Postpartum intrauterine contraceptive device use and its associated factors in Ethiopia: systematic review and meta-analysis

Magnitude and associated factors of postpartum family planning uptake among postpartum women in Ethiopia: an umbrella review

Background

The World Health Organization indicates that despite advancements, the rates of maternal and neonatal mortality and morbidity during the postpartum period continue to be alarmingly high. Furthermore, untapped opportunities to enhance maternal health and promote effective newborn care, including family planning services, have not been fully leveraged. Earlier meta-analyses and systematic reviews have addressed this subject; however, a thorough evidence synthesis has not been provided. Therefore, the objective of this study was to compile the existing systematic reviews (SRs) concerning postpartum family planning uptake among postpartum women in Ethiopia.

Method

This review used an umbrella review method, incorporating numerous systematic reviews. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Meta-analysis of Observational Studies guideline (MOOSE). A comprehensive literature review was conducted across prominent four electronic databases (including MEDLINE/PubMed, Cochrane, Web of Science and Science Direct) from June 15, to July 15, 2024. This review encompassed investigations carried out within the uptake of family planning among post-partum women and its determinants in Ethiopia were the primary outcome. A set of inclusion criteria was established to identify all pertinent systematic reviews, including studies, with no restrictions on data collection and publication year. The quality of the methods was evaluated using the Assessment of Multiple Systematic Reviews tool, (AMSTAR) tool. Statistical analysis was conducted using STATA version 17 software, and the 95% confidence interval was utilized to establish statistical significance. I-squared statistics were employed to evaluate the heterogeneity of the studies by using a random-effects meta-analysis model.

Results

The umbrella review includes five studies with a total of 44,276 postpartum women. The pooled prevalence of postpartum family planning utilization was 36.41% (95% CI: 24.78, 48.03). Family planning counseling (AOR: 4.12, 95% CI: 2.89, 4.71), couple discussion (AOR: 3.06, 95% CI: 1.42, 5.60), and postnatal follow-up (AOR: 3.48, 95% CI: 2.60, 4.83) were significantly associated with postpartum family planning uptake.

Conclusion

The study results indicate that the adoption of postpartum family planning in Ethiopia requires focused intervention. This can be achieved by identifying and enhancing community frameworks to involve men in reproductive health initiatives and by providing comprehensive family planning information and services during postnatal care. Addressing the aforementioned factors is crucial to mitigate the risks associated with unintended pregnancies and to manage the swift increase in population.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024568435, PROSPERO (CRD42024568435).

Knowledge, attitude and practice towards COVID-19 among pregnant women in Africa: A systematic review and meta-analysis

Background

Pregnant women and recent mothers face a higher risk of severe illness from Coronavirus disease 2019 due to physiological and immunological shifts during pregnancy, rendering them more vulnerable to inflammatory lung conditions. This susceptibility poses serious threats to both maternal and newborn health. Therefore, it is imperative for pregnant women to be fully informed about Coronavirus disease 2019 and to implement preventive measures. This study aimed to evaluate the collective knowledge, attitudes, and practices related to Coronavirus disease 2019 among pregnant women across Africa.

Methods

The researchers collected studies from multiple databases, including Pub Med/MEDLINE, EMBASE, CINAHL, Science Direct, Scopus, Web of Science, Cochran library, and Google Scholar. A combination of search terms and Boolean operators were utilized to gather relevant literature. Each study underwent quality assessment by five authors independently, using the modified Newcastle Ottawa Scale tailored for cross-sectional research. Statistical analysis was conducted using STATA™ Version 11 software, and meta-analysis was performed using the random-effects (Der Simonian and Laird) method. Heterogeneity was evaluated using I-squared (I2) statistics, and a one-out sensitivity analysis was carried out.

Results

This systematic review and meta-analysis included 19 articles, involving a total of 7852 participants. It revealed that the combined estimated prevalence of good knowledge about Coronavirus disease 2019, positive attitudes, and good practices among pregnant women was found to be 61.8 % (95 % CI: 53.0%-70.65 %; I2 = 98.7 %), 51.7 % (95 % CI: 30.34%-73.6 %; I2 = 99.3 %), and 52.31 % (95 % CI: 41.48%-63.15 %; I2 = 98.8 %) respectively.

Conclusion

This study emphasizes a significant concern: pregnant women exhibit a notable lack of knowledge, positive attitudes, and preventive practices regarding Coronavirus disease 2019. Considering their heightened vulnerability, urgent action is required to improve their understanding, attitudes, and behaviours related to the virus. Healthcare professionals should take proactive measures to educate pregnant women, addressing this crucial gap through various strategies.

Utilization of family planning and associated factors among women with disabilities in ethiopia: A systematic review and meta-analysis

BACKGROUND

Persons with disabilities have a right to make their own choices about their bodies, health, and lives, especially regarding their sexual and reproductive health. But they may experience more challenges than women without disabilities in having their reproductive health needs met. So there is an urgent need to scale up disability inclusion in all levels of the health system including family planning. Therefore, the objective of this study was to estimate the pooled prevalence of Family Planning Utilization and Associated Factors among Women with Disabilities in Ethiopia.

METHODOLOGY

Studies were gathered from Pub Med/MEDLINE (681), Google Scholar (426), African Journal of Online (AJOL) (36), CINAHL (211), HINARI (191), Scopus (86), Science Direct (62), Excerpta Medica database (EMBA, SE) (113), DOAJ (38), Web of Science (26), Google (271), and other organization's websites (2) using a combination of search terms and Boolean operators. The modified Newcastle Ottawa Scale (NOS) for cross-sectional research was used by three authors to independently assess the quality of each study. For statistical analysis, STATATM Version 11 software was employed. For the meta-analysis, the random-effects (Der Simonian and Laird) technique was applied. The heterogeneity test was performed using I-squared (I2) statistics. A one-out sensitivity analysis was performed.

RESULT

A total of 7 articles with 2787 participants were included in this systematic review and meta-analysis. The pooled prevalence of family planning utilization among Women with Disabilities was 29.6% (95% CI: 22.3, 36.8); I2 = 94.6%). Women who were in marital union (p<0.001) and who had a discussion with their husbands (p = 0.007) were factors significantly associated with the utilization of family planning among women with disabilities.

CONCLUSION

The finding of this study showed that utilization of family planning among women with disability is relatively lower than the Ethiopian Demographic Health Survey 2019. Therefore, the discussions with the partner and their engagement in decisions to use family planning are critical to increase its use.

Immediate postpartum family planning utilization and its associated factors among postpartum women in Ethiopia: a systematic review and meta-analysis

Background

Family planning integration in areas where women contact the healthcare system routinely is essential for addressing the high unmet need for family planning among postpartum women and reducing the risk of short interpregnancies. Immediate postpartum family planning (IPPFP) is an integrated service, and opportunities exist for women by providing family planning (FP) counseling and contraceptives as part of care following childbirth within 48 h. Therefore, this review aimed to assess the pooled estimate of immediate postpartum family planning utilization and its associated factors in Ethiopia.

Method

Electronic databases were used to conduct an extensive search of all published studies, and the digital library was used to identify any unpublished studies. An observational study that reports the prevalence/magnitude and/or associated factors/predictors/determinants of IPPFP utilization in Ethiopia was included. Data were extracted on the Microsoft Excel spreadsheet and analyzed using STATA Version 11. A random-effects model was applied to determine the pooled prevalence of immediate postpartum family planning utilization with a 95% confidence interval (CI). Inverse variance (I2) was used to identify the presence of heterogeneity, and a funnel plot and Egger's test were used to check the presence of publication bias. Subgroup analysis was conducted based on the sample size, region, and year of study to identify the source of heterogeneity.

Result

Of 15 primary studies, the overall pooled prevalence of immediate postpartum family planning utilization among postpartum women in Ethiopia was 21.04% (95% CI: 13.08, 29.00). Received counseling on FP [OR: 3.59; 95% CI (1.84, 7.01; P < 0.001), having a positive attitude toward FP [OR: 3.2; 95% CI (1.23, 8.35); P = 0.017], and partner support to use FP [OR: 5.85; 95% CI (1.12, 30.54; P = 0.036) were significant predictors of immediate postpartum family planning utilization.

Conclusion

Generally, IPPFP utilization in Ethiopia was insufficient. Therefore, to enhance the utilization, integrating FP counseling at all maternal service care points, strengthening community awareness to develop a favorable attitude toward family planning, and promoting partner involvement in family planning counseling are essential.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=239053, identifier: CRD42021239053.

Relationship Between Gender Equality and Husband Support in the Use of Postpartum Family Planning (PPFP)

Introduction

Postpartum family planning (PPFP) has been reported to decrease the risk of stunting by increasing the interval between pregnancies by 0.9 percent every month. In Indonesia, the prevalence of stunting affects 21.6% in 2022; however, it is expected that by 2024, the figure would drop to 14%.

Objective

This study aims to analyze the relationship between gender equality and husband support in the use of PPFP.

Methods

The study was conducted using a cross-sectional method and took place from August to October 2022. The participants comprised 210 women who had given birth in the first 4 to 12 months in Kulon Progo, Yogyakarta, Indonesia. The data was collected from women who visited the pediatrics and family planning clinics of community health centers from August to October 2022, using a structured questionnaire and analyzed using both the Chi-Square Test and Binary Logistic Regression Analysis.

Results

The results showed that 38.1% of the participants used PPFP. The estimated results reveal that variables such as education, husband support, gender equality, home visits, and postnatal visits (p < 0.05) influenced the implementation of postpartum contraception. While other variables such as age, occupation, income, number of children, and parity did not affect the model (p > 0.05).

Conclusion

Participating in postpartum family planning requires the husband's support and gender equality. We recommend a deliberate effort on improving postnatal mothers using postpartum family planning, one of the strategies is to increase intensive outreach to pregnant women with higher education to their husbands about the importance of postpartum family planning.

Strategies for Improving Postpartum Contraception Compared With Routine Maternal Care: A Systematic Review and Meta-Analysis

Objectives: This study aimed to systematically review the effectiveness of service interventions for improving postpartum contraception, including contraceptive use, prevention of repeat pregnancies and induced abortions. Methods: A systematic literature search was conducted in three databases until June 2022 (PROSPERO registration CRD42022328349). Estimates of intervention effects from meta-analyses were represented as odds ratios (OR) with 95% confidence intervals (CI). Results: 16 studies with 14,289 participants were included, with four kinds of interventions recognized. Interventions effect in increasing use of contraceptives and decreasing rates of repeated pregnancy for up to 6 months postpartum (OR = 2.24, 0.06, 95% CI = 1.46-3.44, 0.02-0.22, respectively), with no significant associations with contraceptive use at 12 months postpartum, prevention of postpartum repeat pregnancies and induced abortions during 1 year after childbirth. Conclusion: We concluded that interventions impact the initiation of postpartum contraceptive use and prevention of repeat pregnancy with an overall certainty from low to moderate. These findings highlight the need for additional studies to integrate the beneficial effect of several interventions and then design more feasible strategies, which is important for the maternal and child healthcare systems.

Immediate postpartum intrauterine contraceptive device utilization and associated factors among women who gave birth in public health facilities of Adama town, Ethiopia

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.

HIV Serostatus Disclosure and Its Predictors Among Children Living With HIV in Ethiopia: A Systematic Review and Meta-Analysis

Background

HIV disclosure among children refers to when the caregiver is having disclosed to the child that he or she has HIV specifically. Disclosure significantly improved adherence to treatment and quality of life among children living with HIV/AIDS. Even though, the benefits of disclosure are considerable, informing a child of his or her own HIV status is often delayed. There is a dearth of studies on HIV serostatus disclosure among children in Ethiopia. Therefore, this study aimed to assess the pooled prevalence of HIV serostatus disclosure and associated factors among children living with HIV in Ethiopia.

Methods and Materials

Using a combination of search terms and Boolean operators, studies were retrieved from Pub Med/MEDLINE, EMBASE, CINAHL, Science Direct, Scopus, Web of Science, Cochran library, and Google Scholar. Five authors independently assessed the quality of each study using the modified Newcastle Ottawa Scale (NOS) for cross-sectional studies. STATA Version 11 software was used for statistical analyses. The random-effects (Der Simonian and Laird) method was used for the meta-analysis. The heterogeneity test was carried out with the help of I-squared (I2) statistics. A leave-one-out sensitivity analysis was carried out.

Results

A total of 12 articles with 3,410 participants were included in this systematic review and meta-analysis. The pooled prevalence of HIV serostatus disclosure among children was 36.87% (95% CI: 29.30, 44.44; I2 = 95.8%). Children aged older than 10 years (p = 0.003) and caregivers with primary and above education (p < 0.001) were factors significantly associated with HIV serostatus disclosure among children.

Conclusions

The finding of this study showed that HIV serostatus disclosure among children is relatively low. Therefore, developing clear guideline on HIV serostatus disclosure among children, strengthening public health education or community awareness creation about HIV/AIDS to promote the benefits of disclosure and extensively provision of counseling by health care providers are essential to enhance HIV serostatus disclosure among children.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021239035.