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Ayele SG, Mekonnen B, Deribe L, Tsige AW. Prevalence of modern contraceptive discontinuation and associated factors among married reproductive age group women in Debre Berhan town, Ethiopia: a community-based cross-sectional study. BMJ Open 2024; 14:e066605. [PMID: 38684273 PMCID: PMC11086279 DOI: 10.1136/bmjopen-2022-066605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 03/20/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE To assess the prevalence of modern contraceptive discontinuation and associated factors among married reproductive age (15-49 years) group women. STUDY DESIGN, SETTING AND PARTICIPANTS A community-based cross-sectional study was conducted in Debre Berhan town among 500 reproductive age group women. Study participants were selected using two-stage sampling procedures. Data were collected using a semistructured face-to-face interview questionnaire. The data were entered in EpiData V.4.2.0 and then exported to SPSS V.25 software for data analysis. Descriptive statistics such as mean, per cent and frequency were used to summarise women's characteristics. Binary logistic regression analysis was used to identify predictors' variables with modern contraceptive discontinuation and p<0.05 was used to declare association. RESULTS The prevalence of modern contraceptive discontinuation among married reproductive age group women was 35.2% with a mean duration of use of 2.6±2.1 months. This study also revealed that the discontinuation rate was 12.6% within the first year of use. In the current study, those living with their husband (adjusted OR (AOR)=3.81, p<0.001), experiencing side effects while using modern contraceptives (AOR=2.45, p=0.02), getting counselling service (AOR=5.51, p<0.001) and respondent husband acceptance of her modern contraceptive use (AOR=3.85, p=0.01) were significantly associated with modern contraceptive discontinuation. CONCLUSION The findings of this study showed that the prevalence of modern contraceptive discontinuation rate of all methods among married reproductive age group women was 35.2%. To reduce modern contraceptive discontinuation, mutually, it is important to create community awareness about the importance of the continued use of modern contraceptives, improve the quality of family planning service in the health institution, strengthen family planning counselling service and give adequate counselling on details of effectiveness and side effects.
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Affiliation(s)
| | - Baze Mekonnen
- Department of Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Leul Deribe
- Department of Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
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Cherie N, Tsega Y, Mohammed A, Abegaz Z, Endawkie A, Dawed YA, Kebede N. Client satisfaction and contributing factors towards sexual and reproductive health services delivery system among youth at Family Guidance Association of north Ethiopia (FGAE) clinics, 2023: mixed method study. BMC Health Serv Res 2024; 24:473. [PMID: 38627738 PMCID: PMC11020198 DOI: 10.1186/s12913-024-10874-8] [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: 12/03/2023] [Accepted: 03/15/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The Family Guidance Association of Ethiopia (FGAE) operates as a non-governmental organization dedicated to offering family planning and reproductive health services to the Ethiopian population. The gap in the study regarding client satisfaction and contributing factors towards sexual and reproductive health services for youth at FGAE clinics highlights the need for a comprehensive investigation to fill this void. By conducting a mixed-method study, this research aims to provide a holistic understanding of the factors influencing client satisfaction in the delivery of sexual and reproductive health services to youth at FGAE clinics. The added value of this study lies in its potential to offer valuable insights and recommendations for improving service delivery systems and enhancing client satisfaction levels, ultimately contributing to the overall well-being and health outcomes of youth in North Ethiopia. Therefore study aimed to asses Client Satisfaction and Contributing Factors towards in sexual and reproductive health services delivery system among youth at Family Guidance Association of North Ethiopia (FGAE) Clinics, 2023. METHOD The study was conducted within the clinics of the Family Guidance Association of Ethiopia (FGAE), spanning Dessie, Kombolcha, and Woldia city administrations, involving a participant cohort of 416 clients. Facility-based concurrent type mixed method study design both quantitative and qualitative techniques were applied. Quantitative research employed a simple random sampling technique and conversely, the qualitative study utilized a heterogeneous type of purposive sampling strategy to recruit participants The collected data underwent a rigorous process of entry, cleaning, and coding using Epi-Data 4.6 software, followed by analysis in STATA V17. Descriptive statistics and binary logistic regression were employed to highlight the impact of independent variables on the dependent variable. A more comprehensive examination was provided through multivariable logistic regression. Crude and adjusted odds ratios, along with a 95% confidence interval, were computed, with significance set at a p-value ≤ 0.05. RESULT Nearly more than half of the clients 194 (47.8%) came to receive family planning services followed by maternal and child health 107 (26.4%). Sixty patients (14.8%) didn't receive all the services they wanted or came for. Half of the participants 30 (50%) raised the unavailability of the service as a reason for not taking the service followed by not having enough time in the clinic 12 (20%). About 65.52% (60.74-70.00%) of the participants were satisfied with the Sexual and Reproductive Health services provided by the clinics of FGAE in northeast Ethiopia. Clients in the age group of 25-34 (AOR = 2.04; 95%CI: 1.11-3.72). Clients who had primary and secondary education (AOR = 2.49; 95%CI: 1.03-6.02) and (AOR = 3.05; 95%CI: 1.25-7.49) respectively. Clients who responded that physicians show respect (AOR = 5.59; 95%CI: 1.89-16.49). clients who received an explanation about the side effects of the utilized methods and follow-up dates (AOR = 4.59;95%CI:1.68-12.53) and (AOR = 2.89;95%CI:1.53-5.49) respectively. CONCLUSION The proportion of client satisfaction with Client Satisfaction in the Services delivery system at Family Guidance Association of Ethiopia (FGAE) Clinics was low as compared to the previous study. Age group 25-34 years, primary and secondary education, showing respect, explaining side-effects and follow-up visits were significant associated factors of client service satisfaction. Enhancing service delivery at Family Guidance Association of Ethiopia (FGAE) Clinics by targeting specific areas identified in the study. Strategies should focus on improving communication regarding side effects, ensuring respectful interactions, and prioritizing follow-up visits, particularly for clients aged 25-34 with primary and secondary education backgrounds.
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Affiliation(s)
- Niguss Cherie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie City, Ethiopia
| | - Yawkal Tsega
- Department of Health System and Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie City, Ethiopia
| | - Anissa Mohammed
- Department of Epidemiology and Biostatistics, School of Public Health, Colleges of Medicine and Health Science, Wollo University, Dessie City, Ethiopia
| | - Zinet Abegaz
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie City, Ethiopia
| | - Abel Endawkie
- Department of Epidemiology and Biostatistics, School of Public Health, Colleges of Medicine and Health Science, Wollo University, Dessie City, Ethiopia
| | - Yeshimebet Ali Dawed
- Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie City, Ethiopia.
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Turki A, Ayalew A, Mossie A, Mitiku S. Effects of hormonal contraceptives on lipid profile among women attending family planning unit in Goba Town Public Health Facilities, Bale, Southeast Ethiopia: a comparative cross-sectional study. Reprod Health 2023; 20:185. [PMID: 38115027 PMCID: PMC10729326 DOI: 10.1186/s12978-023-01727-4] [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: 05/19/2023] [Accepted: 12/14/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Hormonal contraceptives are a widely used contraceptive method for the prevention of pregnancy in women. It is associated with change in lipid profile which results in congestive heart failure, coronary heart disease, angina, deep vein thrombosis and stroke which are the major cause of premature death. We aim to investigate the effects of hormonal contraceptive use on lipid profile among women attending family planning unit in Goba Town Public Health Facilities. METHODS A comparative cross-sectional study design was conducted on 93 hormonal contraceptive users and 93 non-users' women in Goba Town Public Health Facilities from September to November, 2022. Blood samples for the estimation of TC, TG, HDL-c and LDL-c levels were collected. Student's independent t-test was used to compare the results of lipid profiles. One-way ANOVA was used to identify the variation of lipid profile between progestin only pills, DMPA and implant users. Simple linear regression was used to determine the change in lipid profiles in relation to the duration of hormonal contraceptive use. P-value less than 0.05 was considered as statistically significant. RESULT The mean serum level of TC, TG and LDL-c was significantly increases in hormonal contraceptive users in comparison with non-users. The mean serum level TC, TG, LDL-c and HDL-c was significantly different between DMPA, implanon and POP users. The mean serum level of TC, TG and LDL-c in implanon users was lower than DMPA and POP users. As the duration of DMPA and POP use increases, the serum level of TC, TG and LDL-c were significantly increased. But, the serum level of HDL-c was significantly decreased. LDL-c was significantly increased with the duration of implanon use. CONCLUSION The mean serum level of TC, TG and LDL-c were significantly increased among hormonal contraceptive users. The mean serum level of lipid profile was significantly different between DMPA, implanon and POP users. The serum level of TC, TG, LDL-c were directly proportional to the duration of DMPA and POP use. Routine evaluation of lipid profiles is advisable before and after initiation of hormonal contraceptives.
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Affiliation(s)
- Awel Turki
- Department of Physiology, Goba Referral Hospital, Madda Walabu University, Bale, Ethiopia
| | - Almaz Ayalew
- Department of Physiology, Saint Paul's Millenium Medical College, Addis Ababa, Ethiopia
| | - Andualem Mossie
- Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Shimelis Mitiku
- Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia.
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Bellow N, Dougherty L, Nai D, Kassegne S, Nagbe RHY, Babogou L, Guede KM, Silva M. Improving provider and client communication around family planning in Togo: Results from a cross-sectional survey. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001923. [PMID: 37289680 DOI: 10.1371/journal.pgph.0001923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/28/2023] [Indexed: 06/10/2023]
Abstract
Previous research has shown that clients are better able to achieve their reproductive intentions when family planning (FP) services meet their needs and they have satisfying client provider interactions. There are several areas of quality provider-client communication, including providers taking a complete reproductive history of their clients to best gauge their needs, communication around alternative FP methods and side effects captured in the method information index, and communication around sexually transmitted infections and HIV risk as it relates to FP choices. This study examines data from a clinic-based intervention in Togo that focuses on strengthening health provider counseling related to FP, including improving in these three areas of provider-client communication. A clustered sampling approach was used to select 650 FP clients from 23 intervention facilities and 235 clients from 17 control facilities in the Lomé and Kara districts of Togo. The FP clients' interactions with providers were observed and clients exit interviews were conducted in December 2021. For each communication area measured through client interviews and observations, principal components analysis and Cronbach's alpha scores were used to ensure that the individual components could be indexed. Outcomes variables based on an index of sub-questions were then created for those who had fulfilled each of the components within an index. Multivariate multilevel mixed-effects logit models accounted for clients nested within facilities and included independent variables capturing client demographic and facility variables. Multivariate results show that all three outcome variables representing the three provider-client communication areas were statistically significantly better for FP clients in intervention clinics versus control clinics (p<0.05). The results speak to the emphasis that the Togo Ministry of Health has placed on building the provider capacity to provide quality counseling and administration of FP methods and working to assist in achieving health programming goals through well-designed interventions.
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Affiliation(s)
- Nicole Bellow
- Avenir Health, Takoma Park, Maryland, United States of America
| | | | - Dela Nai
- Population Council, Accra, Ghana
| | | | | | | | | | - Martha Silva
- Department of International Health and Sustainable Development, Tulane University, New Orleans, Louisiana, United States of America
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Mruts KB, Tessema GA, Kassaw NA, Gebremedhin AT, Scott JA, Pereira G. Achieving reductions in the unmet need for contraception with postpartum family planning counselling in Ethiopia, 2019-2020: a national longitudinal study. Arch Public Health 2023; 81:79. [PMID: 37127656 PMCID: PMC10150151 DOI: 10.1186/s13690-023-01096-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/23/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND An unmet need for contraception is associated with unintended pregnancy and adverse maternal and childhood outcomes. Family planning counselling is linked with reduced unmet need for contraception. However, evidence is lacking in Ethiopia on the impact of integrated family planning counselling on the unmet need for contraception. This study aimed to examine the association between family planning counselling and the unmet need for contraception in Ethiopia. METHODS We used community-based prospective cohort study data from a nationally representative survey conducted by Performance Monitoring for Action Ethiopia between 2019 and 2020. Women who had received three maternal and child health (MCH) services (n = 769) - antenatal care (ANC), facility delivery and child immunisation - were included in this study. The primary exposure variable was family planning counselling provided during the different MCH services. A weighted modified Poisson regression model was used to estimate the adjusted relative risk (aRR) of the unmet need for contraception. RESULTS The prevalence of family planning counselling during ANC, prior to discharge, and child immunisation was 22%, 28%, and 28%, respectively. Approximately one-third (34%) of the women had an unmet need for contraception. Family planning counselling prior to discharge from the facility was associated with reductions in the unmet need for contraception (aRR 0.88; 95% CI 0.67, 1.16). The risk of unmet need for contraception was 31% (aRR 0.69; 95% CI 0.48, 0.98) less likely among women who had received family planning counselling during child immunisation services. However, family planning counselling during ANC was associated with an increased unmet need for contraception (aRR 1.24; 95% CI 0.93, 1.64). CONCLUSION Strongest evidence was observed for moderate associations between reductions in the unmet need for contraception and family planning counselling during the provision of child immunisation services in Ethiopia.
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Affiliation(s)
- Kalayu Brhane Mruts
- School of Public Health, Debre Berhan University, P.O. Box 445, Debre Berhan, Ethiopia.
- Curtin School of Population Health, Curtin University, Perth, Australia.
| | - Gizachew A Tessema
- Curtin School of Population Health, Curtin University, Perth, Australia
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Nigussie Assefa Kassaw
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Jane A Scott
- Curtin School of Population Health, Curtin University, Perth, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- enAble Institute, Curtin University, Perth, Australia
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Asosega KA, Aidoo EN, Adebanji AO, Owusu-Dabo E. Examining the risk factors for overweight and obesity among women in Ghana: A multilevel perspective. Heliyon 2023; 9:e16207. [PMID: 37229171 PMCID: PMC10205511 DOI: 10.1016/j.heliyon.2023.e16207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
Overweight/obesity prevalence is on the increase in epidemic proportions across Low- and Middle-Income countries (LMICs). The public health burden associated with obesity/overweight cannot be underestimated due to its association with chronic health outcomes. This study investigated the individual- and community level risk factors for obesity/overweight among reproductive women. The data used consist of 4393 reproductive women and form part of the 2014 Ghana Demographic and Health Survey (GDHS). Information on these women are clustered within 427 communities. A 2-tier random intercept multilevel logistic model was used to assess the effect of individual- and community level factors on the likelihood of a woman to be obese/overweight. The obesity/overweight prevalence among reproductive women was estimated to be 35.5% (95% CI: 34.04, 36.90%), which significantly differed across clusters. Most at risk were women from middle-income households (aOR = 2.85; 95% CI: 2.28, 3.56), upper-income households (aOR = 5.019, 95% CI: 3.85, 6.55), attaining secondary education (aOR = 1.74; 95% CI: 1.41, 2.16), and higher (aOR = 1.63; 95% CI: 1.14, 2.33), old age (20-29 years (aOR = 4.26; 95% CI: 3.142,5.78); 30-39 years (aOR = 8.59; 95% CI: 6.15, 12.00); 40-49 years (aOR = 12.81; 95% CI: 9.10, 18.16)). Significant differences in the probability of being overweight/obese between different communities were observed (MOR = 1.39). The high prevalence of overweight/obesity requires urgent public health interventions to prevent future public health crises. Efforts to strengthen the healthcare system, encourage lifestyle modification, and public health education are needed to solidify the gains of ensuring a healthy population by 2030 (SDG 3).
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Affiliation(s)
- Killian Asampana Asosega
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana
| | - Eric Nimako Aidoo
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Atinuke Olusola Adebanji
- Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ellis Owusu-Dabo
- Department of Global and International Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Geta T, Awoke N, Lankrew T, Elfios E, Israel E. Prevalence and associated factors of client satisfaction with family planning service among family planning users in Ethiopia: a systematic review and meta-analysis. BMC Womens Health 2023; 23:151. [PMID: 36998000 PMCID: PMC10064780 DOI: 10.1186/s12905-023-02300-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/22/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Considering the importance of client satisfaction in the quality of family planning services, a regular evaluation should be carried out. Several studies have been conducted in Ethiopia, but so far there were no pooled estimates of the prevalence of customer satisfaction with family planning services in the country. Therefore, this systematic review and meta-analysis was intended to estimate the pooled prevalence of client satisfaction with Ethiopian family planning services in Ethiopia. The findings of the review can be used to develop strategies and draft policies in the country. METHODS AND MATERIALS This review included articles published only in Ethiopia. The main databases were Medline/PubMed, Web of Science, Google Scholar, Scopus, Ethiopian University Repository Online, and Cochrane Library. Cross-sectional studies conducted in English and meeting the eligibility criteria were included in the review. A random-effects meta-analysis was performed. Data extraction and analysis were performed using Microsoft Excel and STATA version 14 software, respectively. RESULT The pooled prevalence of customer satisfaction with family planning services in Ethiopia was 56.78% [(95% CI (49.99, 63.56); I2 = 96.2%, p < 0.001]. Waiting time > 30 min [OR = 0.2, 95% CI (0.1-0.29), I2 = 75.0%, p < 0.001], privacy maintained [OR = 5.46, 95% CI (1.43-20.9), I2 = 95.8%, p < 0.001], education status [OR = 0.47], 95% CI (0.22-0.98), I2 = 87.4%, p < 0.001] was significant in client satisfaction related to family planning services. CONCLUSION According to this review, client satisfaction with family planning services in Ethiopia was 56.78%. In addition, waiting time, women's educational level, and respect for privacy were identified as factors that both positively and negatively impact women's satisfaction with family planning services. Decisive action, such as educational intervention, continued monitoring and evaluation of family planning services, and arranging training for providers, is required to address identified issues and ensure higher levels of family satisfaction and utilization. This finding is important for shaping strategic policies and improving the quality of family planning services. This finding is important for designing strategic policy and increasing the quality of family planning services.
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Affiliation(s)
- Temesgen Geta
- School of Nursing, Wolaita Sodo University, Wolaita, Ethiopia.
| | - Nefsu Awoke
- School of Nursing, Wolaita Sodo University, Wolaita, Ethiopia
| | - Tadele Lankrew
- School of Nursing, Wolaita Sodo University, Wolaita, Ethiopia
| | - Eshetu Elfios
- School of Nursing, Wolaita Sodo University, Wolaita, Ethiopia
| | - Eskinder Israel
- School of Public Health, Wolaita Sodo University, Wolaita, Ethiopia
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Abay S, Hagos T, Dellie E, Yazachew L, Teshale G, Debie A. Evaluation of family planning service delivery in Gondar city public health facilities, Northwest Ethiopia: A cross-sectional study. PLoS One 2022; 17:e0274090. [PMID: 36149905 PMCID: PMC9506637 DOI: 10.1371/journal.pone.0274090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Family planning program is low-cost and an effective way to lower maternalmortality by reducing the number of high-risk births. Despite the effectiveness of the program, availability of materials, equipment and trained healthcare providers were some of the challenges in sub-Saharan African countries including Ethiopia. Determining the implementation status and identifying gaps is the aim of this evaluation. Method A facility-based cross-sectional evaluation design with mixed method approach was employed. Quantitative data was collected through the exit interview of 477 clients from March 25-April 25, 2020. The evaluation focused on three dimensions: availability, compliance, and acceptability with multiple data sources. The quantitative data were entered in to Epi-data version 4.6 and exported to SPSS version 25 for analysis. Multivariable logistic regression was done to determine factors associated with client satisfaction. The qualitative data were transcribed, translated and analyzed by using thematic analysis. The evaluation finding was computed and compared with the preset criteria for the final judgment. Result The majority of the health care providers (69.8%) got family planning training in the past two years. Three health facilities (37.5%) had 24hrs electricity with backup generators whereas only 25% of the health facilities had functional piped water inside the service room. Only two (25%) health facilities had a separate room for family planning service and 37.5% of health facilities had national FP guidelines. The overall availability of required resources for family planning service at Gondar city public facilities were 62.1%. Only twenty one (26.3%) of health providers dressed based on dressing code of ethics and none of them had ID during our observation. The overall compliance level of health care providers during providing family planning services were 75.5%. About 53.9% of the clients were satisfied with family planning service provided at Gondar city public health facilities.—and–were significantly associated variables with client satisfaction. Conclusion The overall implementation of family planning service in Gondar city public health facilities with the three evaluation dimensions were judged as fair based on pre-setting judgment matrix. It is better to improve the service through training of healthcare providers, distributed family planning guidelines to health facilities and shortening of waiting time for service.
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Affiliation(s)
- Sefiw Abay
- Univesrity of Gondar comprehensive specialized hospital, Gondar, Ethiopia
| | - Tsega Hagos
- Department of health systems and policy, Institute of public health, College of medicine and health sciences, University of Gondar, Gondar, Ethiopia
| | - Endalkachew Dellie
- Department of health systems and policy, Institute of public health, College of medicine and health sciences, University of Gondar, Gondar, Ethiopia
| | - Lake Yazachew
- Department of health systems and policy, Institute of public health, College of medicine and health sciences, University of Gondar, Gondar, Ethiopia
| | - Getachew Teshale
- Department of health systems and policy, Institute of public health, College of medicine and health sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Ayal Debie
- Department of health systems and policy, Institute of public health, College of medicine and health sciences, University of Gondar, Gondar, Ethiopia
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Hamon JK, Kambanje M, Pryor S, Kaponda AS, Mwale E, Mayhew SH, Webster J, Burchett HED. Integrated Delivery of Family Planning and Childhood Immunisation Services: A Qualitative Study of Factors Influencing Service Responsiveness in Malawi. Health Policy Plan 2022; 37:885-894. [PMID: 35713382 PMCID: PMC9347017 DOI: 10.1093/heapol/czac048] [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: 10/18/2021] [Revised: 06/10/2022] [Accepted: 06/16/2022] [Indexed: 11/14/2022] Open
Abstract
Evidence from several countries in sub-Saharan Africa suggests that the integration of family planning (FP) with childhood immunization services can help reduce the unmet need for FP among postpartum women without undermining the uptake of immunizations. However, the quality and responsiveness of FP services that are integrated with childhood immunizations remain understudied. A qualitative study was conducted in two districts of Malawi, which examined the factors influencing the responsiveness of FP services that were integrated with childhood immunizations in monthly public outreach clinics. Semi-structured interviews with clients (n = 23) and FP providers (n = 10) and a clinic audit were carried out in six clinics. Hardware (material) and software (relational) factors influencing service responsiveness were identified through thematic and framework analyses of interview transcripts, and clinic characteristics were summarized from the audit data to contextualize the qualitative findings. Overall, 13 factors were found to influence service responsiveness in terms of the ease of access, choice of provider, environment, service continuity, confidentiality, communication, dignity and FP counselling afforded to clients. Among these factors, hardware deficiencies, including the absence of a dedicated building for the provision of FP services and the lack of FP commodities in clinics, were perceived to negatively affect service responsiveness. Crucially, the providers’ use of their agency to alter the delivery of services was found to mitigate the negative effects of some hardware deficits on the ease of access, choice of provider, environment and confidentiality experienced by clients. This study contributes to an emerging recognition that providers can offset the effect of hardware deficiencies when services are integrated if they are afforded sufficient flexibility to make independent decisions. Consideration of software elements in the design and delivery of FP services that are integrated with childhood immunizations is therefore critical to optimize the responsiveness of these services.
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Affiliation(s)
| | | | | | | | | | | | | | - Helen E D Burchett
- Department of Public Health, Environments and Society, LSHTM, London, UK
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Hamon JK, Hoyt J, Krishnaratne S, Barbra AA, Morukileng J, Spilotros N, Mbembe M, Marcus S, Webster J. Perceptions of quality and the integrated delivery of family planning with childhood immunisation services in Kenya and Uganda. PLoS One 2022; 17:e0269690. [PMID: 35666759 PMCID: PMC9170085 DOI: 10.1371/journal.pone.0269690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/25/2022] [Indexed: 11/19/2022] Open
Abstract
The integration of family planning (FP) with childhood immunisations is considered a promising approach to addressing postpartum women's unmet need for FP in resource limited settings. This study set out to examine client and health provider perceptions of the quality of FP services that were integrated with childhood immunisations in Kenya and Uganda. Semi-structured interviews with clients (n = 30) and health providers (n = 27) were conducted in 16 rural health facilities. Interviews centred on the respondents' experiences receiving/delivering FP services, their interactions with providers/clients, and their views on the quality of FP services. Client and provider perceptions of quality were compared through a thematic analysis of interview transcripts, and findings were synthesised using Jain and Hardee's revised FP Quality of Care Framework. Using audit data, health facility characteristics and resources were also summarised through descriptive statistics to contextualise the qualitative findings. The dignity and respect experienced by clients was central to the respondents' perceptions of quality. These two dimensions were not conceptualised as distinct facets of quality, but were instead perceived to be a product of the 1) access to needed services, 2) choice of contraceptives, 3) interpersonal communication, 4) information, and 5) confidentiality afforded to clients. Additionally, clients and providers alike believed that the integration of FP services with childhood immunisations had a positive effect on clients' access to needed services and on the confidentiality they experienced in a context where modern contraceptive use was stigmatised and where a lack of support from some husbands impeded access to FP services. Understanding clients' and providers' conceptualisation of quality is critical to the design of high quality and client-centred integrated FP services.
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Affiliation(s)
- Jessie K. Hamon
- Department of Disease Control, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Jenna Hoyt
- Department of Disease Control, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Shari Krishnaratne
- Department of Disease Control, London School of Hygiene &Tropical Medicine, London, United Kingdom
| | | | - Job Morukileng
- International Rescue Committee Uganda, Kampala, Uganda
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Nathaly Spilotros
- International Rescue Committee US, New York, NY, United States of America
| | | | - Seth Marcus
- World Vision US, Monrovia, California, United States of America
| | - Jayne Webster
- Department of Disease Control, London School of Hygiene &Tropical Medicine, London, United Kingdom
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Conlon M, Buyungo P, Njogu J, Nwala A, Gibbs S, Wheatley N. Linking family planning market census data with consumer experiences in three countries: the Consumer’s Market for Family Planning study protocol and data. Gates Open Res 2022; 5:176. [PMID: 35615620 PMCID: PMC9114377 DOI: 10.12688/gatesopenres.13441.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 12/05/2022] Open
Abstract
Background: The Consumer’s Market for Family Planning (CM4FP) project was designed to address limitations of existing family planning (FP) data sources that prevent a full understanding of the total FP market. CM4FP data provide a picture of the complete supply environment and how consumers experience it. Study objectives were to 1) test a ring-fenced census approach consisting of an outlet census in a defined geographical area and a household survey in a smaller inner ring, to comprehensively map the total FP market in a local geography; 2) explore FP supply market dynamism through longitudinal data collection from contraceptive outlets; and 3) test a methodology for directly linking household and outlet data to measure the relationship between contraceptive demand and supply. Methods: Data were collected from study sites
in Nigeria, Kenya, and Uganda from 2019 to 2020. Longitudinal outlet census data and repeated cross-sectional household survey data from women ages 18-49 were collected at three quarterly time points. Outlets were located in an outer ring geography to encompass locations likely visited by women sampled from a smaller inner ring. Data from women who received a contraceptive method in the past 12 months were linked to data for the outlet from which they received the method. Results: Datasets include product audits for 22,380 individual FP products, collected from a total of 1,836 outlets across 12 study sites. The datasets also contain data from 11,536 female respondents, of whom 1,975 were successfully matched to the outlet where they most recently obtained their method. Conclusions: CM4FP data are available at www.cm4fp.org. This unique dataset enables in-depth exploration of the family planning supply market in addition to interactions between the market and consumer perspectives and behaviors within each study site. The data can also be used to explore novel methodologies to inform future study designs.
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Affiliation(s)
- Mark Conlon
- Population Services International, Washington, DC, 20036, USA
| | - Peter Buyungo
- Population Services International Uganda, Kampala, Uganda
| | - Julius Njogu
- Population Services International Global Services Hub, Nairobi, Kenya
| | | | - Susannah Gibbs
- Population Services International, Washington, DC, 20036, USA
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12
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Pan LF, Wang PH, Lin LT, Hsu S, Tsui KH. Factors that infertile couples from mainland China may take into consideration for cross-border reproductive care - A cross-sectional questionnaire study. Taiwan J Obstet Gynecol 2021; 60:24-30. [PMID: 33495003 DOI: 10.1016/j.tjog.2020.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Cross-border reproductive care (CBRC) has become popular in the world, including mainland China. We designed a questionnaire and aimed to determine the main factors that infertile couples from mainland China may consider for CBRC. MATERIALS AND METHODS In this cross-sectional questionnaire-based study, we retrospectively analyzed the data from questionnaires collected at the Reproductive Center of Beijing BaoDao Obstetrics and Gynecology Hospital from January 2018 to June 2018. The questionnaire contained 38 items that belonged to six different categories (environment and equipment, service quality, patient safety, medical quality, information acquisition channel and overseas medical services). The item scores for each factor were calculated and then weighted using principal component analysis. RESULTS A total of 297 infertile couples were identified. Most of the infertile women were aged 31-35 years, were married 1-3 years, and had a bachelor's degree. In the weighted factor analysis, "clean outpatient clinic and medical equipment" had the highest weight in the dimension of environment and equipment. The item with the highest weight in the dimension of service quality was "wait time for examination". In the dimension of patient safety, "health education on medication and surgery by counselors" had the highest weight. The item with the highest weight in the dimension of medical quality was "fee charged for ART treatment". The items with the three highest weights in the dimension of information acquisition channel were "other (seminar, exhibition, dissertation …)", "introduction from friends and relatives", and "telephone inquiry". In the dimension of overseas medical services, the two items with the highest weights were "cultural similarities" and "language similarities". CONCLUSION For CBRC, infertile couples from mainland China may take following significant factors into consideration: a high success rate and inexpensive treatment, cultural and linguistic familiarity, high-quality service and short wait time.
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Affiliation(s)
- Li-Fei Pan
- College of Finance and Banking, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taiwan
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Biological Science, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Shuofen Hsu
- Department of Risk Management & Insurance, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan.
| | - Kuan-Hao Tsui
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Pharmacy and Master Program, College of Pharmacy and Health Care, Tajen University, Pingtung County, Taiwan.
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13
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Assessment of client satisfaction with family planning services and influencing factor in Southern Ethiopia: a community-based cross-sectional study. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01640-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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14
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Arsenault C, Yakob B, Tilahun T, Nigatu TG, Dinsa G, Woldie M, Kassa M, Berman P, Kruk ME. Patient volume and quality of primary care in Ethiopia: findings from the routine health information system and the 2014 Service Provision Assessment survey. BMC Health Serv Res 2021; 21:485. [PMID: 34022856 PMCID: PMC8140434 DOI: 10.1186/s12913-021-06524-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/12/2021] [Indexed: 01/19/2023] Open
Abstract
Background Several studies have reported inadequate levels of quality of care in the Ethiopian health system. Facility characteristics associated with better quality remain unclear. Understanding associations between patient volumes and quality of care could help organize service delivery and potentially improve patient outcomes. Methods Using data from the routine health management information system (HMIS) and the 2014 Ethiopian Service Provision Assessment survey + we assessed associations between daily total outpatient volumes and quality of services. Quality of care at the facility level was estimated as the average of five measures of provider knowledge (clinical vignettes on malaria and tuberculosis) and competence (observations of family planning, antenatal care and sick child care consultations). We used linear regression models adjusted for several facility-level confounders and region fixed effects with log-transformed patient volume fitted as a linear spline. We repeated analyses for the association between volume of antenatal care visits and quality. Results Our analysis included 424 facilities including 270 health centers, 45 primary hospitals and 109 general hospitals in Ethiopia. Quality was low across all facilities ranging from only 18 to 56% with a mean score of 38%. Outpatient volume varied from less than one patient per day to 581. We found a small but statistically significant association between volume and quality which appeared non-linear, with an inverted U-shape. Among facilities seeing less than 90.6 outpatients per day, quality increased with greater patient volumes. Among facilities seeing 90.6 or more outpatients per day, quality decreased with greater patient volumes. We found a similar association between volume and quality of antenatal care visits. Conclusions Health care utilization and quality must be improved throughout the health system in Ethiopia. Our results are suggestive of a potential U-shape association between volume and quality of primary care services. Understanding the links between volume of patients and quality of care may provide insights for organizing service delivery in Ethiopia and similar contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06524-y.
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Affiliation(s)
- Catherine Arsenault
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
| | - Bereket Yakob
- Fenot Project, Harvard T.H. Chan school of Public Health and School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Tizta Tilahun
- Fenot Project, Harvard T.H. Chan school of Public Health and School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Tsinuel Girma Nigatu
- Fenot Project, Harvard T.H. Chan school of Public Health and School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Girmaye Dinsa
- Fenot Project, Harvard T.H. Chan school of Public Health and School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia.,Department of Public Health and Health Policy, College of Health Sciences, Haramaya University, Harar, Ethiopia
| | - Mirkuzie Woldie
- Fenot Project, Harvard T.H. Chan school of Public Health and School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia.,Ministry of Health, Addis Ababa, Ethiopia
| | | | - Peter Berman
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA
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Shukla A, Acharya R, Kumar A, Mozumdar A, Aruldas K, Saggurti N. Client-provider interaction: understanding client experience with family planning service providers through the mystery client approach in India. Sex Reprod Health Matters 2020; 28:1822492. [PMID: 33054696 PMCID: PMC7566859 DOI: 10.1080/26410397.2020.1822492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The benefits of employing a rights-based approach in family planning (FP) programmes have made the client's rights to informed choices and quality care an essential part of any such programme. client-provider interaction is one of the critical components of the quality of care (QoC) framework of FP. While several studies have assessed QoC in FP services in India, very few have focused on the in-depth assessment of the interaction between the client and the provider during service delivery. The present study used the mystery client approach to assess the quality of interactions between clients and FP service providers in two of the most populous states of India: Bihar and Uttar Pradesh (UP). Findings highlighted that the providers spent very little time with the clients, gave them information on only one or two FP methods, and rarely talked about possible side-effects of the methods. Furthermore, the providers seemed hesitant to suggest any FP method other than condoms to newly married women. This study concluded that despite being a government priority, the quality of client-provider interaction in these two states was extremely poor.
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Affiliation(s)
- Ankita Shukla
- Program Officer, Population Council, New Delhi, India
| | | | | | | | - Kumudha Aruldas
- Implementation Science Coordinator, Deworm3 Study, Christian Medical College, Vellore, India
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16
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Wogu D, Lolaso T, Meskele M. Client Satisfaction with Family Planning Services and Associated Factors in Tembaro District, Southern Ethiopia. Open Access J Contracept 2020; 11:69-76. [PMID: 32801953 PMCID: PMC7394595 DOI: 10.2147/oajc.s258831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/21/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Client satisfaction influences the use of family planning and other reproductive health services. This study aimed to assess the magnitude of client satisfaction with family service and its associated factors among reproductive-age women. PATIENTS AND METHODS We conducted a facility-based cross-sectional study. A total of 411 clients, nested in four health facilities, were included in the analysis. Systematic sampling was employed to select study units for the exit interview. Data collection instruments for this study were pre-tested structured questionnaires. Client satisfaction was assessed using fifteen Likert-scaled question items. Each item of question has 5 points ranging from 1 (strongly disagree) to 5 (strongly agree) and, finally, mean was computed. The pre-coded data were entered into Epi Data version 4.2.0 and exported to SPSS version 25 for analysis. Logistic regression analysis was carried out to identify independently associated factors at a confidence interval of 95% and a significance level of p-value less than 0.05. RESULTS Magnitude of client satisfaction with family planning service was 46% [95% CI: 41-50.8]. Rural residence [AOR=3.07; 95% CI: 1.10-8.62], educational level of college and above [AOR=0.22; 95% CI: 0.07-0.70] as compared to the educational level of primary education, waiting time of less than half an hour [AOR=7.80; 95% CI: 2.48-24.48], maintaining privacy [AOR=7.16; 95% CI: 2.89-17.69], describing side effects of methods [AOR=3.14; 95% CI: 1.02-9.76] were factors significantly associated with client satisfaction. CONCLUSION The overall magnitude of client satisfaction with the services was found to be low. Many of the factors that attributed to the low level of client satisfaction are modifiable. There is a need for organizing the family planning room as per standards, maintaining privacy, minimizing waiting time, and describing the side effects during the provision of service.
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Affiliation(s)
- Daniel Wogu
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tsegaye Lolaso
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Mengistu Meskele
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Tessema GA, Mahmood MA, Gomersall JS, Assefa Y, Zemedu TG, Kifle M, Laurence CO. Structural Quality of Services and Use of Family Planning Services in Primary Health Care Facilities in Ethiopia. How Do Public and Private Facilities Compare? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124201. [PMID: 32545564 PMCID: PMC7345433 DOI: 10.3390/ijerph17124201] [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] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022]
Abstract
Background: Family planning (FP) is among the important interventions that reduce maternal mortality. Poor quality FP service is associated with lower services utilisation, in turn undermining the efforts to address maternal mortality. There is currently little research on the quality of FP services in the private sector in Ethiopia, and how it compares to FP services in public facilities. Methods: A secondary data analysis of two national surveys, Ethiopia Services Provision Assessment Plus Survey 2014 and Ethiopian Demographic and Health Survey 2016, was conducted. Data from 1094 (139 private, 955 public) health facilities were analysed. In total, 3696 women were included in the comparison of users’ characteristics. Logistic regression was conducted. Facility type (public vs. private) was the key exposure of interest. Results: The private facilities were less likely to have implants (Adjusted Odds Ratio (AOR) = 0.06; 95% Confidence Interval (CI): 0.03, 0.12), trained FP providers (AOR = 0.23; 95% CI: 0.14, 0.41) and FP guidelines/protocols (AOR = 0.33; 95% CI: 0.19, 0.54) than public facilities but were more likely to have functional cell phones (AOR = 8.20; 95% CI: 4.95, 13.59) and water supply (AOR = 3.37; 95% CI: 1.72, 6.59). Conclusion: This study highlights the need for strengthening both private and public facilities for public–private partnerships to contribute to increased FP use and better health outcomes.
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Affiliation(s)
- Gizachew Assefa Tessema
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia; (M.A.M.); (J.S.G.); (C.O.L.)
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar 196, Ethiopia
- School of Public Health, Curtin University, Perth, WA 6201, Australia
- Correspondence: ; Tel.: +61-470-118399; Fax: +61-8-8313-3339
| | - Mohammad Afzal Mahmood
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia; (M.A.M.); (J.S.G.); (C.O.L.)
| | - Judith Streak Gomersall
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia; (M.A.M.); (J.S.G.); (C.O.L.)
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, QLD 4072, Australia;
| | - Theodros Getachew Zemedu
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa 1242, Ethiopia;
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar 196, Ethiopia
| | - Mengistu Kifle
- Federal Ministry of Health, Addis Ababa, 1234, Ethiopia;
| | - Caroline O. Laurence
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia; (M.A.M.); (J.S.G.); (C.O.L.)
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Pan LF, Wang PH, Lin LT, Hsu S, Tsui KH. Factors that influence infertile couples' selection of reproductive medicine centers---A cross-sectional questionnaire study. Taiwan J Obstet Gynecol 2019; 58:633-639. [PMID: 31542084 DOI: 10.1016/j.tjog.2019.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE The number of infertile women undergoing in vitro fertilization (IVF) cycles has increased annually. Due to this competitive environment, we designed a questionnaire and aimed to investigate factors affecting the choice of reproductive medicine center among infertile couples. MATERIALS AND METHODS This was a retrospective cross-sectional study that analyzed questionnaires provided by the reproductive medicine center of the Kaohsiung Veterans General Hospital from January 2018 to June 2018. In the questionnaire, there are six categories (environment and equipment, service quality, patient safety, medical quality, information acquisition channel and other) and 36 items. The identified factors were scored and then weighted using principal component analysis. RESULTS Most of the 100 identified infertile women were aged 31-35 years, were married 1-3 years, and had a university education level. In the weight analysis, "Clean outpatient clinic and medical equipment" had the greatest weight in the dimension of environment and equipment. The item with the greatest weight in the dimension of service quality was "Waiting time for registration, charging, and receiving medicine". In the dimension of patient safety, "Privacy is highly respected by medical personnel" had the highest weight. The item with the greatest weight in the dimension of medical quality was "Success rate of reproductive medicine center". The three items with the highest weights in the dimension of information acquisition channel were "Newspapers and magazines", "TV media", and "Facebook page and website of our hospital". In the other dimensions, the two with the greatest weights were "Reputation of the hospital" and "Reputation of physicians". CONCLUSION In the infertile couples' view, optimal reproductive medicine centers should have a high success rate and great reputation on the internet and in mass media. Additionally, a short waiting time and high levels of privacy and confidentiality are also imperative.
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Affiliation(s)
- Li-Fei Pan
- College of Finance and Banking, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taiwan; Department of Medical Research, China Medical University Hospital, Taiwan
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shuofen Hsu
- Department of Risk Management & Insurance, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan.
| | - Kuan-Hao Tsui
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Pharmacy and Master Program, College of Pharmacy and Health Care, Tajen University, Pingtung County, Taiwan.
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Mozumdar A, Gautam V, Gautam A, Dey A, Uttamacharya, Saith R, Achyut P, Kumar A, Aruldas K, Chakraverty A, Agarwal D, Verma R, Nanda P, Krishnan S, Saggurti N. Choice of contraceptive methods in public and private facilities in rural India. BMC Health Serv Res 2019; 19:421. [PMID: 31238935 PMCID: PMC6593496 DOI: 10.1186/s12913-019-4249-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 06/12/2019] [Indexed: 12/03/2022] Open
Abstract
Background Client-centric quality of care (QoC) in family planning (FP) services are imperative for contraceptive method adoption and continuation. Less is known about the choice of contraceptive method in India beyond responses to the three common questions regarding method information, asked in demographic and health surveys. This study argues for appropriate measurement of method choice and assesses its levels and correlates in rural India. Methods A cross-sectional study was conducted with new acceptors of family planning method (N = 454) recruited from public and private health facilities in rural Bihar and Uttar Pradesh, the two most populous states in India. The key quality of care indicator ‘method choice’ was assessed using four key questions from client-provider interactions that help in making a choice about a particular method: (1) whether the provider asked the client about their preferred method, (2) whether the provider told the client about at least one additional method, (3) whether the client received information without any single method being promoted by the provider, and (4) client’s perception about receipt of method choice. The definition of method choice in this study included women who responded “yes” to all four questions in the survey. The relationship between contraceptive communication and receipt of method choice was assessed using logistic regression analyses, after adjusting for socio-demographic characteristics of the respondents. Results Although 62% of clients responded to a global question and reported that they received the method of their choice, only 28% received it based on responses about client-provider interactions. Receipt of the information on side-effects of the selected method (Adjusted Odds Ratio [AOR]: 7.4, 95% Confidence Interval [CI]: 3.96–13.86) and facility readiness to provide a range of contraceptive choice (AOR: 2.67, 95% CI: 1.48–4.83) were significantly associated with receipt of method choice. Conclusions Findings demonstrated that women’s choice of contraceptive could be improved in rural India if providers give full information prior to and during the acceptance of a method and if facilities are equipped to provide a range of choice of contraceptive methods.
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Affiliation(s)
| | | | - Abhishek Gautam
- International Center for Research on Women, New Delhi, India
| | - Arnab Dey
- Sambodhi Research and Communications Private Limited, Noida, Uttar Pradesh, India
| | - Uttamacharya
- International Center for Research on Women, New Delhi, India
| | - Ruhi Saith
- Oxford Policy Management, New Delhi, India
| | - Pranita Achyut
- International Center for Research on Women, New Delhi, India
| | | | | | - Amit Chakraverty
- Sambodhi Research and Communications Private Limited, Noida, Uttar Pradesh, India
| | | | - Ravi Verma
- International Center for Research on Women, New Delhi, India
| | - Priya Nanda
- Bill and Melinda Gates Foundation, New Delhi, India
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Tessema GA, Gomersall JS, Laurence CO, Mahmood MA. Healthcare providers' perspectives on use of the national guideline for family planning services in Amhara Region, Ethiopia: a qualitative study. BMJ Open 2019; 9:e023403. [PMID: 30787080 PMCID: PMC6398659 DOI: 10.1136/bmjopen-2018-023403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore healthcare providers' views on barriers to and facilitators of use of the national family planning (FP) guideline for FP services in Amhara Region, Ethiopia. DESIGN Qualitative study. SETTING Nine health facilities including two hospitals, five health centres and two health posts in Amhara Region, Northwest Ethiopia. PARTICIPANTS Twenty-one healthcare providers working in the provision of FP services in Amhara Region. PRIMARY AND SECONDARY OUTCOME MEASURES Semistructured interviews were conducted to understand healthcare providers' views on barriers to and facilitators of the FP guideline use in the selected FP services. RESULTS While the healthcare providers' views point to a few facilitators that promote use of the guideline, more barriers were identified. The barriers included: lack of knowledge about the guideline's existence, purpose and quality, healthcare providers' personal religious beliefs, reliance on prior knowledge and tradition rather than protocols and guidelines, lack of availability or insufficient access to the guideline and inadequate training on how to use the guideline. Facilitators for the guideline use were ready access to the guideline, convenience and ease of implementation and incentives. CONCLUSIONS While development of the guideline is an important initiative by the Ethiopian government for improving quality of care in FP services, continued use of this resource by all healthcare providers requires planning to promote facilitating factors and address barriers to use of the FP guideline. Training that includes a discussion about healthcare providers' beliefs and traditional practices as well as other factors that reduce guideline use and increasing the sufficient number of guideline copies available at the local level, as well as translation of the guideline into local language are important to support provision of quality care in FP services.
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Affiliation(s)
- Gizachew Assefa Tessema
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Judith Streak Gomersall
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Caroline O Laurence
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mohammad Afzal Mahmood
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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Leslie HH, Malata A, Ndiaye Y, Kruk ME. Effective coverage of primary care services in eight high-mortality countries. BMJ Glob Health 2017; 2:e000424. [PMID: 29632704 PMCID: PMC5887868 DOI: 10.1136/bmjgh-2017-000424] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/25/2017] [Accepted: 08/09/2017] [Indexed: 12/03/2022] Open
Abstract
Introduction Measurement of effective coverage (quality-corrected coverage) of essential health services is critical to monitoring progress towards the Sustainable Development Goal for health. We combine facility and household surveys from eight low-income and middle-income countries to examine effective coverage of maternal and child health services. Methods We developed indices of essential clinical actions for antenatal care, family planning and care for sick children from existing guidelines and used data from direct observations of clinical visits conducted in Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania and Uganda between 2007 and 2015 to measure quality of care delivered. We calculated healthcare coverage for each service from nationally representative household surveys and combined quality with utilisation estimates at the subnational level to quantify effective coverage. Results Health facility and household surveys yielded over 40 000 direct clinical observations and over 100 000 individual reports of healthcare utilisation. Coverage varied between services, with much greater use of any antenatal care than family planning or sick-child care, as well as within countries. Quality of care was poor, with few regions demonstrating more than 60% average performance of basic clinical practices in any service. Effective coverage across all eight countries averaged 28% for antenatal care, 26% for family planning and 21% for sick-child care. Coverage and quality were not strongly correlated at the subnational level; effective coverage varied by as much as 20% between regions within a country. Conclusion Effective coverage of three primary care services for women and children in eight countries was substantially lower than crude service coverage due to major deficiencies in care quality. Better performing regions can serve as examples for improvement. Systematic increases in the quality of care delivered—not just utilisation gains—will be necessary to progress towards truly beneficial universal health coverage.
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Affiliation(s)
- Hannah H Leslie
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Address Malata
- Kamuzu College of Nursing, Malawi University of Science and Technology, Limbe, Southern Region, Malawi
| | - Youssoupha Ndiaye
- Planning, Research and Statistics, Ministry of Health and Social Action, Dakar, Senegal
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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