Postpartum intrauterine contraceptive device use and its associated factors in Ethiopia: systematic review and meta-analysis
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SUBMITTER: Kassa B
PROVIDER: S-EPMC8590214 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundPostpartum contraceptive use is defined as the avoidance of short spaced pregnancies and unintended pregnancy through the first 12 months after delivery. In Ethiopia, different studies have been conducted to assess the prevalence of postpartum contraceptive use and associated factors. The findings of these studies were inconsistent and characterized by great variability. Therefore, the aim of this systematic review and meta-analysis was to estimate the pooled prevalence of postpartum contraceptive use and determinants in Ethiopia using the accessible studies.MethodsThe articles were identified through electronic search of reputable databases (MEDLINE through PubMed, EMBASE, HINARI, Science Direct, and Cochrane Library) and the hand search of reference listed in previous prevalence studies to retrieve more. 18 articles are included based on a comprehensive list of inclusion and exclusion criteria. Two authors independently extracted all necessary data using a standardized data extraction format. STATA 14 statistical software was used to analyze the data. The Cochrane Q and I 2 test were used to assess the heterogeneity between the studies. A random effects model was calculated to estimate the pooled prevalence of postpartum contraceptive use. Moreover, the determinants for family planning use were reviewed.ResultsThe pooled prevalence of family planning use among mothers during the postpartum period in Ethiopia was 48.11% (95% CI: 36.96, 59.27). Besides, subgroup analysis revealed that the highest family planning use prevalence among postpartum mothers was observed in Addis Ababa, 65.41 (95% CI: 48.71, 82.11). Resumed sexual activity: 7.91 (95% CI: 4.62, 13.55), antenatal care: 4.98 (95% CI: 2.34, 10.21), secondary school and above level of maternal education: 3.53 (95% CI: 1.67, 7.45), postnatal care: 3.16 (95% CI: 1.7, 5.88), menses resumption: 3.12 (95% CI: 1.52, 6.39), and ≥6 months of postpartum period: 2.78 (95% CI: 1.97, 3.93) have shown a positive association with the use of family planning among mothers in the postpartum epoch.ConclusionsIn this study, family planning use among mothers of the postpartum period in Ethiopia was significantly low compared to the existing global commendation on postpartum contraceptive use. Resumed sexual activity, antenatal care, secondary and above level of maternal education, postnatal care, menses resumption, and postpartum period ≥ 6 months were found to be significantly associated with postpartum contraceptive use.
| S-EPMC6969652 | biostudies-literature
Project description:IntroductionPostpartum intrauterine contraceptive devices (PP-IUCD) are one type of post-partum family planning method, which can be provided to a post-partum woman starting from the placental delivery time (within 10 minutes), or within the first 48 hours of postpartum period. In most developing countries, delivery time is the primary opportunity for women to access post-partum family planning methods, especially for those living in remote areas. Hence, this study assesses providers' knowledge on postpartum intrauterine contraceptive device service provision.MethodsA facility-based cross-sectional study was conducted in Amhara region health center and hospitals. Health providers surveyed included obstetricians, gynecologists, general practitioners, emergency surgical officers, health officers, midwives and nurses from September 18, 2015 to December18, 2016. Simple random sampling was used to select 864 subjects. Data were collected by using a structured self-administered questionnaire and observing the facility. Multilevel analysis was done to see factors associated with outcome.ResultsA total of 197 health facilities and 864 providers are included in the final analysis. Of the total providers 524 (60.6%) were from a health center. The mean age (±SD) of participants was 27.8 years (±5.4). The number of providers with good knowledge accounted for 253 of those surveyed (29.3%). The proportion of good knowledge among trained PP-IUCD providers was 35.7% (those who scored above average), and 27.9% was untrained about PP-IUCD. A considerable heterogeneity was observed between health facilities for each indicator of provider's knowledge. Gender differences were observed as the mean knowledge score deference on PP-IUCD by 0.4 points (β = -0.41; -0.72, -0.10) when the participant was female. Having experience of regular counseling of pregnant women increases PP-IUCD knowledge score by 0.97. (β = 0.97; 95% CI: 0.48, 1.47). Where the health facility requested clients to purchase the IUCD themselves, the mean knowledge score decreased by 0.47 points compared with free of charge at the facility level (β = -0.47; 95%CI: -0.87, -0.07).ConclusionOur findings showed that providers' knowledge about postpartum IUCD was low in the Amhara region public health facility. The lowest knowledge score was noted among nurses, health Officers, midwives, and general practice professionals. Factors associated with providers' knowledge on PP-IUCD are the status of health facility, female sex, training on PP-IUCD, regular counseling of pregnant women, and unavailability of IUCD service.
| S-EPMC6449033 | biostudies-literature
Project description:ObjectiveThis study aimed to assess the intention and barriers to the use of immediate postpartum intrauterine contraceptive devices among pregnant women attending antenatal clinics in Jimma town public healthcare facilities, southwest Ethiopia.MethodsA facility-based cross-sectional study design was conducted from 1 September to 30 October 2020 by using a systematic sampling technique. Data were entered into Epi-data 3.1 version and exported to Statistical Package for Social Sciences 23 for analysis. A binary logistic regression analysis was done to sort candidate variables for multiple logistic regression, and multivariable logistic regressions were done to identify factors associated with the intention to postpartum intrauterine contraceptive devices. Factors associated with intention to use immediate postpartum intrauterine contraceptive device declared at 95% confidence interval.ResultsThis study finding showed that 37.6% (95% confidence interval (31.5, 43.7)) of pregnant women intended to use the immediate postpartum intrauterine contraceptive device after their delivery. The main reason women refused to use immediate postpartum intrauterine contraceptive devices was being satisfied with other methods to use after they gave birth (27.5 %), the concern of health harm (22.2%), and the fear of impaired future fertility (16.4%). The identified factors that were statically significant with the intention to use immediate postpartum intrauterine contraceptive devices among pregnant women were included: attended secondary education (adjusted odd ratio = 2.36; p = 0.03; 95% confidence interval (1.089, 5.128)), attended college and above (adjusted odd ratio = 2.99; p = 0.020; 95% confidence interval (1.189, 7.541)), have high knowledge on immediate postpartum intrauterine contraceptive devices ((adjusted odd ratio = 2.10; p = 0.006; 95% confidence interval (1.236, 3.564)), the previous history of LACM used (adjusted odd ratio = 6.85; p = 0.0001; 95% confidence interval (3.560, 10.021)), parity >4 (adjusted odd ratio = 1.86; p = 0.043; 95% confidence interval (3.99, 8.703)).ConclusionThe intention of pregnant women to use after they gave birth in the study area was low. Maternal educational level, high knowledge, history of previous long-acting contraceptive methods use, and parity were significantly associated with pregnant women's intention to use immediate postpartum intrauterine contraceptive devices. Healthcare providers should focus on delivering crucial information about immediate postpartum intrauterine contraceptive device benefits for postpartum women, particularly concerning reducing barriers during antenatal care follow-up as they plan to use it after their delivery.
| S-EPMC9989451 | biostudies-literature
Project description:Objectives: The evidence on utilization of immediate postpartum intrauterine contraceptive devices (IPPIUCDs) and its associated factors are limited in Ethiopia. Hence, this study intended to assess IPPIUCD utilization and related factors among women who gave birth in Adama town public hospitals, Ethiopia. Method: A facility-based cross-sectional study was done among 493 postpartum mothers at selected government health facilities in Adama town from January 20 to February 20, 2021. All women who gave birth in selected government health facilities and within 48 h of postpartum were included in the study. Data were collected using an interviewer-administered questionnaire. Logistic regression models were used to identify the factors associated with IPPIUCD utilization. Adjusted odds ratios (AORs) with 95% confidence interval (CI) were calculated to measure the strength of association and statistical significance was declared at p < 0.05. Result: In this study, 22.1% (95% CI: 17.3–25.2) of the mothers used IPPIUCDs within 48 h of giving birth. Having three or more children (AOR = 4.18, 95% CI: 1.79–9.79), having no desire to have another child (AOR = 3.9, 95% CI: 1.86–8.17), counseling after delivery (AOR = 3.1 95% CI: 1.52–6.34), and having good knowledge about PPIUCD (AOR = 3.82, 95% CI: 1.94–7.49) were significantly associated with IPPIUCD utilization. Conclusion: The utilization of IPPIUCD in this study was low. Strategies to raise pregnant mothers’ awareness of IPPIUCD through mass media, and integrating standard counseling on immediate postpartum intrauterine device (IPPIUD) during antenatal care, and the immediate postpartum period are required to improve IPPIUD utilization.
| S-EPMC9768822 | biostudies-literature
Project description:BACKGROUND:Intrauterine Contraceptive Device (IUCD) is a highly effective and reversible modern contraceptive, which is still significantly underutilized in Ethiopia. The aim of this study was to identify factors affecting the use of IUCDs among women of reproductive age group in Addis Ababa. METHODS:Facility-based, unmatched case-control study was employed among randomly selected cases and controls in selected health centers in Addis Ababa from August to October 2017. The cases (n = 128) were women of reproductive age group who were IUCD users and controls (n = 256) were women of reproductive age group who were users of oral or injectable contraceptives during the study period. After randomly selecting two health center from each sub-city the number of cases and controls were equally allocated to each of the selected health centers. In each selected health center, all eligible cases were enrolled consecutively until the sample size was achieved. Two consecutive controls were selected for each case. Data was collected face-to-face by trained nurses by using structured questionnaire. Factors associated with IUCD use were identified by multi-variable binary logistic regression models using the backward conditional stepwise method. RESULTS:In the multi-variable analysis, IUCD use was strongly associated with husbands/partners being supportive of IUCD use (Adjusted OR = 13.24, 95% CI; 5.30-33.02), being literate women (Adjusted OR = 5.31, 95% CI; 1.05-26.93), women having a perception of IUCD does not cause infection (Adjusted OR = 4.38, 95% CI; 1.45-13.26) and the source of information about IUCD being mass-media (Adjusted OR = 3.81, 95% CI; 1.49-9.74). CONCLUSIONS:The findings of the study reinforce the need of husbands/partners involvement in the interventions to enhance utilization of IUCD. Moreover, due attention should also be provided for delivering IUCD-related messages in the public mass-media.
| S-EPMC7028271 | biostudies-literature
Project description:Methods:A community-based cross-sectional study was employed among 686 mothers in Burie District from March 16 to March 25, 2017. A multistage sampling technique was used to select the study participants. Data were collected using face to face interviewer administered structured questionnaires. Then, the collected data was entered, coded, and cleaned into EPI Data version 3.1 and exported to SPSS version 20.0 for data analysis. Bivariate and multivariate logistic regression was done to assess the association of factors with postpartum modern contraceptive use. Adjusted odds ratios with 95% confidence intervals were calculated, and p values <0.05 were considered to indicate statistical significance. Result:This study revealed that postpartum modern contraceptive use was found to be 20.7%. Postpartum modern contraceptive use was significantly associated with women's level of education (AOR = 0.15, 95% CI (0.03-0.71)), discussing FP methods with partner (AOR = 0.60, 95% CI (0.40-0.90)), knowing menses return after birth (AOR = 0.39, 95% CI (0.25-0.59)), ever heard about modern FP methods (AOR = 0.06, 95% CI (0.01-0.43)), and contacting health professionals (AOR = 1.85, 95% CI (1.19-2.88)). Conclusion and Recommendations. Postpartum modern contraceptive use was found to be low. Therefore, health professionals should work on improvements in women's educational status, making awareness of the women and counseling of their husbands about the use of postpartum contraception, when fertility returned and risky timing for becoming pregnant.
| S-EPMC7115150 | biostudies-literature
Project description:Background: Intrauterine device (IUD) is the second most commonly utilized modern family planning method in the world next to female sterilization. It is the most cost-effective, safe, long-lasting, rapidly reversible method of contraception, but only 2% of married women are using the IUD in Ethiopia. Objective: To assess the rate of IUD use and associated factors among married reproductive age women in Mettu rural community, Southwest Ethiopia. Methods: A community-based cross-sectional study was done among 501 married reproductive age women in Mettu rural district, Southwest Ethiopia from April to May 2018. Data were collected by using an interviewer-administrated questionnaire. Bivariate and multiple variable logistic regression analysis were employed. Results: Twenty-one (4.1%) women were currently using the IUD. Women's primary education, adjusted odds ratio (AOR) 4.40 (95% C.I 1.32-14.64); secondary and above education, AOR 5.05 (95% C.I 1.11-22.01); having favorable attitudes, AOR 3.24 (95% C.I 1.06-9.89); absence of myth and misconception, AOR 3.40 (95% C.I 1.23-9. 39); having discussion about IUD with women health development army, AOR 3.11 (95% C.I 1.02-9.49); and possessing more than 2 children AOR 3.48 (95% C.I 1.31-9.27) were positively associated with IUD utilization. Conclusion: Only 1 in 25 women was using an IUD. Sociodemographic factors (education and number of children) and behavioral factors (attitudes, myths, and misconceptions) were found to be significant predictors. Scientific community should explore the local contexts of intrauterine use in different parts of Ethiopia.
| S-EPMC7029536 | biostudies-literature
Project description:The postpartum period is a crucial starting point for the delivery of family planning services. To date, there are numerous primary studies in Ethiopia on postpartum contraceptive use and related factors. However, the results of key variables are inconsistent, making it difficult to use the results to advance the service dimensions of postpartum contraceptive use in the country. Therefore, this systematic review and meta-analysis was required to summarize this inconsistency and compile the best available evidence on the impact of maternal educational status, antenatal care and menstrual resumption on postpartum contraceptive use in Ethiopia. PubMed, Google Scholar, Scopus, Science Direct, and the repositories of online research institutes were searched. Data were extracted with Microsoft Excel and analyzed with the statistical software STATA (version 14). Data on the study area, design, population, sample size, and observed frequency were extracted using the Joanna Briggs Institute tool. To obtain the pooled effect size, a meta-analysis was performed using a weighted inverse variance random effects model. Cochran's Q X2 test, and I2 statistics were used to test for heterogeneity, estimate the total quantity, and measure the variability attributed to heterogeneity. A mixed-effects meta-regression analysis was performed to identify possible sources of heterogeneity. To examine publication bias, the Eggers regression test and the Beggs correlation test were used at a p-value threshold of 0.001. Of the 654 articles reviewed, 18 studies met the inclusion criteria and were included in this meta-analysis. Overall, the final analysis includes 11,263 study participants. In Ethiopia, postpartum contraceptive use correlated significantly with maternal educational status (OR = 3.121:95% CI 2.127-4.115), antenatal care follow-up (OR = 3.286; 95% CI 2.353-4.220), and return of the mother's menses (OR = 3.492; 95% CI 1.843-6.615). A uniform meta-regression was performed based on publication year (p = 0.821), sample size (p = 0.989), and city of residence (p = 0.104), which revealed that none of these factors are significant. The use of postpartum contraceptives was found to be better among mothers who are educated, attended antenatal appointments, and resumed their menstrual cycle. Based on our research, we strongly recommended that antenatal care use and maternal educational accessibility need to improve. For family planning professionals, removing barriers to menstruation resumption should be a key priority.
| S-EPMC10403499 | biostudies-literature
Project description:Intrauterine contraceptive devices (IUCD) are a safe and cost-effective contraceptive method for medically eligible women. Despite this, the utilisation rate for IUCDs is relatively low in many high-income countries, including Australia. Provision of education and training regarding IUCDs to healthcare providers, including nurses and midwives, is one approach to overcome some of the barriers that may prevent wider uptake of IUCDs. This study aims to explore the types and impact of IUCD insertion training for healthcare providers. A systematic review was undertaken in January 2017 to determine the effectiveness of IUCD training for healthcare providers in relation to provision of IUCDs to women. The databases MEDLINE, EMBASE, CINAHL, COCHRANE and SCOPUS were searched to identify studies from high-income countries relating to IUCD training for healthcare providers and relevant outcomes. A total of 30 studies were included in the review. IUCD training for healthcare providers contributed to increased knowledge and improved positive attitudes towards IUCDs, high rates of successful insertions, low complication rates, and increased provision of IUCDs. Successful insertions and low complication rates were similar across different healthcare provider types. No notable differences between provider types in terms of knowledge increase or insertion outcomes were observed. Different training programs for healthcare providers were found to be effective in improving knowledge and successful provision of IUCDs. Increasing the number of healthcare providers skilled in IUCD insertions in high-income countries, including nurses and midwives, will enhance access to this method of contraception and allow women greater contraceptive choice.
| S-EPMC6629157 | biostudies-literature
Project description:BackgroundThe postpartum period is a critical moment for the delivery of family planning services. However, the utilization of family planning among women in sub-Saharan Africa is not optimal. Therefore, the current study aims to assess the intention to use postpartum contraception and its related determinants in the sub-Saharan African setting.MethodsThis study utilized a comprehensive search strategy that involved searching several databases, including PubMed, Scopus, EMBASE, Science Direct, Google Scholar, and online research institutional repository homes. Data extraction was performed using Microsoft Excel, and statistical analysis was conducted using STATA software (version 14). To assess publication bias, a forest plot, Begg's rank test, and Egger's regression test were employed. Heterogeneity was evaluated using the I2 statistic, and an overall estimated analysis was conducted. In addition, sensitivity analysis was performed to examine the impact of each study on the overall estimate. Meta-regression analysis was conducted to identify potential sources of heterogeneity. Finally, the pooled odds ratio (OR) for associated factors was calculated.ResultAfter reviewing 1,321 articles, 14 studies were deemed eligible for inclusion in this meta-analysis. The final analysis comprised a total of 39,936 study participants. The overall intention to use postpartum contraception in sub-Saharan Africa was found to be 62.21% (95% confidence interval [CI]: 55.532-68.875). In subgroup analysis, the highest prevalence of intention was observed in Ethiopia (66.71%; 95% CI: 50.36-83.05), while the lowest prevalence was reported in Ghana (59.39%; 95% CI: 50.22-68.57). The intention to use contraception was found to be 67.22% (95% CI: 62.37-72.07) and 54.53% (95% CI: 46.61-62.45) for institutional and community-based studies, respectively. Maternal educational status (OR = 1.22; 95% CI: 1.09-1.38) and husbands' approval of contraceptive use (OR = 2.395; 95% CI: 1.256-4.567) were identified as predictors of intention to use postpartum contraception.ConclusionIn conclusion, the results of our study show a comparatively low intention toward the use of postpartum contraception, in contrast to findings reported in other countries. As such, we recommend that stakeholders prioritize maternal education and encourage male partner involvement in family planning decisions.
| S-EPMC10754424 | biostudies-literature