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Sanz-Martos S, López-Medina IM, Álvarez-García C, Ortega-Donaire L, Álvarez-Nieto C. [Predictor variables of contraceptive method use in young people: A systematic review]. Aten Primaria 2024; 56:102773. [PMID: 38043175 PMCID: PMC10703591 DOI: 10.1016/j.aprim.2023.102773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/08/2023] [Accepted: 08/25/2023] [Indexed: 12/05/2023] Open
Abstract
OBJECTIVE To analyse predictor variables of contraceptive method use in young people. DESIGN Systematic review. DATA SOURCES PubMed, CINAHL, Scopus, Cuiden Plus, LILACS and IME databases were consulted. STUDY SELECTION An assessment of the quality of studies was carried out by two researchers in parallel. As a result, a total of 5 primary research studies were selected. DATA EXTRACTION Information was extracted on the selected study population, contraceptive method studied and predictor variables identified. RESULTS Seven predictor variables were identified that specifically explain the use of the male condom, contraceptive pill or emergency contraceptive pill. The most relevant variables were the level of knowledge and attitudes towards contraceptive use, therefore high knowledge and positive attitudes increase the likelihood of contraceptive use. Another notable finding was the presence of a formative bias with women having higher knowledge of hormonal contraceptive options and more positive attitudes. CONCLUSION Future training programs should be oriented towards assessing behavioral changes through the development of positive attitudes towards contraceptive use by gaining knowledge of contraceptive options.
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Gyan SE, Boafo IM. "When you use tramadol, the sperms will not come out. . .": Unconventional strategies for avoiding unintended pregnancy among adolescents in Ghana. SAGE Open Med 2024; 12:20503121231224660. [PMID: 38292416 PMCID: PMC10826370 DOI: 10.1177/20503121231224660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/05/2023] [Indexed: 02/01/2024] Open
Abstract
Background In spite of adolescents' high knowledge about modern contraceptives, usage is low especially in sub-Saharan Africa. Little is known about what adolescents use in place of modern contraceptive methods. Objective This paper discusses lay strategies that adolescents use in their quest to prevent unintended pregnancy. Methods A qualitative approach was used in the study reported in this paper. The paper draws on focus group data from a larger study looking at adolescent contraceptive needs in Ghana. A purposive sampling technique was used to select 79 adolescents who participated in a focus group discussion. Eight focus group discussions were held with both male and female adolescents aged 15-19. The data were analysed using the inductive thematic analysis method after transcribing the data. Results We found that after having sex without using condom, adolescent girls ejected sperms by using water, salt solution or ice cubes, while others engaged in pushing with pelvic floor muscles. In their bid to prevent pregnancy, for boys, engaging in masturbation and the intake of Tramadol before sex was observed. When these lay strategies fail, adolescents resorted to unsafe and illegal abortion. Conclusions Though adolescents girls engaged in unprotected sex, they still tried to avoid pregnancy, and consequently adopted lay strategies of pregnancy prevention that do not expose them to stigma. It is therefore recommended that the Ministry of Health through the Ghana Health Service consider establishing more adolescent-friendly health centres and expanding existing ones where adolescents could easily visit to have their sexual and reproductive health needs addressed in a very confidential and non-judgemental manner.
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Affiliation(s)
- Sylvia Esther Gyan
- Department of Sociology, College of Humanities, University of Ghana, Accra, Ghana
| | - Isaac Mensah Boafo
- Department of Sociology, College of Humanities, University of Ghana, Accra, Ghana
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Iheanacho CO. "An antibiotic turned contraceptive": The tale of ampicillin-cloxacillin. Health Sci Rep 2022; 5:e481. [PMID: 35059505 PMCID: PMC8757572 DOI: 10.1002/hsr2.481] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 12/01/2021] [Accepted: 12/13/2021] [Indexed: 12/04/2022] Open
Abstract
Antibiotic misuse is a major public health threat globally, requiring active efforts toward halting its progression. The African sub-region is worst hit by communicable diseases, and also possesses weak health systems to effectively combat the menace of antimicrobial resistance. Meanwhile, antibiotics are among the most regularly misused medicines in Nigeria, particularly for inappropriate indication and duration. This is seen in its use as a contraceptive by young women in the country. This paper evaluates the reliance and use of an antibiotic for contraception, a practice that has continuously being a large source of antibiotic misuse in Nigeria. Its causes and effects are also evaluated in this commentary. To effectively combat the increasing antimicrobial misuse, correct use of antibiotics for their appropriate indications is highly essential. Adequate knowledge of contraception should be ensured among young women in developing countries, particularly in Nigeria.
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Affiliation(s)
- Chinonyerem O. Iheanacho
- Department of Clinical Pharmacy and Public Health, Faculty of PharmacyUniversity of CalabarCalabarNigeria
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Kwame KA, Bain LE, Manu E, Tarkang EE. Use and awareness of emergency contraceptives among women of reproductive age in sub-Saharan Africa: a scoping review. Contracept Reprod Med 2022; 7:1. [PMID: 35039074 PMCID: PMC8762930 DOI: 10.1186/s40834-022-00167-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency contraception (EC) is a method used to avoid pregnancy after unprotected sexual intercourse. Emergency contraceptives can reduce the risk of unintended pregnancy by up to over 95% when taken within 72 h of sexual intercourse. EC is helpful to women who have experienced method failure, incorrect use of contraceptives, raped or have consented to unplanned, and unprotected sexual intercourse. We set out to systematically review the current literature on the awareness and usage patterns of ECs among women of reproductive age in Sub-Saharan Africa. METHOD Eight hundred and sixty-seven (867) articles were selected from EMBASE and Google Scholar databases after a search was conducted. Sixty (60) full-text articles were checked for eligibility and 27 articles met our inclusion criteria. Manual data extraction on excel sheets was used to extract the authors' names, year of publication, country, sample size, study type, objectives, awareness levels, and the EC types. FINDINGS Awareness rates ranged from 10.1 to 93.5% (both reported from Ethiopia). The level of use was relatively low (ranging from 0% in DR Congo and Ethiopia to 54.1% in Nigeria). The most used types of EC were Postinor 2 (levonorgestrel), EC pills such as Norlevo (levonorgestrel only) and Nodette (levonorgestrel and estradiol), and intrauterine contraceptive device (IUCD). CONCLUSIONS Although variations in use and awareness do exist between countries in SSA according to the year of study, the general level of EC awareness has been on the increase. On the other hand, the level of EC use was lower compared to the level of awareness. Postinor 2 (levonorgestrel-only pills) was reported as the most type used EC. Further, studies could be done to find out the effect of culture, religion and believes on the use of contraceptive methods. It is important to understanding barriers to EC use despite high awareness rates. Emergency Contraceptive awareness and use should be promoted among women of reproductive age in SSA to reduce unwanted pregnancies and their complications.
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Affiliation(s)
| | - Luchuo Engelbert Bain
- Lincoln International Institute for Rural Health, LIIRH, University of Lincoln, Lincoln, UK.
- Global South Health Services and Research, GSHS, Amsterdam, The Netherlands.
| | - Emmanuel Manu
- School of Public Health, University of Health and Allied Sciences, PMB 31, Ho, Ghana
| | - Elvis Enowbeyang Tarkang
- School of Public Health, University of Health and Allied Sciences, PMB 31, Ho, Ghana
- HIV/AIDS Prevention Research Network Cameroon, PO Box 36, Kumba, Cameroon
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Effect of levonorgestrel emergency contraception on implantation and fertility: a review. Contraception 2022; 109:8-18. [DOI: 10.1016/j.contraception.2022.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 12/30/2022]
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Awopegba OE, Chukwudeh OS, Owolabi EO, Ajayi AI. Trends in emergency contraception awareness among women and girls in 28 sub-Saharan countries. BMC Public Health 2021; 21:1987. [PMID: 34732160 PMCID: PMC8567620 DOI: 10.1186/s12889-021-12067-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background Studies have shown that emergency contraception (EC) remains underutilised in preventing unintended pregnancy in sub-Saharan Africa (SSA). Small-scale surveys have attributed EC underutilisation to gaps in EC awareness among SSA women and girls. However, limited studies have explored trends in EC awareness in SSA. We address this gap by examining trends in EC awareness using data from 28 SSA countries. Our analysis was disaggregated by age distribution, place of residence, level of education, and wealth to show differences in EC awareness trend. Methods We analysed the Demographic and Health Surveys (DHS) data of 1,030,029 women aged 15 to 49 on emergency contraception awareness. EC awareness was defined as having ever heard of special pills to prevent pregnancy within 3 days after unprotected sexual intercourse. Frequencies and percentages were used to summarise trends in EC awareness between years 2000 and 2019. Results Overall, there was an upward shift in the level of EC awareness in all countries, except in Burkina Faso, Niger, Chad, and Ethiopia. While some countries recorded a significant upward trend in EC awareness, others recorded just a slight increase. Women in Kenya, Ghana, Gabon, and Cameroon had the highest upward shift in EC awareness. For example, only 28% of women were aware of EC in Ghana in 2003, but in 2014, 64% of women knew about EC, an increase of over 36 percentage points. Increase in EC awareness was starker among women aged 20–24 years, those who resided in urban areas, had higher education, and belong to the highest wealth quintile, than those aged 15–19, in rural areas, with no formal education and belonging to the lowest wealth quintile. Conclusion Our analysis shows that the level of EC awareness has increased substantially in most SSA countries. However, EC awareness still differs widely within and between SSA countries. Intervention to improve EC awareness should focus on women aged 15 to 19, those with no formal education, residing in rural areas, and within the lowest quintile, especially, in countries such as Chad, Niger, Burkina Faso, and Ethiopia where level of EC is low with lagging progress. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12067-y.
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Affiliation(s)
- Oluwafemi Emmanuel Awopegba
- Economics and Business Policy Department, Nigerian Institute of Social and Economic Research, Ibadan, Nigeria
| | - Okechukwu Stephen Chukwudeh
- Department of Criminology and Security Studies, Faculty of Social Sciences, Federal University, Oye-Ekiti, Nigeria
| | - Eyitayo Omolara Owolabi
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Centre, APHRC Campus, Manga Close, Nairobi, Kenya.
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Ahinkorah BO, Obisesan MT, Seidu AA, Ajayi AI. Unequal access and use of contraceptives among parenting adolescent girls in sub-Saharan Africa: a cross-sectional analysis of demographic and health surveys. BMJ Open 2021; 11:e051583. [PMID: 34551951 PMCID: PMC8461275 DOI: 10.1136/bmjopen-2021-051583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We examined the divergent patterns, prevalence and correlates of contraceptive use among parenting adolescents in sub-Saharan Africa using the Demographic and Health Survey datasets of 17 countries. DESIGN We included a weighted sample of 9488 parenting adolescent girls in our analysis. Current contraceptive use was defined as the use of any methods to delay or avoid getting pregnant at the survey time. We reported the prevalence of any contraceptive use for all countries and used multilevel binary logistic regression analysis to examine the individual and contextual factors associated with contraceptive use. OUTCOME MEASURES Contraceptive use. RESULTS We found an overall contraceptive prevalence of 27.12% (CI 27.23% to 28.03%) among parenting adolescent girls in sub-Saharan Africa, ranging from 70.0% (CI 61.76% to 77.16%) in South Africa to only 5.10% (CI 3.04% to 8.45%) in Chad. The prevalence of contraceptive use was lowest in West andCentral Africa, with most countries having less than 20% prevalence. Increasing age (adjusted OR (aOR)=1.46, 95% CI 1.28 to 1.65), being married (aOR=1.63, 95% CI 1.43 to 1.87), having a secondary or higher level of education (aOR=2.72, 95% CI 2.25 to 2.3.27), and media exposure (aOR=1.21, 95% CI 1.08 to 1.36), were associated with higher odds of contraceptive use in the pooled data but preference for a higher number of children (more than five children) (aOR=0.61, 95% CI 0.52 to 0.72) was related to lower likelihood of use. Significant heterogeneity was observed in the country-level disaggregated results. CONCLUSION African countries differ widely when it comes to contraceptive use among parenting adolescent girls, with only three countries having a relatively high prevalence of use. The governments of countries in sub-Saharan Africa, particularly those in West and Central Africa, should invest in expanding access to contraceptives for adolescent mothers to prevent repeat pregnancy and improve the overall well-being of parenting adolescent girls.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Department of Estate Management, Takoradi Technical Unversity, Takoradi, Ghana
| | - Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya
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Asaolu I, Kram N, Ajala C, Aquaisua E, Asaolu A, Kato-Lagumbay K, Abuh A, Bernand M, Ehiri J. “Antibiotics Can Work as a Contraceptive:” Contraceptive Knowledge and Use Among University Students in Calabar, Nigeria. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:665653. [PMID: 36303954 PMCID: PMC9580625 DOI: 10.3389/frph.2021.665653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/25/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction: Many sexually active youths who wish to delay pregnancy are not using any form of modern contraceptives. In sub-Saharan Africa, less than 1 in 5 sexually active youth do not use contraceptives. In Nigeria, 48.4% of all sexually active unmarried women have an unmet need for contraception. Although the literature is replete with information on structural barriers to modern contraceptives, there is limited scholarship on contextual factors that may inhibit modern contraceptive use among Nigerian youth. This study uses a qualitative research approach to assess knowledge and use of natural, modern, and folkloric contraceptive methods among a sample of university students in Calabar, Nigeria. Methods: This study used data from focus group discussions among women and men in university halls of residence, all of whom were unmarried. Also, three male pharmacists and three female community health workers were interviewed. All focus group discussions and interviews took place in August 2017 and were conducted in Calabar Metropolis, Cross River State, Nigeria. The audio recordings were transcribed into detailed summaries of the interviews and focus group discussions. All data analysis was completed using Atlas.Ti (version 8). Results: University men and women have limited knowledge of and application of natural and modern contraception. Participants listed folkloric methods of contraceptives, including repurposing pharmaceuticals (e.g., antibiotics, quinine, and Andrews Livers Salt-a laxative) as contraceptive agents. Respondents also discussed the use of non-pharmaceuticals such as water, salt solution, and squatting after intercourse as contraceptives. Generally, university students defaulted to withdrawal, calendar method, and emergency contraceptives as preferred methods of contraception. Lastly, condoms were used among participants in causal sexual encounters. In dating relationships, however, both male and female students cited their partners' hesitancy to condom use as such act could indicate distrust. Conclusion: Awareness and use of modern contraceptives are limited among university students in Calabar, Nigeria. The use of folkloric contraceptives could lead to bodily harm and unintended pregnancy. Further research is needed to elucidate factors that promote use of folkloric methods of contraceptives. Integration of contraceptive awareness into health promotion services for young people may help to dispel myths about folkloric methods of contraceptives while promoting awareness and use of safe and effective contraception.
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Affiliation(s)
- Ibitola Asaolu
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- *Correspondence: Ibitola Asaolu
| | - Nidal Kram
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Christopher Ajala
- Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ememobong Aquaisua
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
| | - Akinsola Asaolu
- Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Kylie Kato-Lagumbay
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Alice Abuh
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
| | - Moses Bernand
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
| | - John Ehiri
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
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Ajayi AI, Otukpa EO, Mwoka M, Kabiru CW, Ushie BA. Adolescent sexual and reproductive health research in sub-Saharan Africa: a scoping review of substantive focus, research volume, geographic distribution and Africa-led inquiry. BMJ Glob Health 2021; 6:bmjgh-2020-004129. [PMID: 33568395 PMCID: PMC7878134 DOI: 10.1136/bmjgh-2020-004129] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Previous review studies have not systematically mapped the existing body of knowledge on adolescent sexual and reproductive health (ASRH) in sub-Saharan Africa (SSA). Our scoping review addresses this gap by examining how the body of research on ASRH in SSA has evolved over the past decade, and its present profile, in terms of trends in volume, geographic and substantive focus, and Africa-led inquiry. METHODS We used a three-step search strategy to identify English and French peer-reviewed publications and relevant grey literature on ASRH in SSA published between January 2010 and December 2019. Two reviewers screened the titles, abstracts and full texts of publications for eligibility and inclusion. RESULTS A total of 1302 articles were published over the period, rising from 91 in 2010 to 183 in 2015. However, the bulk of the studies (63.9%) focused on six (South Africa, Kenya, Nigeria, Tanzania, Uganda and Ethiopia) of the 46 SSA countries. Ten countries had no ASRH papers, while five others each had only one publication. While issues like HIV (17.2%), sexual behaviours (17.4%) and access to sexual and reproductive health services (13.0%) received substantial attention, only a few studies focused on early adolescence (10-14 years), programme interventions, scaling up of interventions and policy evaluation. Just over half of publications had authors with African institutional affiliations as first authors (51.1%) or last author (53.0%). Sixteen per cent of papers did not include any authors from institutions in Africa. CONCLUSIONS Our review demonstrated that research on ASRH is limited in focus and is unevenly distributed across SSA countries. The identified gaps can guide future research and funding to advance ASRH policies and programmes. It is also vital for stakeholders in the research enterprise, including researchers, donors, ethical review boards, and journal editors and reviewers, to implement measures that foster national investigators' inclusion.
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Affiliation(s)
- Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health and Rights Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Emmanuel Oloche Otukpa
- Population Dynamics and Sexual and Reproductive Health and Rights Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Meggie Mwoka
- Population Dynamics and Sexual and Reproductive Health and Rights Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Caroline W Kabiru
- Population Dynamics and Sexual and Reproductive Health and Rights Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Boniface Ayanbekongshie Ushie
- Population Dynamics and Sexual and Reproductive Health and Rights Unit, African Population and Health Research Center, Nairobi, Kenya
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Henry EG, Agula C, Agyei-Asabere C, Asuming PO, Bawah AA, Canning D, Shah I. Dynamics of Emergency Contraceptive Use in Accra, Ghana. Stud Fam Plann 2021; 52:105-123. [PMID: 34110017 DOI: 10.1111/sifp.12154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Recent data suggest increasing rates of emergency contraception (EC) use in Ghana, particularly in urban areas. In 2018, we collected survey data from 3,703 sexually experienced women aged 16-44 years living in low-income settlements of Accra. We estimated the prevalence of lifetime and current EC use. Multivariate logistic regression was used to assess factors associated with current use of EC. Retrospective monthly calendar data on contraceptive use were analyzed to identify patterns of EC use, including repeat and continuous use, and uptake of other contraceptive methods in the months following EC use. Nearly 15 percent of women had ever used EC. About half of recent EC users (52 percent) used EC for at least four months cumulatively within a 12-month window. There was no evidence of adoption of other modern methods in the months after using EC. Our results suggest that EC is a common method for pregnancy prevention in Accra, particularly among young, unmarried, highly educated women. Counseling on effective EC use and strategies that promote equitable access should be prioritized.
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Topic: prevalence and determinants of adolescent pregnancy among sexually active adolescent girls in Niger. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01154-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ahinkorah BO, Kang M, Perry L, Brooks F, Hayen A. Prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa: A multi-country analysis. PLoS One 2021; 16:e0246308. [PMID: 33539394 PMCID: PMC7861528 DOI: 10.1371/journal.pone.0246308] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 01/15/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION In low-and middle-income countries, pregnancy-related complications are major causes of death for young women. This study aimed to determine the prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa. METHODS We undertook a secondary analysis of cross-sectional data from Demographic and Health Surveys conducted in 32 sub-Saharan African countries between 2010 and 2018. We calculated the prevalence of first adolescent (aged 15 to 19 years) pregnancy in each country and examined associations between individual and contextual level factors and first adolescent pregnancy. RESULTS Among all adolescents, Congo experienced the highest prevalence of first adolescent pregnancy (44.3%) and Rwanda the lowest (7.2%). However, among adolescents who had ever had sex, the prevalence ranged from 36.5% in Rwanda to 75.6% in Chad. The odds of first adolescent pregnancy was higher with increasing age, working, being married/cohabiting, having primary education only, early sexual initiation, knowledge of contraceptives, no unmet need for contraception and poorest wealth quintile. By contrast, adolescents who lived in rural areas and in the West African sub-region had lower odds of first adolescent pregnancy. CONCLUSION The prevalence of adolescent pregnancy in sub-Saharan African countries is high. Understanding the predictors of first adolescent pregnancy can facilitate the development of effective social policies such as family planning and comprehensive sex and relationship education in sub-Saharan Africa and can help ensure healthy lives and promotion of well-being for adolescents and their families and communities.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Melissa Kang
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Lin Perry
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Fiona Brooks
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Andrew Hayen
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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Ajayi AI, Odunga SA, Oduor C, Ouedraogo R, Ushie BA, Wado YD. "I was tricked": understanding reasons for unintended pregnancy among sexually active adolescent girls. Reprod Health 2021; 18:19. [PMID: 33482843 PMCID: PMC7821647 DOI: 10.1186/s12978-021-01078-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/11/2021] [Indexed: 12/03/2022] Open
Abstract
Background While the Kenya government is mobilizing high-level strategies to end adolescent pregnancy by 2030, a clear understanding of drivers of early unintended pregnancy in the country is a necessary precursor. In this study, we determine the prevalence, associated factors, and reasons for unintended pregnancy among sexually active adolescent girls (aged 15–19 in two Kenya counties with the highest rate of teenage pregnancy. Methods We used the “In Their Hands” (ITH) program's baseline evaluation data. The study adopted a mixed-methods design with 1110 sexually active adolescent girls in the quantitative component and 19 girls who were either pregnant or nursing a child in the qualitative. We used adjusted and unadjusted logistic regression to model factors associated with unintended pregnancy among respondents. We used a thematic analysis of qualitative data to examine girls’ reasons for having unintended pregnancy. Results Overall, 42% of respondents have had an unintended pregnancy; however, higher proportions were observed among girls who were 19 years (49.4%), double orphans (53.6%), never used contraceptive (49.9%), out-of-school (53.8%), and married (55.6%). After adjusting for relevant covariates, the odds of unintended pregnancy were higher among girls who resided in rural areas (AOR 1.64, 95% CI 1.22–2.20), had primary or no formal education (AOR 1.50 95% CI 1.11–2.02), and had never used contraceptive (AOR 1.69 95% CI 1.25–2.29) compared with their counterparts. Current school attendance was associated with a 66% reduction in the probability of having an unintended pregnancy. Participants of the qualitative study stated that the desire to maintain a relationship, poor contraceptive knowledge, misinformation about contraceptive side effects, and lack of trusted mentors were the main reasons for their unintended pregnancies. Conclusion A massive burden of unintended pregnancy exists among sexually active adolescent girls in the study setting. Adolescent boys and girls need better access to sexuality education and contraceptives in the study setting to reduce early unintended pregnancy.
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Affiliation(s)
- Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya.
| | - Sally Atieno Odunga
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
| | - Clement Oduor
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
| | - Ramatou Ouedraogo
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
| | - Boniface Ayanbekongshie Ushie
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
| | - Yohannes Dibaba Wado
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Off Kirawa Road, Manga Close, Kenya
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Fontanelli Sulekova L, Spaziante M, Vita S, Zuccalà P, Mazzocato V, Spagnolello O, Lopalco M, Pacifici LE, Bello L, Borrazzo C, Angeletti S, Ciccozzi M, Ceccarelli G. The Pregnancy Outcomes Among Newly Arrived Asylum-Seekers in Italy: Implications of Public Health. J Immigr Minor Health 2020; 23:232-239. [PMID: 33278011 PMCID: PMC7914189 DOI: 10.1007/s10903-020-01126-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
Background Migration has a significant impact on overall health and pregnancy outcome. Despite the fact that growing volume of migration flows significantly engaging the public health system of European host countries, there is a lack of evidence concerning pregnancy outcomes of newly arrived asylum-seeking women. Methods Data about pregnant asylum seekers hosted in the Italian Reception Centers between the 1 st June 2016 and the 1st June 2018 were retrospectively collected and analysed in the present study. We examined the following pregnancy outcomes: miscarriage, self-induced abortion, voluntary pregnancy termination, live-birth; and studied potentially related socio-demographic factors. Results Out of the 110 pregnant women living in the reception centers, 44 (40%) had eutocic delivery, 8 (7.3%) dystocic delivery, 15 (13.6%) miscarriage, 17 (15.5%) self-induced abortion and 26 (23.6%) underwent voluntary pregnancy termination. Nigerian women were at a significantly higher risk of abortive outcomes for voluntary pregnancy termination (p < 0.001), miscarriage (p = 0.049) and self-induced abortion (p < 0.001). Being unmarried was significantly associated with voluntary pregnancy termination and self-induced abortion. Women who chose to undergo unsafe abortion did not result to have significantly lower educational levels, compared to women who preferred medical abortion. Conclusion This study offers first insights into pregnancy outcomes among asylum-seeking women in Italy. The country of origin and marital status seem to significantly impact on pregnancy outcome. We identified sub-groups of migrant women at increased risk of abortive outcomes, and highlight the need to improve care in order to promote migrant women’s reproductive health.
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Affiliation(s)
- Lucia Fontanelli Sulekova
- Department of Public Health and Infectious Diseases, Policlinico Umberto I Hospital. University of Rome Sapienza, Rome, Italy. .,Migrant and Global Health Organization (Mi-HeRO), Rome, Italy. .,Auxilium Soc Coop. Sanitary Bureau of Asylum Seeker Center of Castelnuovo di Porto, Senise, Italy.
| | - Martina Spaziante
- Department of Public Health and Infectious Diseases, Policlinico Umberto I Hospital. University of Rome Sapienza, Rome, Italy.,Migrant and Global Health Organization (Mi-HeRO), Rome, Italy.,Auxilium Soc Coop. Sanitary Bureau of Asylum Seeker Center of Castelnuovo di Porto, Senise, Italy
| | - Serena Vita
- Department of Public Health and Infectious Diseases, Policlinico Umberto I Hospital. University of Rome Sapienza, Rome, Italy.,Migrant and Global Health Organization (Mi-HeRO), Rome, Italy.,Auxilium Soc Coop. Sanitary Bureau of Asylum Seeker Center of Castelnuovo di Porto, Senise, Italy
| | - Paola Zuccalà
- Auxilium Soc Coop. Sanitary Bureau of Asylum Seeker Center of Castelnuovo di Porto, Senise, Italy.,Italian Red Cross, Sanitary Bureau of) Extraordinary Reception Centers for Migrants "ENEA", "Pietralata" and "Penelope" of Rome, Rome, Italy
| | - Valentina Mazzocato
- Italian Red Cross, Sanitary Bureau of) Extraordinary Reception Centers for Migrants "ENEA", "Pietralata" and "Penelope" of Rome, Rome, Italy
| | - Ornella Spagnolello
- Department of Public Health and Infectious Diseases, Policlinico Umberto I Hospital. University of Rome Sapienza, Rome, Italy.,Emergency NGO, Milan, Italy.,Emergency Department, Policlinico Umberto I Hospital, University of Rome Sapienza, Rome, Italy
| | - Maurizio Lopalco
- Auxilium Soc Coop. Sanitary Bureau of Asylum Seeker Center of Castelnuovo di Porto, Senise, Italy
| | - Laura Elena Pacifici
- UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Luca Bello
- Unit of Gynecology, Department of Obstetrics and Gynecology, University of Turin, Maria Vittoria Hospital, Turin, Italy
| | - Cristian Borrazzo
- Statistical Unit, Department of Public Health and Infectious Diseases, University of Rome Sapienza, Rome, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Policlinico Umberto I Hospital. University of Rome Sapienza, Rome, Italy.,Migrant and Global Health Organization (Mi-HeRO), Rome, Italy.,Auxilium Soc Coop. Sanitary Bureau of Asylum Seeker Center of Castelnuovo di Porto, Senise, Italy.,Italian Red Cross, Sanitary Bureau of) Extraordinary Reception Centers for Migrants "ENEA", "Pietralata" and "Penelope" of Rome, Rome, Italy.,Italian Red Cross, Metropolitan Area of Rome Committee, Sanitary Direction of Reception Centers for Migrants, Rome, Italy
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15
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Ahinkorah BO, Seidu AA, Appiah F, Budu E, Adu C, Aderoju YBG, Adoboi F, Ajayi AI. Individual and community-level factors associated with modern contraceptive use among adolescent girls and young women in Mali: a mixed effects multilevel analysis of the 2018 Mali demographic and health survey. Contracept Reprod Med 2020; 5:27. [PMID: 33062298 PMCID: PMC7547459 DOI: 10.1186/s40834-020-00132-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/30/2020] [Indexed: 12/02/2022] Open
Abstract
Background Unintended pregnancy constitutes a significant public health challenge in sub-Saharan Africa and particularly among young people, who are more likely to closely space births and experience adverse obstetric outcomes. Studies on modern contraceptive use have mostly focused on women of reproductive age in general with limited attention to factors associated with modern contraceptive use among adolescents and young women (aged 15–24) in Mali. We examined the individual and community-level factors associated with modern contraceptive use among this age cohort using the 2018 Mali demographic and health survey data. Methods We analyzed data from 2639 adolescent girls and young women, and our outcome of interest was current use of modern contraceptives. We performed descriptive analysis using frequencies and percentages and inferential analysis using mixed-effects multilevel logistic regression. The results of the mixed-effects multilevel logistic regression were presented as adjusted odds ratios with their corresponding 95% confidence intervals. Results The prevalence of modern contraceptive use among adolescent girls and young women in Mali was 17.1% [95% CI, 15–19%]. Adolescent girls and young women who were married [aOR = 0.20, CI = 0.09–0.41], had no formal education [aOR = 0.43, CI = 0.32–0.59], in the poorest wealth quintile [aOR = 0.38, CI = 0.19–0.79] and had no children [aOR = 0.38, CI = 0.27–0.53] were less likely to use modern contraceptives. Similarly, those who had low knowledge of modern contraception [aOR = 0.60, CI = 0.42–0.85] and whose ideal number of children was six or more [aOR = 0.66, CI = 0.43–0.99] were less likely to use modern contraceptives. However, those with four or more births were more likely to use modern contraceptives [aOR = 1.85, CI = 1.24–2.77]. Conclusion Modern contraceptive use among adolescent girls and young women in Mali has improved slightly relative to the prevalence of 2012, though the prevalence is still low, compared to the prevalence in other sub-Saharan African countries and the prevalence globally. Individual-level factors such as marital status, educational level, wealth quintile, parity, ethnicity and ideal number of children were associated with the use of modern contraceptive among adolescent girls and young women in Mali. Community knowledge of modern contraceptives was found as a community-level factor associated with modern contraceptive use among adolescent girls and young women. Therefore, Mali’s Ministry of Health and Public Hygiene's Health Promotion and Education unit should prioritise and intensify contraceptive education to increase coverage of modern contraceptive use and address disparities in the use of modern contraceptives. Such education should be done, taking into consideration factors at the individual and community-level of the target population.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
| | - Francis Appiah
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Collins Adu
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yaa Boahemaa Gyasi Aderoju
- Department of Adult Health Nursing, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Faustina Adoboi
- Cape Coast Nursing and Midwifery Training College, Cape Coast, Ghana
| | - Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health and Rights Unit, African Population and Health Research Center, Manga Close, Off Kirawa Road, Kitisuru, Nairobi, 00100 Kenya
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16
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Ajayi AI, Ezegbe HC. Association between sexual violence and unintended pregnancy among adolescent girls and young women in South Africa. BMC Public Health 2020; 20:1370. [PMID: 32894130 PMCID: PMC7487533 DOI: 10.1186/s12889-020-09488-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unintended pregnancy has dire consequences on the health and socioeconomic wellbeing of adolescent girls and young women (AGYW) (aged 15-24 years). While most studies tend to focus on lack of access to contraceptive information and services, and poverty as the main contributing factor to early-unintended pregnancies, the influence of sexual violence has received limited attention. Understanding the link between sexual violence and unintended pregnancy is critical towards developing a multifaceted intervention to reduce unintended pregnancies among AGYW in South Africa, a country with high teenage pregnancy rate. Thus, we estimated the magnitude of unintended pregnancy among AGYW and also examined the effect of sexual violence on unintended pregnancy. METHODS Our study adopted a cross-sectional design, and data were obtained from AGYW in a South African university between June and November 2018. A final sample of 451 girls aged 17-24 years, selected using stratified sampling, were included in the analysis. We used adjusted and unadjusted logistic regression analysis to examine the effect of sexual violence on unintended pregnancy. RESULTS The analysis shows that 41.9% of all respondents had experienced an unintended pregnancy, and 26.3% of those unintended pregnancies ended in abortions. Unintended pregnancy was higher among survivors of sexual violence (54.4%) compared to those who never experienced sexual abuse (34.3%). In the multivariable analysis, sexual violence was consistently and robustly associated with increased odds of having an unintended pregnancy (AOR:1.70; 95% CI: 1.08-2.68). CONCLUSION Our study found a huge magnitude of unintended pregnancy among AGYW. Sexual violence is an important predictor of unintended pregnancy in this age cohort. Thus, addressing unintended pregnancies among AGYW in South Africa requires interventions that not only increase access to contraceptive information and services but also reduce sexual violence and cater for survivors.
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Affiliation(s)
- Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health, Africa Population and Health Research Center, Off Kirawa Road, Manga Close, Nairobi, Kenya
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17
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Sanz-Martos S, López-Medina IM, Álvarez-García C, Clavijo-Chamorro MZ, Ramos-Morcillo AJ, López-Rodríguez MM, Fernández-Feito A, Navarro-Prado S, Álvarez-Serrano MA, Baena-García L, Navarro-Perán MÁ, Álvarez-Nieto C. Young Nursing Student's Knowledge and Attitudes about Contraceptive Methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5869. [PMID: 32823694 PMCID: PMC7459644 DOI: 10.3390/ijerph17165869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 12/02/2022]
Abstract
PURPOSE Adolescence is considered a period in which individuals are particularly at risk of negative consequences related to sexual health. Increased knowledge levels have traditionally been used as an indicator of the effectiveness of educational programs, but attitudes are not addressed and are a key element for the success of such programs. The aim of this study is to determine the level of knowledge and attitudes toward the use of contraceptive methods among nursing students. A multicenter cross-sectional study was carried out. In total, 2914 university students (aged 18-25 years) enrolled in the study. Participants completed two validated scales to measure knowledge level and attitudes toward contraceptive use. Nursing degree students who received training about contraceptives obtained a success rate of over 70%, compared to 15.3% among students who had not received such training (p < 0.001). The mean attitude score was 43.45 points (10-50), but there were no significant differences in terms of student training (p = 0.435), although they were significantly higher among students who used contraceptives at first or last sexual intercourse (p < 0.001). There was a significant weak correlation between the level of knowledge and attitudes toward the use of contraceptives. An adequate level of knowledge about sexuality and contraceptive methods does not correspond to positive attitudes toward their use, although having an excellent attitude toward contraceptive use is related to their use during youth and adolescence.
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Affiliation(s)
- Sebastián Sanz-Martos
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Campus Las Lagunillas, 23071 Jaén, Spain; (S.S.-M.); (C.Á.-G.); (C.Á.-N.)
| | - Isabel María López-Medina
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Campus Las Lagunillas, 23071 Jaén, Spain; (S.S.-M.); (C.Á.-G.); (C.Á.-N.)
| | - Cristina Álvarez-García
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Campus Las Lagunillas, 23071 Jaén, Spain; (S.S.-M.); (C.Á.-G.); (C.Á.-N.)
| | | | | | | | | | - Silvia Navarro-Prado
- Department of Nursing, Faculty of Health Sciences of Melilla, University of Granada, 52005 Melilla, Spain;
| | | | - Laura Baena-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain;
| | | | - Carmen Álvarez-Nieto
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Campus Las Lagunillas, 23071 Jaén, Spain; (S.S.-M.); (C.Á.-G.); (C.Á.-N.)
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18
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Ajayi AI, Somefun OD. Patterns and determinants of short and long birth intervals among women in selected sub-Saharan African countries. Medicine (Baltimore) 2020; 99:e20118. [PMID: 32384488 PMCID: PMC7440207 DOI: 10.1097/md.0000000000020118] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Optimal birth spacing (defined as a birth spacing of 24-59 months) is incontrovertibly linked to better health outcomes for both mothers and babies. Using the most recent available Demographic and Health Survey data, we examined the patterns and determinants of short and long birth intervals among women in selected sub-Saharan African (SSA) countries.Reproductive health and sociodemographic data of 98,934 women from 8 SSA countries were analyzed. Unadjusted and adjusted multinomial logistic regression models were used to examine the net relationship between all the independent variables and short and long birth intervals.Overall, the majority of women in all the countries optimally spaced births. However, a significant proportion of women had short birth intervals in Chad (30.2%) and the Democratic Republic of Congo (Congo DRC) (27.1%). Long birth spacing was more common in Eastern and Southern African countries, with Zimbabwe having the highest rate of long term birth interval (27.0%). Women who were aged 35 years and above in Uganda (RRR = 0.72, CI = 0.60-0.87), Tanzania (RRR = 0.62, CI = 0.49-0.77), Zimbabwe (RRR = 0.52, CI = 0.31-0.85), Nigeria (RRR = 0.82, CI = 0.72-0.94) and Togo (RRR = 0.67, CI = 0.46-0.96) had significantly lower odds of having short birth intervals compared to women aged 15-24 years. Older women (above 34 years) had increased odds for long birth intervals in all countries studied (Chad (RRR = 1.44, CI = 1.18-1.76), Congo DRC (RRR = 1.73, CI = 1.33-2.15), Malawi (RRR = 1.54, CI = 1.23-1.94) Zimbabwe (RRR = 1.95, CI = 1.26-3.02), Nigeria (RRR = 1.85 CI = 1.56-2.20), Togo (RRR = 2.12, CI = 1.46-3.07), Uganda (RRR = 1.48, CI = 1.15-1.91), Tanzania RRR = 2.12, CI = 1.53-2.93).The analysis suggested that the determinants of long and birth intervals differ and varies from country to country. The pattern of birth spacing found in this study appears to mirror the contraceptive use and fertility rate in the selected SSA countries. Birth intervals intervention addressing short birth intervals should target younger women in SSA, especially in Chad and Congo DRC, while intervention for long birth spacing should prioritize older, educated and wealthy women.
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Affiliation(s)
- Anthony Idowu Ajayi
- Sociology Department, University of Fort Hare, East London Campus, 50, Church Street, East London
| | - Oluwaseyi Dolapo Somefun
- Demography and Population Studies (DPS), University of the Witwatersrand, Johannesburg, South Africa
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19
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Arije O, Ojo T, Titus R, Alaba O, Adegbenro A, Jah F, Connolly S, Onayade A. Young people’s perceptions about abortion in Southwest Nigeria: Findings from formative audience research. AAS Open Res 2020. [DOI: 10.12688/aasopenres.13047.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Community dialogue around abortion in Nigeria often revolves around legality and morality. Termination of pregnancy is a criminal offense except in instances where the mother’s health is in jeopardy. Young people bear a huge burden of adverse outcomes from induced abortions in Nigeria therefore viable interventions are needed. This study explored adolescents and young people’s perceptions about abortion in three selected states in southwest Nigeria. Methods: This study is part of larger formative audience research (FAR) to gather information about the lives of married and unmarried adolescents and young persons in the study area to support the development of understandable, high-quality, and culturally appropriate radio serial dramas in the local language (Yoruba). We conducted 16 focus group discussion sessions that included questions on abortion among eligible male and female participants aged 15 – 25 years. This section of the discussion guide on abortion consisted of a set of open‐ended questions posed concerning the vignette of a young girl who was seeking to terminate a pregnancy. All discussions where transcribed verbatim and analyzed by thematic content analysis using ATLAS.ti 8 software. Results: Young people indicated that the general public looks unfavorably on abortion. However, personal opinions were likely to be based on whether the person was directly involved, as female participants were more open to the issue than males. Some female participants also indicated that compared with adults, young people had greater negative experiences when procuring abortion ranging from higher cost to stigmatization. Conclusions: In a background of restrictive abortion laws, negative societal perceptions about abortion and adverse outcomes associated with illegal abortion, young people are the most at risk of the harmful outcomes of procuring abortion in Nigeria. More innovative approaches are required to promote healthy sexual and reproductive health (SRH) among young people in Nigeria.
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20
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Ajayi AI, Ismail KO, Akpan W. Factors associated with consistent condom use: a cross-sectional survey of two Nigerian universities. BMC Public Health 2019; 19:1207. [PMID: 31477068 PMCID: PMC6719351 DOI: 10.1186/s12889-019-7543-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background Consistent condom use is central to the prevention of transmission of human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs), especially among young adults. This study drew from a cross-sectional survey of two Nigerian universities to determine the level of consistent condom use, explored the determinants of condom use consistency and reasons for inconsistent condom use. Methods We adopted a descriptive cross-sectional design, which involves the recruitment of 800 male and female students using stratified random sampling. Adjusted and unadjusted logistic regression models were used to examine the factors associated with consistent condom use among a final sample of 498 students who engaged in sex in the last year preceding the study. Results Only 38.6% of sexually active participants (n = 498) used condoms consistently in the previous year. High condom self-efficacy score (AOR: 2.40; 95% CI: 1.58–3.64), discussion of HIV/STIs with sexual partner (AOR: 1.91; 95%CI: 1.29–2.83), knowing partner’s HIV status (AOR: 1.48; 95% CI: 1.02–2.16), being students of university located in a high HIV prevalence area (AOR: 2.86; 95% CI: 1.92–4.28) and engaging in sex with only steady partner (AOR: 1.74; 95% CI: 1.17–2.60) were associated with a higher odds of consistent condom use. Trust, unavailability of condoms, dislike of condoms and a perception that condoms reduced sexual pleasure were the main reasons for inconsistent use of condoms. Conclusion The study found a low level of consistent condom use among study participants. Counselling young adults in Nigeria on condom self-efficacy, providing condoms on campuses and encouraging the discussion of sexually transmitted infections with sexual partners are central to improving the level of consistent condom use among Nigerian university students. Electronic supplementary material The online version of this article (10.1186/s12889-019-7543-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anthony Idowu Ajayi
- Population Dynamics and Reproductive Health Unit, African Population and Health Research Center, APHRC Campus, Off Kirawa Road, Nairobi, Kenya.
| | - Kafayat Olanike Ismail
- Department of Sociology, Faculty of the Social Sciences, University of Ilorin, Ilorin, Nigeria
| | - Wilson Akpan
- Research and Innovation, Walter Sisulu University, Nelson Mandela Drive, Mthatha, South Africa
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21
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Sanz-Martos S, López-Medina IM, Álvarez-García C, Álvarez-Nieto C. Sexuality and contraceptive knowledge in university students: instrument development and psychometric analysis using item response theory. Reprod Health 2019; 16:127. [PMID: 31438978 PMCID: PMC6704703 DOI: 10.1186/s12978-019-0791-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/12/2019] [Indexed: 11/24/2022] Open
Abstract
Background As a consequence of biological, psychological and social changes during puberty, youth is a period characterized by impulsiveness and risk-taking. Members of this population often feel invulnerable and have a strong motivation to explore their identity. A good level of knowledge is necessary to allow young people to experience their sexuality in a healthy way, without associated risks. In our environment there is currently no valid Spanish-language tool to measure the level of knowledge about sexuality and contraception. This study sought to develop and test the psychometric properties of a new sexuality and contraception knowledge instrument. Methods This is a cross-sectional study to validate the sexuality and contraception knowledge instrument. The validation process followed four phases: (1) development of the instrument, (2) content validation by an expert panel, (3) pilot test and (4) psychometric analysis of the instrument using item response theory according to the Rasch model. The validation process took place from September 2017 to February 2018. Results The sample included 387 students enrolled at the Nursing and Law degrees from the University of Jaen. The final instrument was made up of 15 items. All of the items presented good adaptation values with respect to the model. The scale showed good fit and reliability: 0.99 for items and 0.74 for people. The temporal stability of the scale was calculated using test–retest, obtaining a value of 0.81 (CI 0.692–0.888). The construct validity showed the one-dimensionality of the construct, while the discriminant validity obtained good results, so the scale appears to be able to differentiate between participants with low or high levels of knowledge. Conclusion The results suggest the Sexuality and Contraception Knowledge Instrument is psychometrically valid and reliable for measuring the knowledge level concerning sexuality and contraceptive methods in young university students.
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Affiliation(s)
- Sebastian Sanz-Martos
- Research Group Nursing and Healthcare Innovation (CuiDsalud), University of Jaén, Jaén, Spain
| | - Isabel M López-Medina
- Department of Nursing. Faculty of Health Sciences, Research Group Nursing and Healthcare Innovation (CuiDsalud), University of Jaén (Spain), Edif. B3, Dep. 265, Campus Las Lagunillas, s/n, 23071, Jaén, Spain.
| | - Cristina Álvarez-García
- Department of Nursing. Faculty of Health Sciences, Research Group Nursing and Healthcare Innovation (CuiDsalud), University of Jaén (Spain), Edif. B3, Dep. 265, Campus Las Lagunillas, s/n, 23071, Jaén, Spain
| | - Carmen Álvarez-Nieto
- Department of Nursing. Faculty of Health Sciences, Research Group Nursing and Healthcare Innovation (CuiDsalud), University of Jaén (Spain), Edif. B3, Dep. 265, Campus Las Lagunillas, s/n, 23071, Jaén, Spain
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Rokicki S, Merten S. The context of emergency contraception use among young unmarried women in Accra, Ghana: a qualitative study. Reprod Health 2018; 15:212. [PMID: 30567545 PMCID: PMC6299944 DOI: 10.1186/s12978-018-0656-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the past decade, awareness and use of emergency contraceptive pills (ECPs) among young women has rapidly increased in Ghana; however, the rate of unintended pregnancy among this group remains high. We conducted a qualitative study to better understand the context and patterns of ECP use among young unmarried women in Ghana. METHODS We conducted in-depth interviews with unmarried sexually active women aged 18-24 in Accra, Ghana to explore their perceptions, experiences, and opinions regarding sexual relationships and contraceptive methods, and to examine the factors that influence choice of ECPs. A total of 32 young women participated in the study. RESULTS Most participants had used ECPs at least once. Participants described being unable to plan for sexual encounters, and as a result preferred ECPs as a convenient post-coital method. Despite being widely and repeatedly used, women feared the disruptive effects of ECPs on the menstrual cycle and were concerned about long-term side-effects. ECPs were sometimes used as a back-up in cases of perceived failure of traditional methods like withdrawal. Misinformation about which drugs were ECPs, correct dosage, and safe usage were prevalent, and sometimes spread by pharmacists. Myths about pregnancy prevention techniques such as urinating or washing after sex were commonly believed, even among women who regularly used ECPs, and coincided with a misunderstanding about how hormonal contraception works. CONCLUSIONS ECPs appear to be a popular contraceptive choice among young urban women in Ghana, yet misinformation about their correct usage and safety is widespread. While more research on ECP use among young people is needed, these initial results point to the need to incorporate information about ECPs into adolescent comprehensive sexuality education and youth-friendly services and programmes.
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Affiliation(s)
- Slawa Rokicki
- Geary Institute, University College Dublin, Dublin, Ireland
| | - Sonja Merten
- Society, Gender and Health Unit, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland. .,University of Basel, Petersplatz 1, 4001, Basel, Switzerland.
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Ajayi AI, Ismail KO, Adeniyi OV, Akpan W. Awareness and use of pre-exposure and postexposure prophylaxes among Nigerian university students: Findings from a cross-sectional survey. Medicine (Baltimore) 2018; 97:e12226. [PMID: 30200145 PMCID: PMC6133481 DOI: 10.1097/md.0000000000012226] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Despite the recent advances in biomedical preventive strategies, young adults-especially adolescent girls- continue to be disproportionately at risk of acquiring HIV. To avert this trend, it is critical that access to HIV preventive strategies, such as pre-exposure prophylaxis (PrEP) and postexposure prophylaxis be expanded, especially in sub-Saharan Africa, where young adults are known to engage in risky sexual practices. This study examined awareness levels and use of pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) among Nigerian university students.A cross-sectional survey was conducted among 800 students selected using stratified random sampling at 2 Nigerian universities. Descriptive and inferential statistics were used for data analysis on 784 complete responses.The levels of awareness of PrEP and PEP were 18.9% and 25.4%, respectively. Ever tested for human immunodeficiency virus [HIV] (AOR: 1.58; 95% CI: 1.04-2.42) and knowledge of partner's HIV status (AOR: 1.87; 95% CI: 1.25-2.79) were the significant determinants of awareness to PrEP. In contrast, only ever tested for HIV (AOR: 1.50; 95% CI: 1.02-2.19), knowledge of partner's HIV status (AOR: 1.55; 95% CI: 1.07-2.24), ever used condoms (AOR: 1.65; 95% CI: 1.04-2.62), and nude exchanges (AOR: 1.62; 95% CI: 1.13-2.31) were independent determinants of awareness of PEP. Only a few students had seen (5.6%) or used (1.5%) any prophylaxes.The study findings indicate a low level of awareness and use of PrEP and PEP. To ensure no one is left behind in the goal of elimination of new HIV infections, intervention to expand access to these preventive strategies is needed in the study settings.
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Affiliation(s)
- Anthony Idowu Ajayi
- Department of Sociology, Faculty of Social Sciences and Humanities, University of Fort Hare, East London, South Africa
| | | | - Oladele Vincent Adeniyi
- Department of Microbiology, Faculty of Sciences and Agriculture, University of Fort Hare, Alice, South Africa
| | - Wilson Akpan
- Department of Sociology, Faculty of Social Sciences and Humanities, University of Fort Hare, East London, South Africa
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Ajayi AI, Adeniyi OV, Akpan W. Maternal health care visits as predictors of contraceptive use among childbearing women in a medically underserved state in Nigeria. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2018; 37:19. [PMID: 30041704 PMCID: PMC6057093 DOI: 10.1186/s41043-018-0150-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 07/17/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Health care visits during pregnancy, childbirth and after childbirth may be crucial in expanding the uptake of contraceptive care in resource-poor settings. However, little is known about how health care visits influence the uptake of modern contraception in Nigeria. The focus of this paper was to examine how health care visits influence the use of contraceptives among parous women in a medically underserved setting. METHODS The study adopted a descriptive survey design. Data was collected from 411 women who gave birth between 2010 and 2015 selected through a two-stage cluster random sampling technique. Health care visits for antenatal care services, childbirth, postnatal care and modern contraceptive were dichotomised (yes, no). Descriptive analyses were performed, and percentages, frequencies and means were reported. Multiple logistic regressions were computed, and odds ratios and 95% confidence intervals were calculated. RESULTS Knowledge of all contraceptive methods was lowest among women who reside in rural areas. Health care visits for antenatal care (UOR 4.5; 95% CI 2.0-10.5), childbirth (UOR2.1; 95% CI 1.4-3.2) and postnatal care services (UOR 2.3; 95% CI 1.5-3.5) independently predict ever use of any contraceptive methods. Likewise, health care visits for antenatal care (UOR 5.6; 95% CI 2.1-14.8), childbirth (UOR 2.3; 95% CI 1.5-3.6) and postnatal care services (UOR 2.8; 95% CI 1.8-4.5) were independent predictors of current use of modern contraceptive methods. In the adjusted model, health care visits for antenatal care services (AOR 3.2; 95% CI 1.1-8.8) were significantly associated with the use of modern contraceptive methods. CONCLUSION Health care visits significantly predict the use of modern contraceptive methods. Expanding access to health care services would potentially increase contraceptive use among childbearing women in the medically underserved settings.
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Affiliation(s)
- Anthony Idowu Ajayi
- Department of Sociology, Faculty of Social Sciences & Humanities, University of Fort Hare, 50 Church street, East London, 5200 South Africa
| | - Oladele Vincent Adeniyi
- Department of Family Medicine, Walter Sisulu University, Cecilia Makiwane Hospital, East London Hospital Complex, East London, South Africa
| | - Wilson Akpan
- Department of Sociology, Faculty of Social Sciences & Humanities, University of Fort Hare, 50 Church street, East London, 5200 South Africa
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Ajayi AI, Akpan W. Determinants of condom use among parous women in North Central and South Western Nigeria: a cross-sectional survey. BMC Res Notes 2018; 11:467. [PMID: 30005715 PMCID: PMC6044001 DOI: 10.1186/s13104-018-3573-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 07/06/2018] [Indexed: 11/20/2022] Open
Abstract
Objectives There appears to be an increasing trend of condom use for pregnancy prevention among nulliparous and multiparous women in developing countries. Drawing from a cross-sectional survey involving 1227 women selected using a 3-stage cluster random sampling technique, the study examines the rates of condom use and its determinants among parous women in three states in North Central and South Western Nigeria. Results The rate of condom use among parous women was 13.8% and 23.2% among women using any form of contraceptives. After adjusting for confounding factors (religion and marital status, socioeconomic status and access to a health facility in the resident community), women aged 26–35 (AOR 2.7; CI 1.6–4.5), urban residence (AOR: 3.6; CI 2.2–5.8), no income (AOR: 2.7; CI 1.4–4.9), living in Ekiti State (AOR: 1.8; CI 1.2–2.8) and having a tertiary level of education (AOR: 4.5; CI 1.3–15.6) were the independent predictors of condom use. There is an increasing trend of condom use among parous women. Electronic supplementary material The online version of this article (10.1186/s13104-018-3573-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anthony I Ajayi
- Department of Sociology, University of Fort Hare, 50 Church Street, East London, 5200, South Africa.
| | - Wilson Akpan
- Department of Sociology, University of Fort Hare, 50 Church Street, East London, 5200, South Africa
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Ajayi AI, Adeniyi OV, Akpan W. Use of traditional and modern contraceptives among childbearing women: findings from a mixed methods study in two southwestern Nigerian states. BMC Public Health 2018; 18:604. [PMID: 29739372 PMCID: PMC5941455 DOI: 10.1186/s12889-018-5522-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 04/27/2018] [Indexed: 11/27/2022] Open
Abstract
Background Contraceptive use has numerous health benefits such as preventing unplanned pregnancies, ensuring optimum spacing between births, reducing maternal and child mortality, and improving the lives of women and children in general. This study examines the level of contraceptive use, its determinants, reasons for non-use of contraception among women in the reproductive age group (18–49 years) in two southwestern Nigerian states. Methods The study adopted an interviewer-administered questionnaire to collect data from 809 participants selected using a 3-stage cluster random sampling technique. We also conducted 46 in-depth interviews. In order to investigate the association between the socio-demographic variables and use of contraceptive methods, we estimated the binary logistic regression models. Results The findings indicated that knowledge of any methods of contraception was almost universal among the participants. The rates of ever use and current use of contraception was 80 and 66.6%, respectively. However, only 43.9% of the participants had ever used any modern contraceptive methods, considered to be more reliable. The fear of side effects of modern contraceptive methods drove women to rely on less effective traditional methods (withdrawal and rhythm methods). Some women employed crude and unproven contraceptive methods to prevent pregnancies. Conclusion Our findings show that the rate of contraceptive use was high in the study setting. However, many women chose less effective traditional contraceptive methods over more effective modern contraceptive methods due to fear of side effects of the latter. Patient education on the various options of modern contraceptives, their side effects and management would be crucial towards expanding the family planning services in the study setting.
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Affiliation(s)
- Anthony Idowu Ajayi
- Department of Sociology, Faculty of Social Sciences & Humanities, University of Fort Hare, 50 Church street, East London, 5200, Eastern Cape, South Africa.
| | - Oladele Vincent Adeniyi
- Department of Family Medicine, Cecilia Makiwane Hospital, East London Hospital Complex, Walter Sisulu University, East London, Eastern Cape, South Africa
| | - Wilson Akpan
- Department of Sociology, Faculty of Social Sciences & Humanities, University of Fort Hare, 50 Church street, East London, 5200, Eastern Cape, South Africa
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Adeniyi OV, Ajayi AI, Moyaki MG, Goon DT, Avramovic G, Lambert J. High rate of unplanned pregnancy in the context of integrated family planning and HIV care services in South Africa. BMC Health Serv Res 2018; 18:140. [PMID: 29482587 PMCID: PMC5828463 DOI: 10.1186/s12913-018-2942-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integration of family planning services into HIV care was implemented in South Africa as a core strategy aimed at reducing unintended pregnancies among childbearing women living with HIV. However, it is unclear whether this strategy has made any significant impact at the population level. This paper describes the prevalence and correlates of self-reported unplanned pregnancy among HIV-infected parturient women attending three large maternity centres in the Eastern Cape, South Africa. We also compare unplanned pregnancy rates between HIV-infected parturient women already in care (who have benefitted from services' integration) and newly diagnosed parturient women (who have not benefitted from services' integration). METHODS Drawing from the baseline data of the East London Prospective Cohort Study (ELPCS), data of 594 parturient women living with HIV in the Eastern Cape were included. Chi-square statistics and binary logistics regression were employed to determine the correlates of unplanned pregnancy among the cohort. RESULTS The prevalence of unplanned pregnancy was 71% (n = 422) with a higher rate among parturient women newly diagnosed during the index pregnancy (87%). Unplanned pregnancy was significantly associated with younger age, single status, HIV diagnosis at booking, high parity and previous abortion. Women who reported unplanned pregnancy were more likely to book late and have lower CD4 counts. After adjusting for confounding variables, having one child and five to seven children (AOR = 2.2; CI = 1.3-3.1), age less than 21 years (AOR = 3.3; CI = 1.1-9.8), late booking after 27 weeks (AOR = 2.7; CI = 1.5-5.0), not married (AOR = 4.3; CI = 2.7-6.8) and HIV diagnosis at booking (AOR = 3.0; CI = 1.6-5.8) were the significant correlates of unplanned pregnancy in the cohort. CONCLUSION Unplanned pregnancy remains high overall among parturient women living with HIV in the region, however, with significant reduction among those who were exposed to integrated services. The study confirms that integration of HIV care and family planning services is an important strategy to reduce unplanned pregnancy among women living with HIV. The study's findings have significant implications for the elimination of mother-to-child transmission of HIV in South Africa. Innovative interventions are needed to further consolidate and maximise the benefit of the integration of family planning services with HIV care.
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Affiliation(s)
- Oladele Vincent Adeniyi
- Department of Family Medicine and Rural Health, Walter Sisulu University, Cecilia Makiwane Hospital/East London Hospital Complex, East London, South Africa
| | - Anthony Idowu Ajayi
- Department of Sociology, University of Fort Hare, 50, Church Street, East London, South Africa
| | | | - Daniel Ter Goon
- Faculty of Health Sciences, University of Fort Hare, East London, South Africa
| | - Gordana Avramovic
- University College Dublin/Mater Misericordiae University Hospital, Catherine McAuley Education & Research Centre, Dublin, Ireland
| | - John Lambert
- University College Dublin/Mater Misericordiae University Hospital, Catherine McAuley Education & Research Centre, Dublin, Ireland
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