[Determinants of contraceptive use in Mumbunda health zone in Lubumbashi, Democratic Republic of Congo]

Barriers to family planning use in the Eastern Democratic Republic of the Congo: an application of the theory of planned behaviour using a longitudinal survey

OBJECTIVE

In the Democratic Republic of the Congo, there is a low adherence of the population to the use of family planning (FP) due to various social barriers. This study aimed to understand the drives from social barriers to the use of FP in women in the Kivu, a region particularly affected by poverty and many years of conflicts. A theory of planned behaviour (TPB) using a generalised structural equation modelling has been applied to understand the complex sociocultural drivers to the intention and the ultimate decision to use FP.

DESIGN

Longitudinal study.

SETTING

A community-based approach was used to investigate FP use in the North and South-Kivu regions.

PARTICIPANTS

Overall, 1812 women 15 years and older were enrolled in the baseline study and 1055 were retrieved during the follow-up.

PRIMARY AND SECONDARY OUTCOMES

FP use and intention to use FP.

RESULTS

The mean age was 36±12.9 years, with a minimum of 15 years old and a maximum of 94 years old. Among sexually active participants, more than 40% used a modern contraceptive method at the last sexual intercourse. Education was positively and significantly associated with intention to use FP (β=0.367; p=0.008). Being married was positively and marginally significantly associated with intention to use FP (β=0.524: p=0.050). Subjective norms were negatively and significantly associated with intention to use FP (β=-0.572; p=0.003) while perceived control was positively associated with intention to use FP (β=0.578; p<0.0001). Education and perceived control were positively and significantly associated with the use of FP (respectively, β=0.422, p=0.017; and β=0.374; p=0.017), while Intention to use FP was positively and marginally significantly associated with the use of FP (β=0.583; p=0.052).

CONCLUSION

TPB helped understand sociocultural barriers to FP use and it can be useful to define adapted strategies in different contexts.

Uptake of Modern Contraceptive Methods among Burundian Women and Associated Factors: Analysis of Demographic and Health Survey Data, Burundi 2016-2017

Background:

Globally in 2017, Burundi was the 9^th country with the highest population growth rate of 3.2% and a fertility rate of 5.5 children per woman. This probably suggested low uptake of Modern Contraceptive methods (MCM) in the country. Our analysis investigated factors associated with low uptake of MCM among women of reproductive age in Burundi.

Methods:

Cross sectional data of non-pregnant women aged 15-49 years was extracted from the Burundi Demographic and Health Survey (2016-2017). We analysed the data at univariate, bivariate and multivariate levels to assess factors influencing MCM uptake among these women using Epi-Info 7.2.2.6.

Results:

Of the 9,945 women, 2,372 (23.8%) were using MCM. Ngozi province had the highest prevalence of MCM users [284/691(37.7%)]. The most used MCM among respondents was injectable contraceptive (48.3%). As respondent's age increases, the odds of using MCM decreases; 20-24 years (aOR=0.9, 95% CI [0.6–1.2]), 30–34 years (aOR=0.8, 95% CI [0.5–1.0]), 35-39 years (aOR=0.7, 95% CI [0.5–0.9]), 40-44 years (aOR=0.5, 95% CI [0.5–0.9]) and 45-49 years (aOR=0.4, 95% CI [0.2–0.5]) compared with those in the age group 15–19 years. Muslims (aOR=1.5, 95% CI [1.2–1.9]) and Jehovah witnesses (aOR=3.1, 95% CI [1.7–6.5]) were more likely to use MCM than Catholics.

Conclusion:

The prevalence of MCM remains low among women of reproductive age in Burundi, with injectables being the most used method. Factors such as respondent's age and religion were significantly associated with MCM use. Enhanced access to family planning information and services targeting women who are 30 years or more and engaging religious leaders for their active participation is recommended.

Using data to support evidence-informed decisions about skilled birth attendants in fragile contexts: a situational analysis from Democratic Republic of the Congo

BACKGROUND

Most low- and middle-income countries are experiencing challenges in maternal health in relation to accessing skilled birth attendants (SBA). The first step in addressing this problem is understanding the current situation. We aimed to understand SBA's availability and distribution in Ituri Province, North Eastern Democratic Republic of the Congo (DRC) from 2013 to 2017.

METHODS

We used available data on SBAs (doctors, nurses and midwives) from the Ituri Provincial Human Resource for Health Management Unit's database from 2013 to 2017. The current distribution across and within three categories of district (rural, peri-urban and urban) and characteristics of SBAs as well as 5-year trends and vacancy trends were identified. Data on training outputs for SBA cadres was collected from training schools in the province. Descriptive analysis, disaggregating by district, cadre and gender where possible, was conducted using Excel.

RESULTS

The national ratio of SBAs per 1000 population is four times less than the Sustainable Development Goals threshold (4.45) while the Ituri Province ratio is one of the lowest in DRC. There are more doctors and nurses in urban and peri-urban districts compared to posts, and shortages of midwives in all district categories, particularly in rural districts. From 2013 to 2017, occupied posts for doctors and nurses in all three categories of districts increase while midwives decrease in peri-urban and rural districts. There is clear gender and occupational segregation: doctors and nurses are more likely to be male, whereas midwives are more likely to be female. The projections of training outputs show a surplus against authorised posts of doctors and nursing increasing, while the shortfall for midwives remains above 75%.

CONCLUSION

This is the first study to use existing human resource data to analyse availability and distribution of SBAs in a DRC province. This has provided insight into the mismatch of supply and demand of SBAs, highlighting the extreme shortage of midwives throughout the province. Further investigations are needed to better understand the situation and develop strategies to ensure a more equitable distribution of SBAs throughout this province and beyond. Without this, DRC will continue to struggle to reduce maternal mortality.

Factors Impacting Family Planning Use in Mali and Senegal

The total fertility rate in Mali (6.2) is the third highest in the world. Despite sociocultural similarities, the total fertility rate in neighboring Senegal is 4.2. The aim of this study is to identify factors which may help to explain the differences between the two countries and which may thereby inform family planning policy in Mali. A cross-sectional study was conducted with a convenience sample of 602 married women aged 16–50 from urban and rural sites in southern Mali and Senegal. A total of 298 respondents from Mali and 304 from Senegal completed a structured questionnaire between July and October 2018. In total, 11.1% of the Malian respondents and 30.9% of the Senegalese respondents were currently using family planning, and 34.6% and 40.5%, respectively, had ever used a modern family planning method. Pressure from husbands was cited as a primary influence for having more children (in 50.3% of Malians and 45.4% of Senegalese, p = 0.000). Women’s age, education level, and knowledge of different contraceptive methods were associated with ever use of contraceptives. After adjustment for confounders, discussing family planning with one’s husband was the strongest predictor of contraceptive use among both Senegalese (OR = 3.4, 95% CI (1.9–6.3), p = 0.000) and Malian respondents (OR = 7.3, (4.1–13.3), p = 0.000).

[Couples' competences in immediate postpartum family planning in the Biyem-Assi health district Cameroon]

Introduction

La planification familiale en post-partum immédiat reste encore peu connue et peu pratiquée par la plupart des couples au Cameroun. Pourtant, juste après un accouchement, nombreux sont ceux qui désirent différer la naissance de leur prochain enfant. Cette étude avait pour objectif de déterminer le niveau de compétences et le besoin éducationnel des couples en matière de planification familiale en post-partum immédiat dans le District de Santé de Biyem-Assi.

Méthodes

Il s'agissait de mener une enquête CAP (connaissances, attitudes et pratiques), dans le District de Santé de Biyem-Assi. La collecte des données s'est faite à l'aide de deux questionnaires de 40 questions chacun, rédigés en français, l'un adressé aux femmes en couple et en post-partum et l'autre aux hommes en couple et ayant au moins un enfant. Les données recueillies ont été saisies dans le logiciel CSPro version 6.2, puis analysées à l'aide du logiciel SPSS version 20.0.

Résultats

Un total de 300 individus a été interrogé avec un sex-ratio de 1. Plus de la moitié (56,7%) avait une connaissance approximative de la planification familiale en post-partum immédiat. Pour 36% des répondants, le post-partum immédiat n'était pas un moment approprié pour l'utilisation d'une méthode contraceptive moderne, l'interaction entre contraceptifs et lait maternel (65,4%) et l'infertilité de la femme (26,3%) étaient les principales raisons évoquées. Les pratiques contraceptives en post-partum immédiat de 60,5% des couples vivant dans le District de Santé de Biyem-Assi étaient inadéquates. Par conséquent, la plupart des enquêtés avaient un niveau de compétences insuffisant (32,6%) et faible (23,3%) en matière de planification familiale en post-partum immédiat.

Conclusion

Certains préjugés et de fausses idées persistent dans la population du District de Santé de Biyem-Assi en ce qui concerne les méthodes contraceptives modernes, et constituent un frein à la pratique contraceptive en général et en post-partum immédiat en particulier. Des efforts de sensibilisation et d'éducation des couples pour l'amélioration de leurs compétences en matière de contraception en post-partum immédiat s'avèrent nécessaires.

[Use of modern contraceptive methods in the Democratic Republic of the Congo: prevalence and barriers in the health zone of Dibindi, Mbuji-Mayi]

Introduction

l’objectif de cette étude était de déterminer la prévalence contraceptive moderne et les barrières à l’utilisation des méthodes contraceptives modernes chez les couples de la Zone de Santé Dibindi, à Mbuji-Mayi en République Démocratique du Congo.

Méthodes

de Mai à Juin 2015, nous avons réalisé une étude descriptive transversale. Nous avons inclus les femmes âgées de 15 à 49 ans, en union maritale, non enceinte au moment de l’enquête, qui habitaient la Zone de santé Dibindi depuis deux ans et ayant consenti librement de participer à l’étude. La collecte des données a été réalisée par interview libre des femmes. La prévalence contraceptive moderne se référait aux femmes en cours d’utilisation, au moment de l’enquête, des contraceptifs modernes. La comparaison des proportions a été réalisée au seuil de signification de 5%. Le test de Bonferroni a été utilisé pour comparer, deux à deux, les proportions des barrières à l’utilisation des contraceptifs modernes.

Résultats

la prévalence contraceptive moderne à Dibindi, en 2015, était de 18,4%. Elle était faible eu égard aux services de planification familiale disponibles dans cette Zone de santé. Plusieurs femmes refusaient d’utiliser les méthodes contraceptives modernes malgré l’information dont elles disposaient à cause de leur désir de maternité, l’interdiction religieuse, l’opposition du conjoint et la crainte des effets secondaires.

Conclusion

l’information suffisante et centrée sur chaque cliente ou son couple, sur la planification familiale, devrait être renforcée de façon à éliminer les fausses croyances, ce qui accroitrait l’utilisation des méthodes contraceptives modernes.