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Utilization and predictors of long acting reversible contraceptive methods among reproductive age women in Hawassa city, South Ethiopia: a community based mixed methods.

ABSTRACT: Background:Long acting reversible contraceptive methods are highly effective, safe and provide uninterrupted protection to women for 3 to 12?years, yet are little used in the Ethiopia. Assessment of the utilization and predictors of long acting reversible contraceptive methods assist health planners to prioritize promotion strategies, and is a fundamental step for intervention. Therefore, this study aimed to assess the utilization and predictors of long acting reversible contraceptives among reproductive age women in Hawassa city, South Ethiopia; 2019. Methods:A community-based cross-sectional study was conducted using a mixed method among the sample of 660 reproductive age women in Hawassa city, South Ethiopia from January 1-30, 2019. We have used a systematic and purposive sampling technique to select the study participants. A structured interview-administrated questionnaire and focus group discussion were used to collect the data. The data were entered using Epi data version 3.1 and analyzed using SPSS version 20. Chi-square (X2) test was used to determine the overall association between explanatory and outcome variables. The variables were entered into the multivariable model using the backward stepwise regression approach. Bi-variable and multivariable logistic regression analyses were conducted. The qualitative data were analyzed using a manual thematic analysis technique. Results:The overall utilization of long acting reversible contraceptive methods was 22% (95% CI?=?19.50-25.50%). Among this, 17.5 and 4.5% of women utilized the implants and IUCD, respectively. Good knowledge (AOR?=?4.0; 95% CI?=?1.66-9.60; P =?0.001) and positive attitude (AOR?=?7.9; 95% CI?=?3.84-16.10; P =?0.001) of women about LARC methods were positively associated with utilization of LARC methods. The odds of utilizing LARC methods increased 8.2 times for women who have no desire to have a child (AOR?=?8.2, 95% CI?=?3.13-21.30) as compared to those who have the desire to have a child. The discussion of women about LARC methods with providers (AOR?=?4.1; 95% CI?=?1.24-5.24) and husbands (AOR?=?2.7; 95% CI =1.02-7.20) were positively associated with utilization of LARC methods. These findings were supported by the individual, institutional and socio-cultural qualitative findings. Conclusions:The utilization of LARC methods far below the national target (22?V 40%) in the study area. Good knowledge and positive attitude about LARC methods, no desire to have a child, discussion with husbands and providers were major predictors of the LARC methods utilization. Increasing knowledge and positive attitude of the women about LARC methods using various methods of health education should be considered.

SUBMITTER: Tilahun A

PROVIDER: S-EPMC7336663 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Utilization and predictors of long acting reversible contraceptive methods among reproductive age women in Hawassa city, South Ethiopia: a community based mixed methods.

Tilahun Aklilu A Yoseph Amanuel A Dangisso Mesay Hailu MH

Contraception and reproductive medicine 20200706

<h4>Background</h4>Long acting reversible contraceptive methods are highly effective, safe and provide uninterrupted protection to women for 3 to 12 years, yet are little used in the Ethiopia. Assessment of the utilization and predictors of long acting reversible contraceptive methods assist health planners to prioritize promotion strategies, and is a fundamental step for intervention. Therefore, this study aimed to assess the utilization and predictors of long acting reversible contraceptives a ...[more]

PMID: 32647585

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Project description:BackgroundSame-day placement of long-acting reversible contraceptives, occurring when the device is requested and placed within a single visit, reduces barriers to the patient and reduces unintended pregnancies. Despite the safety and efficacy of same-day placement, access to same-day services remains low.ObjectiveThis study aimed to evaluate the effects of the Delaware Contraceptive Access Now initiative, a statewide initiative in Delaware focused on increasing same-day access to effective contraception on same-day receipt of long-acting reversible contraceptives.Study designWe used Medicaid claims and encounter data to identify instances of same-day and multivisit receipts of long-acting reversible contraceptives among Medicaid-enrolled individuals in Delaware and Maryland aged 15-44 years who were covered in a full-benefits or family planning Medicaid aid category during the month of the placement and the 2 previous months. We used a difference-in-differences design that compared changes in the outcome from before to after implementation of the initiative among placements at agencies that participated in the initiative (n=6676) vs 2 alternative comparison groups: placements at Delaware agencies that did not participate (n=688) and placements in Maryland (n=35,847).ResultsWe found that the intervention was associated with a 13.3 percentage point increase (95% confidence interval, 1.9%-24.7%) in receipt of same-day long-acting reversible contraceptives using a nonparticipating Delaware comparison group, a 21.1 percentage point increase (95% confidence interval, 13.7%-28.6%) using a Maryland comparison group, and a 21.0 percentage point increase (95% confidence interval, 14.1%-27.9%) using a pooled comparison group. The effects were larger for implants than intrauterine devices.ConclusionThe Delaware Contraceptive Access Now initiative substantially increased the number of patients receiving long-acting reversible contraceptives through a single-visit encounter. Our findings suggested that coordinated interventions involving provider and staff training and capital investments that seed device stocking can increase the number of patients receiving same-day long-acting reversible contraceptives.

Project description:ObjectivesThis analysis aimed to estimate the average annual cost of available reversible contraceptive methods in the United States. In line with literature suggesting long-acting reversible contraceptive (LARC) methods become increasingly cost-saving with extended duration of use, it aimed to also quantify minimum duration of use required for LARC methods to achieve cost-neutrality relative to other reversible contraceptive methods while taking into consideration discontinuation.Study designA three-state economic model was developed to estimate relative costs of no method (chance), four short-acting reversible (SARC) methods (oral contraceptive, ring, patch and injection) and three LARC methods [implant, copper intrauterine device (IUD) and levonorgestrel intrauterine system (LNG-IUS) 20 mcg/24 h (total content 52 mg)]. The analysis was conducted over a 5-year time horizon in 1000 women aged 20-29 years. Method-specific failure and discontinuation rates were based on published literature. Costs associated with drug acquisition, administration and failure (defined as an unintended pregnancy) were considered. Key model outputs were annual average cost per method and minimum duration of LARC method usage to achieve cost-savings compared to SARC methods.ResultsThe two least expensive methods were copper IUD ($304 per women, per year) and LNG-IUS 20 mcg/24 h ($308). Cost of SARC methods ranged between $432 (injection) and $730 (patch), per women, per year. A minimum of 2.1 years of LARC usage would result in cost-savings compared to SARC usage.ConclusionsThis analysis finds that even if LARC methods are not used for their full durations of efficacy, they become cost-saving relative to SARC methods within 3 years of use.ImplicationsPrevious economic arguments in support of using LARC methods have been criticized for not considering that LARC methods are not always used for their full duration of efficacy. This study calculated that cost-savings from LARC methods relative to SARC methods, with discontinuation rates considered, can be realized within 3 years.

Project description:PURPOSE:The study aimed to assess the proportion of eye care service utilization and associated factors among older adults age ≥ 40 years in Hawassa city, South Ethiopia, June 2019. METHOD:A community-based cross-sectional study was conducted among adults aged 40 years and above who permanently live in Hawassa city from April 25 to May 30, 2019. Multistage sampling technique was used to select 704 participants. An interviewer-administered questionnaire was used to collect the data. The collected data was entered to EPI info version 7 & was analyzed by SPSS version 20. Binary logistic regression model was used to identify actual predictors of eye care service utilization. All variables were entered to multivariable analysis and variables with p-value < 0.05 were considered as statistically significant. RESULT:A total of 668 adults participated with a response rate of 94.9%. The median (±IQR) age of study respondents was 48(±10) years and 52.7% were females. The proportion of eye care service utilization within the past 2 years was found to be 23.8% [95% CI: 20.5%-27.1%]. Having history of eye disease [AOR = 9.8, 95% CI: 6.1-15.6], having awareness of regular eye checkup importance [AOR = 7.3, 95% CI:4.4-12.2], older age (age ≥65 years) [AOR = 5.0, 95% CI:1.9-13.3] and higher family monthly income (income ≥6000 ETB) [AOR = 3.0, 95% CI:1.5-5.7] and income 4001-5999 ETB [AOR = 2.9, 95% CI: 1.4-5.9] were positively associated with eye care service utilization. CONCLUSION AND RECOMMENDATION:The proportion of eye care service utilization among older adults in Hawassa city was low. Having a history of eye disease, having awareness about regular eye checkup importance, older age and higher family monthly income were significantly associated with utilization of eye care service. Therefore, it is recommended to provide eye health education for the community to increase awareness about eye care service utilization which can improve eye care service utilization.

Project description:Background:The sharp fertility drop-off in the Amhara region between 2000 and 2011 was due to an increase in modern contraceptive utilization of rural women. However, long-acting contraceptive method utilization was higher among urban than rural women. Therefore, this study aimed to assess rural-urban differentials of long-acting contraceptive method utilization and the contributing factors among reproductive-age women in the Amhara region: analysis of the 2016 EDHS. Methods:The 2016 EDHS data were used. A weighted sample of 2188 (1675 rural and 513 urban) fecund reproductive-age women was used, and a mixed-effects logistic regression model was fitted. Multivariable logistic regression analysis at a P-value <0.05 and adjusted odds ratio with a 95% confidence interval were used to declare significant associations. Results:The overall long-acting contraceptive method use was 13.3% (95% CI=11.6-15.8), and it was 14.8% (95% CI=12.4-17.2) among rural and 8.3% (95% CI=4.5-12.4) among urban women. Among urban women, the odds of long-acting contraceptive method use was higher for women living with a partner (AOR=6.83; 95% CI=1.23-37.84), married women (AOR=5.21; 95% CI=1.95-13.89), women living in a male-headed household (AOR=5.29; 95% CI=1.26-22.38), and women whose partner wanted fewer children (AOR=11; 95% CI=3.46-16.2). Among rural women, the odds of long-acting contraceptive use was higher for women in the richest wealth index (AOR=6.69; 95% CI=3.02-14.83), married women (AOR=30.26; 95% CI=8.81-42.9), women with good knowledge of LACMs (AOR=1.75; 95% CI=1.25-2.46), and women who had no correct knowledge of their ovulatory cycle (AOR=1.93; 95% CI=1.16-3.19). Conclusion:Long-acting contraceptive method use was lower than the national target. LACM use was 8.3% (95% CI=4.5-12.4) among urban and 14.8% (95% CI=12.4-17.2) among rural women. Overall, marital status, educational level, the total number of children, knowledge of LACMs, and correct knowledge of the ovulatory cycle were significantly associated with LACM use.

Project description:Introduction:Sub-Saharan Africa, including Ethiopia, faces serious population and reproductive health challenges, indicated by a higher unmet need for family planning, especially for long-acting contraceptive methods, higher fertility, and population growth rates. The utilization of long-acting reversible contraceptive methods in Ethiopia and in particular in the study area is low. Objective:This study aimed to assess the utilization of long-acting reversible contraceptive methods among female health care workers in the reproductive age group in East Gojjam Zone, Northwest Ethiopia, in 2018. Methods:Institutional-based cross-sectional study was conducted from 1 to 30 March 2018. A total of 392 female health care workers have participated. Data were collected by a structured, pretested, and self-administered questionnaire, then entered into Epi-info Version 7, and analyzed by SPSS Version 21. Bivariable and multivariate binary logistic regression analyses were carried out. p value <0.05 was considered to declare statistically significant variables. Result:The current utilization of long-acting contraceptive methods among female health workers was found to be 22.7%. Supportive attitude of their husbands/partners (AOR at 95% CI 4.62 (1.52-14.09)), having <5000 EBrr monthly family income (AOR at 95% CI 2.813 (1.04-7.57)), supportive attitude towards the utilization of long-acting contraceptive methods (AOR at 95% CI 5.13 (2.03-12.95)), and the desire to have 0-2 children (AOR at 95% CI 5.34 (1.80-15.80)) were positively associated factors towards the utilization of long-acting contraceptive methods. Conclusion:The current utilization of long-acting contraceptive methods was found low. Husbands/partners' supportive attitude, the number of children they want to have, attitude, and monthly family income were identified as significant factors. The East Gojjam Zonal Health Department and other stakeholders should work on the promotion of partners/husbands' involvement in the utilization of long-acting contraceptive methods among reproductive age women, including health care workers.

Project description:Background:Globally, unintended pregnancy has been very high accounting for 27% of maternal deaths. Different studies noted that nearly half of HIV positive women who gave unintended birth were using contraceptive methods prior to their unintended pregnancy. This implies that contraceptive failure contributes to unintended pregnancy. Long-term and permanent contraceptive methods are safe and effective contraceptive options. In women who are using long acting and permanent methods, the unintended pregnancy rate is very low and it is almost the same both in typical and perfect users. However, there is limited information on factors that affect long acting and permanent contraceptive methods utilization among Human Immuno-deficiency Virus (HIV) positive women in Ethiopia. Therefore, the purpose of this study was to assess long acting and permanent contraceptive utilization and its associated factors. Methods:An institution-based cross-sectional study was conducted among 505 married women attending care at Anti Retroviral Therapy (ART) clinics in Bahir Dar from March 16, 2014 to April 15, 2014. The data were collected using a structured and interviewer administered questionnaire. Both bivariate and multivariate logistic regressions were used to identify associated factors. Results:A total of 505 married women participated in the study with a response rate of 99.6%. The utilization of long acting and permanent contraceptive methods (LAPMs) was 27.5% [95% CI, 23.8-31.5]. The multivariate analyses showed that women who were getting pre- anti retroviral therapy (Pre-ART) services [Adjusted Odds Ratio?=?2.65, 95% confidence interval: 1.44, 4.86], had spousal discussion on family planning sometimes [Adjusted Odds Ratio?=?6.03, 95% CI:2.42-15.01] and frequently [Adjusted Odds Ratio?=?6.61, 95% confidence interval: 2.49-17.47], had previous experience on long acting contraceptive methods [Adjusted Odds Ratio?=?9.06, 95% confidence interval: 5.38-15.26], no exposure to myths about LAPMs [Adjusted Odds Ratio?=?2.07, 95% confidence interval: 1.24-3.45], had birth intention after 2 years [Adjusted Odds Ratio?=?6.95, 95% confidence interval: 3.35-14.42], and no such intention [Adjusted Odds Ratio?=?7.60, 95% confidence interval: 3.77-15.34] were factors significantly associated with utilization of long acting and permanent contraceptive methods. Conclusion:The utilization of long acting and permanent contraceptive methods was relatively high. Discussion with partners on family planning, previous experiences of LAPMs, not hearing myths about LAPMs, women not started ART, and no birth intention were positively associated with LAPMs utilization. It is therefore recommended that health service providers need to make couples counseling on FP, undergo behavioral change communication (BCC) to avoid misconceptions/myths regarding LAPMs. Further research is also recommended to address the gaps mentioned in the limitation section and to explore the reason/s for not using LAPMs (qualitative study).

Dataset Information

Utilization and predictors of long acting reversible contraceptive methods among reproductive age women in Hawassa city, South Ethiopia: a community based mixed methods.

Publications

Utilization and predictors of long acting reversible contraceptive methods among reproductive age women in Hawassa city, South Ethiopia: a community based mixed methods.

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