Determinants of long acting contraceptive utilization among HIV positive reproductive age women attending care at art clinics of public health facilities in Arba Minch town, Southern Ethiopia, 2019: a case control study

Determinants of long act reversible contraceptive utilization among HIV positive reproductive age women attending ART clinic in South West Ethiopia

BACKGROUND

Identifying the determinants of long-acting contraceptive utilization and managing the sexual and reproductive health of HIV-infected women is critical to reducing HIV transmission and maternal mortality. However, the determinants of long-acting contraceptive utilization have not been well understood in resource-limited settings like Ethiopia. The aim of this study was to identify determinants of long-acting reversible contraceptive utilization among HIV-positive women on ART in southwest Ethiopia.

METHODS

A facility-based, unmatched case control study was conducted from July 24 to August 28, 2021, in south-west Ethiopia. The study participants were HIV positive women, with a sample size of 109 cases and controls. An interviewer administered a questionnaire, and a check list was used for data collection. A systemic random sampling technique was used to collect data from cases and controls. Bivariate and multivariable logistic regressions were employed to determine the determinants of LARC utilization among HIV-positive women. To demonstrate the strength of the determinant, the odds ratio was calculated with 95% confidence intervals, and a P-value less than 0.05 was used to declare statistical significance.

RESULT

A total of 324 women (108 cases and 216 controls) of reproductive age who were HIV positive were interviewed, with a response rate of 99.0%. urban residence (AOR = 2.67, 95%CI: 1.23- 5.77), having formal education (AOR = 2.93, 95% CI:1.36, 6.34), being counseled by health care provider (AOR = 5.42,95% CI: 2.67-11.03), no future fertility intention (AOR = 2.87, 95% CI:1.44-5.70), having CD4 count less than 500 cell/mm³ (AOR = 4.18,95% CI:2.12-8.23), having information of HIV transmission from mother to child (AOR = 3.65,95% CI:1.49-8.95),not using condom during sexual intercourse (AOR = 4.86,95% CI:2.46-9.62),,having knowledge towards LARC (AOR = 2.38,95% CI:1.24-4.58) and attitude towards LARC (AOR = 6.41,95%CI:3.16-13.0) were independent determinants of LARC utilization among HIV positive women.

CONCLUSION AND RECOMMENDATION

Women being counseled by a health care provider, having no future fertility intention, and having a CD4 count less than 500 cells/mm³ were found to be determinants of long-acting contraceptive method utilization among HIV-positive reproductive-age women. Also, our study supports the WHO Strategic Concepts for Improving the Links between Family Planning and HIV/AIDS Policy, Programs, and Services. It is recommended that Health care providers should use these factors as base line during family planning counseling and service delivery.

Four in ten married women demands satisfied by modern contraceptives in high fertility sub-Saharan Africa countries: a multilevel analysis of demographic and health surveys

BACKGROUND

Demand satisfied with modern contraceptive can be seen on both a health and economic level. Additionally, family planning helps to regulate fertility, prevent unintended pregnancies and their consequences. Thus, the aim of this study was to identify the magnitude of demand satisfied with modern contraceptive among married/in-union women in ten high fertility sub Saharan African countries.

METHODS

Recent Demographic and Health Surveys that included a weighted sample of 43,745 women of reproductive age provided the data for this study. All statistical analyses were conducted once the data had been weighted, and Stata version 16.0 was used. A multilevel mixed-effect binary logistic regression model was fitted. To determine statistically significant individual and community-level factors associated with demand satisfied for modern contraceptive, odds ratios with a 95% confidence interval was generated. A p-value less than 0.05 was declared as statistical significance.

RESULTS

Overall, demand satisfied to use modern contraceptive in high fertility sub-Saharan Africa countries was 39.53% (95%CI: 39.06, 39.98). Women aged 25-34 (AOR: 1.34, 95%CI: 1.26, 1.42) and 35-49 (AOR: 1.28, 95%CI: 1.20, 1.38), women education: primary (AOR: 1.35, 95%CI: 1.27, 1.44) and secondary (AOR: 2.05, 95%CI: 1.90, 2.21), husband education: primary (AOR: 1.26, 95%CI: 1.18, 1.35) and secondary (AOR: 1.54, 95%CI: 1.43, 1.66), husband residence (AOR: 1.75, 95%CI: 1.60, 1.91), media exposure (AOR: 1.22, 95%CI: 1.15, 1.29), wealth index: poorer (AOR: 1.1, 95%CI: 1.02, 1.19), middle (AOR: 1.18, 95%CI: 1.08, 1.28), richer (AOR: 1.37, 95%CI: 1.26, 1.49) and richest (AOR: 1.34, 95%CI: 1.56, 1.89), number of children: 4-6 (AOR: 0.48, 95%CI: 0.43, 0.55) and above 6 (AOR: 0.39, 95%CI: 0.29, 0.59), perceived distance to the health facility not big problem (AOR: 1.11, 95%CI: 1.04, 1.15), urban residence (AOR: 1.18, 95%CI: 1.10, 1.27), high community level poverty (AOR: 0.85, 95%CI: 0.74, 0.97) were significantly associated with demand satisfied for modern contraceptives.

CONCLUSION

Only four in ten married reproductive age women demands satisfied with modern contraceptives in high fertility Sub Saharan African countries. Modern contraceptives should therefore be more widely available, especially in rural areas and for those living away from health facilities. Also, increasing media exposure and education, providing financial support, and making contraceptive access easier for married women from poor households are important interventions that need to be put in place.

Dual contraceptives and associated predictors in HIV positive women: a case-control study

Background

People living with the human immune deficiency virus (PLHIV) are an important group to address HIV prevention. Mostly, 90% of the HIV cases in children are usually through mother-to-child transmission. Dual contraception (barrier condoms i.e., male, and female condoms) are one of the most effective ways to avoid HIV transmission. Thus, the present study was carried out to establish the predictors associated with the use of dual contraceptives in sexually active HIV positive women in Hossana, Southern Ethiopia.

Methods

An institution based unmatched case–control study among randomly selected 312 sexually active HIV positive women was conducted from February 2021 to May 2021. The data were collected through structured questionnaire and anti-retroviral treatment (ART) cards considering the case-to-control ratio of 1:3. The information was coded, entered into Epi-Info7.0 and exported to SPSS 20.0 for further analysis. A P-value < 0.25 in bi-variate analysis was further processed for multi-variate analysis and P-value < 0.05 was considered statistically significant.

Results

A response rate of 97.2% was recorded. A significant difference was observed towards the use of dual contraceptives in sexually active HIV positive women living in urban vs rural areas (AOR = 0.28; 95% CI = 0.09–0.84), having sexual intercourse with a regular partner (AOR = 3.77; 95% CI = 1.48–9.55) and taking first initiation to use (AOR = 0.05; 95% CI = 0.02–0.11).

Conclusion

The determinants associated with lower use of dual contraceptives were residing in rural areas, sexual intercourse with a regular partner and low initiation rate at first time for use of dual contraceptives. Therefore, we strongly recommend that open discussion about sexually transmitted infections like HIV and their prevention, providing adequate facilities in rural areas can help to prevent HIV transmission and reduce the disease burden. The health professionals are encouraged to organize awareness campaigns in rural areas for use of dual contraceptives among PLHIV.

HIV/AIDS has become a serious global threat to human beings. People living with HIV are an important group that needs attention. About 90% of the children get HIV infection through their mothers that involved mother-to-child transmission of HIV. Therefore, World Health Organization has focused on the use of condoms to prevent the transmission of sexually transmitted diseases (STDs) and to avoid unwanted pregnancies. Out of these contraceptives, the use of dual contraceptives has been considered the best to prevent the transmission of STDs/HIV. Therefore, the present study tried to identify the use of dual contraceptives (barrier condoms i.e., male, and female condoms) and factors associated with its use in sexually active HIV women in Hossana, SNNPR, Ethiopia. We conducted a case–control study and recruited 312 sexually active HIV positive women that were on antiretroviral therapy and visiting the ART clinics for their follow-ups. The present investigation revealed that women living in rural areas were not aware about the use of dual contraceptives when compared to urban areas. Also, it was observed that women, those involved in sexual activities with multiple partners and had an open discussion with their partners about using dual contraceptives at first were more when compared to others. Although, the use of dual contraceptives among HIV positive women living in Hossana was low. Hence, this needs more focused awareness programs in rural areas and people having sexual intercourse with regular partners.

Factors associated with modern contraceptive demands satisfied among currently married/in-union women of reproductive age in Ethiopia: a multilevel analysis of the 2016 Demographic and Health Survey

OBJECTIVES

Regardless of the local and international initiatives, excluding exempting services, demand satisfied for contraceptives remains low in Ethiopia. This circumstance is supposed to be attributed to different level factors; however, most were not well addressed in the previous studies. Therefore, this study aimed at assessing the magnitude and individual, household and community-level factors associated with demand satisfied for modern contraceptive (DSFMC) methods among married/in-union women of reproductive age.

DESIGN

Cross-sectional study.

SETTING

A community-based study across the country.

PARTICIPANTS

Randomly selected 9126 married/in-union women had participated using a structured questionnaire.

OUTCOME

DSFMC methods among married/in-union women of reproductive age.

RESULTS

DSFMC methods in Ethiopia was 39.5% (95% CI 38.5% to 40.5%). Women aged 35-49 years (adjusted OR (AOR): 0.43, 95% CI 0.32 to 0.58), Muslim religion (AOR: 0.58, 95% CI0.43 to 0.78), husband lived elsewhere (AOR: 0.42, 95% CI 0.29 to 0.60), joint decision making to use (AOR: 1.30, 95% CI 1.04 to 1.62), good knowledge (AOR: 1.57, 95% CI 1.32 to 1.86) and wealth status of poorer (AOR: 1.56, 95% CI 1.17 to 2.06), middle (AOR: 1.77, 95% CI 1.33 to 2.35), richer (AOR: 1.96, 95% CI 1.49 to 2.59), and richest (AOR: 1.49, 95% CI 1.05 to 2.08), pastoralist regions (AOR: 0.28, 95% CI 0.18 to 0.42), and agrarian regions (AOR: 1.72, 95% CI 1.21 to 2.44) and rural residency (AOR: 0.56, 95% CI 0.37 to 0.82) were factors significantly associated.

CONCLUSIONS

Women's age, religion, the current living place of husbands and women's knowledge were individual-level factors. Household wealth status and mutual decision making to use were household-level factors. Region and residency were households and community-level factors associated with DSFMCs. Increasing the accessibility of modern contraceptive methods to women in rural areas and pastoralist regions, those living separately, engaging religious leaders and men in the programme, would increase their satisfying demand.