 6 mg/day or placebo on days 1 to 21 of each contraceptive cycle. Plasma samples were collected predose and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 12, and 24 hours postdose on day 21 of each cycle for determination of AUC0-24 h and Cmax of ethinyl estradiol and norelgestromin. Lack of a clinically important effect was declared if the 90% confidence intervals for the geometric mean ratio of AUC0-24 h and Cmax in the absence and presence of taranabant were contained within the predefined bounds of (0.8, 1.25). The geometric mean ratios and 90% confidence intervals of ethinyl estradiol and norelgestromin, respectively, were 0.93 (0.87, 1.00) and 1.02 (0.96, 1.09) for AUC0-24 h and 0.95 (0.88, 1.01) and 0.95 (0.88, 1.01) for Cmax. In summary, coadministration of multiple-dose taranabant 6 mg with oral contraceptives did not lead to clinically meaningful alterations in the pharmacokinetic profiles of ethinyl estradiol or norelgestromin.

SUMMARY A sharper Bonferroni procedure for multiple tests of significance is derived. This procedure is an improvement of Hochberg's (1988) procedure which contrasts the individual P-values with corresponding critical points. It is shown that Hochberg's original procedure is conservative, and can be made more powerful by enlarging the rejection region so that the type-one error is exactly at the nominal level. It is also shown that the modified procedure retains all the desired properties of the original procedure.

The solubility and the dissolution rate of the sodium salt of an acidic drug (REV 3164; 7-chloro-5-propyl-1H,4H-[1,2,4]triazolo[4,3-alpha]quinoxaline-1,4-dione) decreased by the effect of common ion present in aqueous media. The solubility of the sodium salt of REV 3164 in a buffered medium was much lower than that in an unbuffered medium. Also, the presence of NaCl decreased its solubility in water. The apparent solubility product (K'sp) of the salt, however, did not remain constant when the concentration of NaCl was changed. A decrease in K'sp value with the increase in NaCl concentration was observed; for example, the K'sp values at 0 and 1 M NaCl were 7.84 X 10(-4) and 3.94 X 10(-4) M2, respectively. Even when corrected for the effect of ionic strength, the solubility product decreased. This decrease in the solubility product in the presence of NaCl indicated a decrease in the degree of self-association (increase in activity coefficient) of the drug in aqueous media.