Aime Patrick Niyomugabo, Olufunke Onaadepo, Leopold Ntakirutimana, Muluken Walle Birhanie, Onyinye Cynthia Okeke, Abdul-Rahuf Aderemi Feyitimi, Ejike Daniel Eze, Abdulazeez Jimoh, Abdullateef Isiaka Alagbonsi, Makinde Vincent OlubiyiDepartment of Medical Physiology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, RwandaCorrespondence: Makinde Vincent Olubiyi, Department of Medical Physiology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda, Email m.olubiyi@ur.ac.rwBackground: Hormonal contraceptives (HCs) modulate endocrine and metabolic function. Some formulations have been associated with reduced insulin sensitivity, increasing the functional demand on pancreatic β-cells. This systematic review synthesised evidence on pancreatic β-cell adaptation to HC exposure.Methods: In accordance with PRISMA 2020, PubMed, Scopus and Wiley Online Library were searched for records published from January 2000 to December 2025, combining terms for β-cell function and adaptation with terms for hormonal contraceptives and for glucose homeostasis and insulin resistance. Eligible studies were original investigations in humans and rodents examining β-cell structural, functional or signalling adaptation to HC exposure, with a comparison group or pre-exposure baseline. Risk of bias was assessed by design using RoB 2, NIH and Newcastle-Ottawa criteria, SYRCLE, and adapted in vitro indicators. Findings were synthesised thematically.Results: Of 502 records identified, seven studies met the criteria: four human, two rodent in vivo and one isolated islet study. In women, ethinylestradiol with norgestimate improved insulin sensitivity in lean participants but reduced it in those with obesity; a drospirenone-containing pill raised HOMA-IR; an oral levonorgestrel preparation reduced insulin sensitivity more than an etonogestrel vaginal ring, with β-cell function unaltered by either; and androgenic formulations amplified postprandial glucose and insulin responses despite unchanged fasting values. In rodents, drospirenone-containing exposure produced hyperinsulinemia with preserved glucose tolerance, attributable to enhanced secretory activity and reduced insulin clearance; levonorgestrel impaired glucose tolerance and raised HOMA-IR, HOMA-β and circulating corticosterone. In isolated rat islets, gestodene metabolites increased insulin and glucokinase expression and glucose-stimulated insulin secretion via oestrogen receptor-dependent pathways.Conclusion: Effects of HC on glucose metabolism and β-cell function appear to depend on progestin composition, route of administration and pre-existing metabolic status. Longitudinal human studies using direct measures of secretory capacity are needed to establish whether compensatory capacity is sustained under continued exposure.Keywords: hormonal contraceptives, progestins, androgenicity, pancreatic β-cell, insulin secretion, insulin resistance, glucose homeostasis
Gaylord Amani Ngaboyeka,1,2 Aladin Mugisho Snr,1 Anouk Neven,3 Claude Kisubi Idumbo,1 Christian Byamungu Mugisho,1 Jean Corneille Zubulu Lembebu,1 Joelle Nsimire,1 Musafiri Namegabe Moïse Snr,1,2 Armand Bisimwa Mulume,1 Serge Chentwali,4 Julien Bacirhukenge Migabo Snr,1 Bony Bugugu,1 Ghislain Bisimwa Balaluka,1 Pacifique Mwene-Batu11École Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo; 2Institut Supérieur de Techniques Médicales Kanyamulande, Walungu, South Kivu, Democratic Republic of Congo; 3Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg; 4Department of Obstetrics and Gynecology, General Referral Hospital of Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of CongoCorrespondence: Gaylord Amani Ngaboyeka, École Régionale de Santé Publique, Université Catholique de Bukavu, B.O. 285 Bukavu, Bukavu, Democratic Republic of Congo, Email amaningaboyekagaylord@gmail.comBackground: Adolescents living in conflict-affected settings face major barriers to accessing sexual and reproductive health (SRH) information and services. Evidence on SRH knowledge, attitudes and practices (KAP) among adolescents in eastern Democratic Republic of the Congo (DRC) remains limited. This study assessed SRH KAP and identified factors associated with good SRH knowledge among school-going adolescents in North and South Kivu.Methods: A school-based cross-sectional study was conducted from April to July 2023 among 559 school-going adolescents from 28 secondary schools in seven health zones of North and South Kivu. Data were collected using a pre-tested structured questionnaire. Good SRH knowledge was defined as an overall knowledge score of ≥ 75%. Factors associated with good SRH knowledge were assessed using Poisson regression with robust variance, and adjusted prevalence ratios (aPRs) with 95% confidence intervals (95% CIs) were estimated.Results: Overall, 559 participants were included and 50.5% were girls. After age recoding, mean age was 17.2 ± 1.3 years. Overall, 29.7% had ever had sexual intercourse, while 8.1% had ever used SRH services. High domain knowledge was recorded for 32.7% of the 379 participants with general genital-organ categories, 30.2% for HIV transmission, and 26.8% for contraceptive methods. In the adjusted analysis (n=550), high overall SRH knowledge was associated with South Kivu residence (aPR=6.94; 95% CI: 3.84– 12.56; p< 0.001), Internet information (aPR=1.53; 95% CI: 1.22– 1.93; p< 0.001), information from another doctor (aPR=1.64; 95% CI: 1.26– 2.15; p< 0.001), and information from the mother (aPR=1.56; 95% CI: 1.08– 2.24; p=0.017). Household size was inversely associated with high knowledge (aPR=0.957 per additional person; 95% CI: 0.917– 0.999; p=0.046). Age and school year were not significant after adjustment.Conclusion: Adolescents in North and South Kivu showed substantial gaps in SRH knowledge, low utilization of SRH services, and several indicators of sexual vulnerability. Important differences in SRH knowledge were observed between the two provinces, with higher prevalence of good knowledge among adolescents in South Kivu. Strengthening comprehensive sexuality education and improving access to reliable, adolescent-friendly SRH information through schools, families, healthcare providers, digital platforms, and other appropriate communication channels may help address these gaps. Interventions should also consider the social and contextual barriers that may affect adolescents’ access to SRH information and services in conflict-affected settings.Keywords: adolescents, sexual and reproductive health, knowledge, attitudes, practices, conflict-affected settings, Democratic Republic of Congo
Purpose:Adolescent pregnancy rates have remained unacceptably high in Uganda, with a minimal decline over 20 years despite several interventions at the school and community levels. This study aimed at piloting and evaluating the effectiveness of facility-based group postpartum and postabortion counselling compared with routine care in increasing same-day uptake of modern contraception among adolescent girls and young women in selected health facilities in Southwestern Uganda. Methods:We conducted a quasi-experimental study among 393 participants in eight health facilities in four districts in Southwestern Uganda. Participants who were at least six weeks or more postpartum or two weeks postabortion were enrolled in the study between January and March 2024. A pre- and post-health facility visits questionnaire was conducted to assess whether a participant accepted a modern contraceptive method during routine care (control group) or following a group counselling session (intervention group). We conducted a Poisson regression to determine the prevalence ratio for uptake of modern contraception among participants. Results:A total of 393 participants (195 vs 198) were enrolled in the control (standard of care) and intervention group, respectively. Of these, 64 (16.3%) were younger than 18 years, 208 (52%) were single, 117 (29.8%) had sex younger than 15 years, and 51 (12%) had repeat pregnancies. A total of 108 (55.1%) vs 49 (25.1%) participants had same-day uptake of contraception within the intervention and control groups, respectively, with injectable contraception being the most common method used. Compared with those who received routine care, participants who received group counselling were more likely to accept a contraceptive method (PR= 2.24, 95% CI: 1.70-3.00, P<0.001). Conclusion:The rate of contraception uptake among participants in the intervention group was more than double that of those receiving routine counselling. This is a promising tailored intervention targeting adolescent girls and young women within healthcare settings that may be considered for scale-up in different contexts and further validation in cluster or individual randomized trials.
Background:Unintended pregnancies remain a major public health concern in Sub-Saharan Africa (SSA), especially among adolescent girls and young women (AGYW). In Southern Africa, where HIV prevalence is among the highest globally, modern contraceptive use is critical for both pregnancy prevention and HIV risk reduction. Therefore, this study sought to determine the magnitude and multilevel determinants of modern contraceptive use among sexually active AGYW in six Southern African countries with high HIV prevalence. Methods:This study used cross-sectional data from the Demographic and Health Surveys (DHSs) of six Southern African countries, including a weighted sample of 18,265 sexually active AGYW aged 15-24 years. We fitted multilevel logistic regression models to examine the individual and community-level determinants of modern contraceptive use, with statistical significance at p <0.05. Results:Most participants were aged 20-24 years (61.7%). The pooled magnitude of modern contraceptive use among sexually active AGYW was 46.3% (95% CI: 45.2-47.5%). At individual level, AGYW with higher education (aOR = 3.73, 95% CI: 2.89-4.81), employed (aOR = 1.20, 95% CI: 1.13-1.29), married (aOR = 1.29, 95% CI: 1.19-1.40), lacked desire for more children (aOR = 1.23, 95% CI: 1.06-1.43), and those with a recent health facility visit (aOR = 1.32, 95% CI: 1.22-1.42) had higher odds of modern contraceptive use. At the community level, AGYW from communities with higher education levels (aOR = 1.21, 95% CI: 1.10-1.34) also had increased odds of modern contraceptive use. Conclusion and Recommendations:Less than half of AGYW in the six high HIV prevalence Southern African countries reported modern contraceptive use. Several multilevel determinants influenced uptake. Therefore, governments in the six countries need to address disparities through targeted policies and interventions, such as enhancing education, engaging in mass media outreach programmes, and improving healthcare access, which could increase modern contraceptive use, reduce unintended pregnancies, and contribute to HIV prevention efforts.
Background:Closely spaced pregnancies increase the risks of maternal and perinatal morbidity. Initiation of contraception in the immediate postpartum period offers a critical opportunity to address this unmet need during a window when women are in contact with health services. We explored barriers and facilitators of immediate postpartum contraceptive uptake at a tertiary hospital in southwestern Uganda, using the Theory of Planned Behavior. Methods:We conducted a qualitative descriptive study between August and December 2025 at Mbarara Regional Referral Hospital. Using purposive sampling, we conducted 7 focus group discussions among postpartum women (24), spouses (19), midwives (20), and doctors (12) involved in maternity care using semi-structured interview guides grounded in the TPB. Audio-recorded interviews were transcribed verbatim, translated where necessary, and analysed using thematic analysis. Themes were deductively mapped onto the TPB domains of attitudes, subjective norms, and perceived behavioural control until no new themes emerged across successive focused group discussions. Results:Participants generally viewed postpartum family planning positively and recognized its role in child spacing, maternal recovery, and family wellbeing. However, uptake was hindered by fears of side effects, misconceptions about infertility and contraceptive failure, concerns regarding immediate postpartum initiation, and limited awareness of methods suitable for use. While partner support facilitated uptake, opposition and community myths discouraged use. Perceived behavioural control was constrained by inadequate counselling, limited provider confidence, poor integration of family planning services within maternity care, and inconsistent availability of contraceptive methods. Conclusion:Immediate postpartum contraceptive uptake is influenced by interconnected individual, social, and health-system factors. It requires multi-level interventions: integrated contraceptive counselling across the antenatal-postnatal continuum, structured male partner engagement, correction of community misconceptions, training of health care providers, and onsite availability of methods within labour wards and theatres.
