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Factors associated with unmet need for limiting childbirth among women living with HIV in Togo: An averaging approach.

ABSTRACT: BACKGROUND:Access to antiretroviral treatment has improved the life expectancy of HIV-positive patients, most often associated with a desire to limit childbearing. Women living with HIV (WLHIV) commonly have unmet need for contraception and could be at risk of unintended pregnancy. Preventing unintended pregnancies among women living with HIV are effective strategies to eliminate mother-to-child transmission of HIV. OBJECTIVE:The aim of this study was to assess unmet need for limiting childbirth and its associated factors among women living with HIV in Togo. METHODS:This facility based cross-sectional study was conducted, between June and August 2016, among WLHIV in their reproductive age (15-49 years) in HIV-care settings in Centrale and Kara regions Data was collected using a structured and pretested questionnaire. WLHIV who desired to limit childbirth but not using contraception were considered to have unmet need of birth limitations. Univariate and multivariate Poisson regression models with robust variance were performed to identify associated factors with unmet needs. A multi-model averaging approach was used to estimate the degree of the association between these factors and the unmet need of birth limitations. RESULTS:A total of 443 WLHIV were enrolled, with mean age of 34.5 years (standard deviation [SD] = 7.0). Among them 244 (55.1%) were in couple and 200 (45.1%) had at least the secondary level of education. 39.1% were followed-up in a private healthcare facility. At the time of the survey, 40.0% did not desire childbearing but only 9.0% (95% CI [6.7-12.1]) of them expressed unmet needs for limiting childbirth. In multivariable analysis, associated factors with unmet needs of birth limitations were: being aged 35 years or more (adjusted prevalence ratio (aPR) = 3.11, 95% confidence intervals (95% CI) [1.52-6.38]), living in couple (aPR = 2.32 [1.15-4.65]), living in Kara region (aPR = 0.10 [0.01-0.76]), being followed in a private healthcare facility (aPR = 0.08[0.01-0.53]) and having severe HIV symptoms (aPR = 3.50 [1.31-9.37]). CONCLUSION:Even though the unmet need for births limitation was relatively low among WLHIV in Togo, interventions to improve more access to contraceptive methods, and targeting 35 to 49 years old women, those in couple or followed in the public healthcare facilities would contribute to the eradication of mother-to-child transmission of HIV.

SUBMITTER: Yaya I

PROVIDER: S-EPMC7239477 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Factors associated with unmet need for limiting childbirth among women living with HIV in Togo: An averaging approach.

Yaya Issifou I Nambiema Aboubakari A Dieng Sokhna S Djalogue Lihanimpo L Agboyibor Mawuényégan Kouamivi MK N'Dri Mathias Kouamé MK Baba-Toherou Takiyatou T Patassi Akouda Akessiwe AA Landoh Dadja Essoya DE Kolani Kanfitine K Aboubakari Abdoul-Samadou AS Saka Bayaki B

PloS one 20200520 5

<h4>Background</h4>Access to antiretroviral treatment has improved the life expectancy of HIV-positive patients, most often associated with a desire to limit childbearing. Women living with HIV (WLHIV) commonly have unmet need for contraception and could be at risk of unintended pregnancy. Preventing unintended pregnancies among women living with HIV are effective strategies to eliminate mother-to-child transmission of HIV.<h4>Objective</h4>The aim of this study was to assess unmet need for limi ...[more]

PMID: 32433689

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Project description:BackgroundNFHS-4 stated high unmet need for family planning (FP) among married women in Uttar Pradesh. Unmet need is highest among age groups: 15-19 and 20-24 years. Currently few data is available about unmet need for FP among vulnerable section of the community, i.e.15-24 year's age group living in the urban slums. Therefore this study was conducted to assess the unmet need for FP services and its determinants among this under-privileged and under-served section of society residing in urban slums of Uttar Pradesh, India.MethodsCross sectional study was conducted in the slums of Lucknow, India. One Urban-Primary Health Centre (U-PHC) was randomly selected from each of the eight Municipal Corporation zones in Lucknow and two notified slums were randomly selected from each U-PHC. All the households in the selected slums were visited for interviewing 33 young married women (YMW) in each slum, with a pre-structured and pre tested questionnaire, to achieve the sample size of 535. Analysis of the data was done using logistic regression.ResultsThe unmet need for family planning services among YMW was 55.3%. About 40.9% of the unmet need was for spacing methods and 14.4% for limiting methods. Important reasons cited for unmet need for family planning services were negligent attitude of the women towards family planning, opposition by husband or others, embarrassment / hesitation / shyness for contraceptive use, poor knowledge of the FP method or availability of family planning services. Among method related reasons health concerns and fear of side effects were frequently cited reasons. On multiple logistic regression: age, educational status, duration of marriage, number of pregnancies, knowledge of contraceptive methods, opposition to contraceptive use and contact with Auxiliary Nurse Midwife (ANM) showed independently significant association with unmet need for family planning services.ConclusionsUnmet need for family planning services is very high among the YMW of urban slums. The findings stress that program managers should take into cognizance these determinants of high level of unmet need for family planning among YMW and make intense efforts for addressing these issues in a holistic manner.

Project description:BackgroundUnmet need for family planning is high (30%) in Ghana. Reducing unmet need for family planning will reduce the high levels of unintended pregnancies, unsafe abortions, maternal and neonatal morbidity and mortality. The purpose of this study was to examine factors that are associated with unmet need for family planning to help scale up the uptake of family planning services in Ghana.MethodsThis cross sectional descriptive and inferential study involved secondary data analysis of women in the reproductive age (15-49 years) from the Ghana Demographic and Health Survey 2014 data. The outcome variable was unmet need for family planning which was categorized into three as no unmet need, unmet need for limiting and unmet need for spacing. Chi-squared test statistic and bivariate multilevel multinomial mixed effects logistic regression model were used to determine significant variables which were included for the multivariable multilevel multinomial mixed effects logistic regression model. All significant variables (p < 0.05) based on the bivariate analysis were included in the multinomial mixed effects logistic regression model via model building approach.ResultsWomen who fear contraceptive side effects were about 2.94 (95% CI, 2.28, 3.80) and 2.58 (95% CI, 2.05, 3.24) times more likely to have an unmet need for limiting and spacing respectively compared to those who do not fear side effects. Respondents' age was a very significant predictor of unmet need for family planning. There was very high predictive probability among 45-49 year group (0.86) compared to the 15-19 year group (0.02) for limiting. The marginal predictive probability for spacing changed significantly from 0.74 to 0.04 as age changed from 15 to 19 to 45-49 years. Infrequent sexual intercourse, opposition from partners, socio-economic (wealth index, respondents educational level, respondents and partner's occupation) and cultural (religion and ethnicity) were all significant determinants of both unmet need for limiting and spacing.ConclusionsThis study reveals that fear of side effect, infrequent sex, age, ethnicity, partner's education and region were the most highly significant predictors of both limiting and spacing. These factors must be considered in trying to meet the unmet need for family planning.

Project description:BACKGROUND:Malawi has a high fertility rate which is also characterized by a relatively high prevalence of unmet need for contraception. However, little is known about the influence of individual- and community- level characteristics on unmet need in Malawi. This study examined the individual- and community- level factors associated with unmet need for family planning (FP) among Malawian women. METHODS:Data from the 2015-16 Malawi demographic and health survey were used to analyze 15, 931 women. The association between individual- and community- level factors and unmet need was assessed using multilevel binary logistic regression models. RESULTS:The prevalence of total unmet need was 21.0%. Women aged ?35?years were more likely to have total unmet need [adjusted odds ratio (aOR)?=?1.19, 95% confidence interval (CI)?=?1.04-1.35] compared with those aged 15-24?years. Women who were married [aOR?=?0.41, 95% CI?=?0.35-0.48], and those employed [aOR?=?0.78, 95% CI?=?0.71-0.85] were associated with less likelihood of having total unmet need compared with unmarried, and unemployed women, respectively. At community-level, women from communities with a high percentage of women from rich households [aOR?=?0.81, 95% CI?=?0.67-0.96], and those from communities with a middle and high percentage of educated women [aOR?=?0.86, 95% CI?=?0.76-0.96 and aOR?=?0.81, 95% CI?=?0.70-0.93, respectively] were less likely to have total unmet need for FP compared with those from communities with low percentages of rich and educated women, respectively. The proportional change in variance showed that about 36.0% of total variations in the odds of unmet need across the communities were explained by both individual- and community-level factors. Moreover, the intraclass correlation showed that about 3.0% of the total variation remained unexplained even after controlling for both individual- and community-level factors. CONCLUSION:Both individual- and community- level factors influenced unmet need for FP in Malawi. Public health practitioners should conduct community profiling and consider individual and community factors when designing FP programs.

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Factors associated with unmet need for limiting childbirth among women living with HIV in Togo: An averaging approach.

Publications

Factors associated with unmet need for limiting childbirth among women living with HIV in Togo: An averaging approach.

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