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Negesse A, Girma T, Desalegn BB, Kerac M, Berhane M. The epidemiology and associated factors of non-exclusive breastfeeding: a comparative cross-sectional study of livelihood-secure and insecure areas. Front Nutr 2024; 11:1347780. [PMID: 38826580 PMCID: PMC11141399 DOI: 10.3389/fnut.2024.1347780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/29/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction Regardless of national commitment, non-exclusive breastfeeding (NEBF) is a public health problem that worsens over time. It can be associated with sociodemographic, economic, and environmental factors and may vary depending on livelihood security. Hence, this study aimed to determine the magnitude of NEBF and identify its associated factors by considering two areas with varied degrees of livelihood security. Methods This study represented a comparative cross-sectional survey of 1,060 under 6 months (u6m) infant-mother pairs. Both descriptive and analytic statistics were evaluated using STATA version 17 packages. A binary logistic regression was used to identify associated factors of NEBF. The odds ratio (OR) with a 95% confidence interval (CI) was used to measure the significance of the association at a p-value of <0.05. Results The pooled magnitude of 51% of NEBF mothers (95% CI: 48.0, 54.0) was 53.1% (95% CI: 49.2, 57.0) and 48.1% (95% CI: 43.4, 52.8) in livelihood-secure and livelihood-insecure areas, respectively. The lack of recollecting the infant's birth date by mothers (AOR = 2.4; 95% CI = 1.15-4.40) had the highest odds of NEBF while household heads with tertiary education (AOR = 0.14; 95% CI = 0.01-0.54) and the poorest households (AOR = 0.43; 95%CI = 0.20-0.82) had the lowest odds of NEBF in livelihood-secure areas but not in livelihood-insecure areas. Moreover, mothers with male infants (AOR = 1.9; 95% CI = 1.18-2.92) had high odds of NEBF in livelihood-insecure areas but not in livelihood-secure areas. Infants of 2 to less than 4-month-old (AOR = 8.5; 95% CI = 3.47-18.63) and 4 to less than 6-month-old (AOR = 22.2; 95% CI = 8.02-51.97) in livelihood-secure areas and infants of 2 to less than 4-month-old (AOR = 4.3; 95% CI = 1.29-11.67) and 4 to less than 6-month-old (AOR = 8.3; 95% CI = 2.44-22.39) in livelihood-insecure areas had high odds of NEBF. Conclusion Over half of the mothers were practicing NEBF, which represents a failure to meet national and international targets. Area vulnerability to livelihood security modifies factors of NEBF. Male infants in insecure areas, infants of unknown age in secure areas, and infants aged 2 months or older, regardless of setting, were more vulnerable to NEBF. However, households with the lowest wealth and higher household head educational status in livelihood-secure areas were less vulnerable to NEBF. Hence, livelihood-based interventions targeting mothers of 2 to less than 6-month-old infants, with emphasis on these factors, may help address and reduce NEBF.
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Affiliation(s)
- Ayenew Negesse
- Academic center of Excellence in Human Nutrition, School of Nutrition, Food Science and Technology (SNFST), Hawassa University, Hawassa, Ethiopia
- Department of Human Nutrition, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Tsinuel Girma
- Department of Paediatrics and Child Health, Jimma University, Jimma, Ethiopia
- University of British Colombia (UBC), Vancouver, BC, Canada
| | - Beruk Berhanu Desalegn
- Academic center of Excellence in Human Nutrition, School of Nutrition, Food Science and Technology (SNFST), Hawassa University, Hawassa, Ethiopia
| | - Marko Kerac
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Melkamu Berhane
- Department of Paediatrics and Child Health, Jimma University, Jimma, Ethiopia
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Titiyos A, Mehretie Y, Alemayehu YK, Ejigu Y, Yitbarek K, Abraham Z, O'Connell KA, Kassaw J. Family planning integration in Ethiopia's primary health care system: a qualitative study on opportunities, challenges and best practices. Reprod Health 2023; 20:176. [PMID: 38041131 PMCID: PMC10693018 DOI: 10.1186/s12978-023-01709-6] [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: 07/07/2023] [Accepted: 11/09/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Family planning (FP) service integration into primary health care (PHC) is an effective approach to realize reproductive autonomy, increase the use of contraceptives, and improve maternal and child health outcomes. The Ethiopian government promotes integration of FP services into primary health care (PHC). However, there is paucity of evidence on the status of FP service integration. The aim of this study is to explore the state of FP integration into PHC services and identify facilitators and barriers to integration. METHODS A qualitative study nested with a larger national study was conducted from July to October 2022. A total of 60 interviews were conducted with FP stakeholders including, government organizations, non-governmental organizations, donors, service providers, and clients. Interviews were audio recorded, transcribed, and coded using OpenCode 4.03. The coded data were analyzed using framework analysis approach, using the Primary Health Care Performance Initiative (PHCPI) framework. Direct quotes and results from the coding and categorization were used to develop the report. RESULTS Family planning is largely provided in designated units by dedicated staff within PHC facilities. The provision of integrated FP service within each service unit is in its early stage. Successful examples of integration include integration of FP with postnatal care, abortion care, and youth-friendly service centers. Facilitators of integration include commitment of the government and partners, the presence of policies and guidelines, and positive attitude of service providers and clients. However, integration of FP also faces challenges that are largely related to challenges of the FP program even before integration. These include resource shortage, health workers shortage, health workers' capacity/skill gaps, misconceptions about FP, religious and socio-cultural norms, and lack of awareness. CONCLUSIONS Integration of FP with PHC services in the Ethiopian public health facilities is viable. Pre-existing challenges of the FP program continued to be barriers to integration. Expanding the experiences of good practices in the integration of FP with post abortion care, post-natal care, and youth-friendly service centers to other components of PHC warrants attention. Addressing both supply- and demand-side challenges of the FP program is needed to facilitate the integration of FP with other PHC services.
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Trisolini M, Javier ME, Jabar M, Rodriguez C, Varquez J, Danganan OD, Benabaye RM, Reynaldo CA, Conti-Lopez MA, Dela Rosa JJ, Mendoza O, Dasmarinas E, Stan L, Bisson C, Oliveros Y. Improving the quality of family planning services in the Philippines: Barriers and opportunities. Int J Health Plann Manage 2023; 38:1629-1643. [PMID: 37486971 DOI: 10.1002/hpm.3683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 04/25/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
Abstract
We conducted qualitative research with family planning clients, potential clients, and service providers on barriers and opportunities for improving the quality of family planning services in the Philippines. The family planning service providers included the primary, secondary, and tertiary levels of the health system. Our goal was to aid in developing more effective family planning quality improvement (QI) programs. Our methods included focus groups, key informant interviews and thematic content analysis of the qualitative data. We found four themes: the components of quality of family planning care; factors influencing quality; challenges for improving quality; and provider bias in the types of family planning services offered to clients. We identified five implications for QI, including: reduce provider bias; level off the understanding of QI concepts and roles among the different family planning service providers; involve men more actively; design new digital communication strategies for reaching clients and potential clients; and explore collaborations with private sector pharmacies. The findings from this study can guide the development of a pilot family planning QI programme in the Philippines. The findings provide themes and practical insights for an intervention-focused theory of change on how to improve current programs, design new programs, be more responsive to the needs and concerns of clients and potential clients and be well-accepted and sustained by providers. This can lay the groundwork for improving family planning outcomes and reducing teenage pregnancy rates and the unmet need for family planning throughout the Philippines.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Ophelia Mendoza
- RTI International, Research Triangle Park, North Carolina, USA
| | | | - Laurentiu Stan
- RTI International, Research Triangle Park, North Carolina, USA
| | - Cristina Bisson
- RTI International, Research Triangle Park, North Carolina, USA
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Abera L, Ejigu E, Hailu M, Tadesse D, Omer A. Quality of family planning services and associated factors among reproductive age women attending family planning unit at public health facilities in Dire Dawa, Eastern Ethiopia, 2021. Contracept Reprod Med 2023; 8:33. [PMID: 37221622 DOI: 10.1186/s40834-023-00231-1] [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: 12/14/2022] [Accepted: 05/10/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Improving the quality of care has been a necessary goal for family planning programs worldwide. Even though extensive work has been done, the contraceptive prevalence rate is still low (41% in Ethiopia, 30.5% in Dire Dawa) and the unmet need for contraception is high (26%) in Ethiopia. Moreover, quality of care in family planning services has an important role in increasing coverage of services and program sustainability. Therefore, the objective of this study was to assess quality of family planning services and associated factors among reproductive age women attending family planning unit in public health facilities in Dire Dawa, Eastern Ethiopia. METHODS A facility-based cross-sectional study was conducted among reproductive-age women attending a family planning unit in Dire Dawa, Eastern Ethiopia, from September 1-30/2021. A total of 576 clients were selected by systematic random sampling and interviewed using a pre-tested structured questionnaire. SPSS version 24 was used to analyze the data, which included descriptive statistics, bi-variable and multivariable logistic regression analyses. To determine the presence of an association between dependent and independent variables, AOR, P-value 0.05, and 95% CI were used. RESULTS A total of 576 clients participated in the study and provided a response rate of 99%. The overall satisfaction of clients with FP services was 79%[95% CI:75.2%, 82.9%]. Having primary education (AOR = 2.11, 95% CI(1.11-4.24), convenient facility opening hours (AOR = 3.13, 95% CI (2.12-5.75), maintaining privacy (AOR = 4.1, 95% CI(2.50-8.12), demonstrating how to use F/P method (AOR = 1.98, 95% CI (1.01-5.20), and discussing F/P issues with husbands (AOR = 5.05, 95% CI: 3.33-7.64) were positively significantly associated with client satisfaction. CONCLUSION AND RECOMMENDATION This study revealed that about four-fifth of the clients was satisfied with the service they received. Clients' education, facility opening hour, maintained privacy, discussion with husband, and demonstration of how to use the methods were associated with client satisfaction. Therefore, health facility heads should improve facility opening hour. Health care providers should maintain client privacy every time, and should consistently utilize information, education, and communication materials during consultation sessions by giving more attention to client who has no education. Partner's discussion on family planning issues should also be encouraged.
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Affiliation(s)
- Legesse Abera
- Department of Public Health, College of Medicine and Health Sciences in Dire Dawa University, Dire Dawa, Ethiopia
| | - Ezira Ejigu
- Department of Anesthesia College of Medicine and Health Sciences in Dire, Dawa University, Dire Dawa, Ethiopia
| | - Mickiale Hailu
- Department of Midwifery College of Medicine and Health Sciences in Dire, Dawa University, Dire Dawa, Ethiopia.
| | - Daniel Tadesse
- Department of Midwifery College of Medicine and Health Sciences in Dire, Dawa University, Dire Dawa, Ethiopia
| | - Abdu Omer
- Department of Public Health, College of Medicine and Health Sciences in Dire Dawa University, Dire Dawa, Ethiopia
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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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Negash WD, Belachew TB, Asmamaw DB. Long acting reversible contraceptive utilization and its associated factors among modern contraceptive users in high fertility sub-Saharan Africa countries: a multi-level analysis of recent demographic and health surveys. Arch Public Health 2022; 80:224. [PMID: 36280847 PMCID: PMC9590189 DOI: 10.1186/s13690-022-00977-1] [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: 06/05/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Long-acting reversible contraceptives (LARC) have been hailed as one of the safest and most effective methods of contraception. However, the use of LARC is low in the world, including Sub Saharan Africa; therefore, the aim of this study was to assess LARC utilization and associated factors among modern contraceptive users in high fertility SSA countries. METHODS Data for this study was obtained from the most recent Demographic and Health Surveys. A total weighted sample of 14,828 reproductive age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of long acting reversible contraception utilization. Finally, the Adjusted Odds Ratio (AOR) with 95% confidence interval was used to declare as statistical significance. RESULTS Overall prevalence of LARC utilization was observed to be 20.1% (19.45, 20.74). The factors significantly associated with the utilization were women's age ≥ 35 years (AOR = 1.42; 95% CI: 1.19,1.68), having media exposure (AOR = 1.13; 95% CI: 1.05, 1.28), number of alive children: 1-2 (AOR = 2.35; 95% CI: 1.38, 4.01), 3-4 (AOR = 2.98; 95% CI: 1.74, 5.10), [Formula: see text] 5 (AOR = 2.82; 95% CI:1.63, 4.86), have no history of abortion (AOR = 1.33; 95% CI: 1.17,1.51) and who have no big problem with distance to the health facility (AOR = 1.29; 95% CI: 1.16, 1.43). CONCLUSION The use of long acting reversible contraception in this study was relatively low. To improve the utilization of long acting reversible contraceptives governments, policymakers, and stakeholders should implement health promotion strategies through media and improve accessibilities of health facilities.
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Affiliation(s)
- Wubshet Debebe Negash
- grid.59547.3a0000 0000 8539 4635Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadele Biresaw Belachew
- grid.59547.3a0000 0000 8539 4635Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- grid.59547.3a0000 0000 8539 4635Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Lukyamuzi Z, Tetui M, Fonseca-Rodríguez O, Atuyambe L, Makumbi FE, Baroudi M. Quality of Care in Family Planning Services: Differences Between Formal and Informal Settlements of Kira Municipality, Uganda. Front Glob Womens Health 2021; 2:656616. [PMID: 34816214 PMCID: PMC8593991 DOI: 10.3389/fgwh.2021.656616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/19/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Quality of care (QoC) of family planning (FP) affects contraceptive use, and it varies across types of urban settlement. This study assesses the difference in service delivery point (SDP) structural and process factors between formal and informal urban settlements, and the opinion of the client on the QoC in informal settlements. This is useful in creating an evidence base to advocate for better quality services for the most vulnerable in society. Methods: This was a cross-sectional survey that included SDPs of Kira municipality in Wakiso district, Uganda. Data were collected from all the service points in Kira municipality with the caretakers consented. In addition, using multi-stage sampling, 626 women of reproductive age (15-49 years) who lived in the informal settlements of Kira municipality were interviewed. Data were collected using structured questionnaires, descriptive analysis was carried out in Stata version 14.0, and Chi-square and t-tests were used to compare the informal with the formal settlements. Results: Formal settlements generally had more higher-level SDPs compared to informal settlements (value of p < 0.001). SDPs in the formal settlements provided more FP methods and had more community health workers (CHW) to support their work. Also, SDPs in the formal settlements were more likely to have long-term FP methods available and more likely to have trained personnel to insert and remove implants and IUDs compared to those in informal settlements. Additionally, more SDPs in the formal settlements provided counseling for permanent, long-term, and short-term FP methods. Of the 626 interviewed women, most of the women (68.6%) reported that they would not return to the previous FP provider or refer a friend to the same provider (72.7%). Conclusions: There is a lower quality FP services in the informal settlements with a commensurable effect on the client satisfaction with the services. Therefore, improving the quality of FP services in informal settlements should be a top priority. Improved quality of services could act as a motivation to increase the uptake of modern contraceptives in such settings.
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Affiliation(s)
- Zubair Lukyamuzi
- Makerere University, Johns Hopkins University Collaboration (MU-JHU), Kampala, Uganda
| | - Moses Tetui
- School of Pharmacy, Waterloo University, Waterloo, ON, Canada
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Osvaldo Fonseca-Rodríguez
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden
| | - Lynn Atuyambe
- Department of Community Health and Behavioural Sciences Makerere University School of Public Health, Kampala, Uganda
| | - Fredrick Edward Makumbi
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Mazen Baroudi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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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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Handebo S. Informed Choice of Contraceptive Methods among Women in Ethiopia: Further Analysis of the 2016 Ethiopian Demographic Health Survey. Open Access J Contracept 2021; 12:83-91. [PMID: 33758556 PMCID: PMC7981166 DOI: 10.2147/oajc.s292923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/21/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Delivering modern contraceptive methods only may not provide much insight into the quality of family-planning services. Informed choice emphasizes that clients select the method that best satisfies their needs by informing them about all available contraceptive methods, side effects of the methods, and how to deal with the side effects if experienced. This study investigated informed choice regarding contraceptives and associated factors among women in Ethiopia. METHODS Data were extracted from the 2016 Ethiopian Demographic and Health Survey. Information on informed choice was extracted from the individual women's data. Subjects comprised 3,511 (weighted) reproductive-age women aged 15-49 years using selected contraceptive methods. Bivariate and multivariate logistic regression models were used to assess factors associated with informed of contraceptive choice among women in Ethiopia. P<0.05 was considered statistically significant. RESULTS Only 36.2% of the participants were informed on contraceptive methods. Increased age, watching television less than once per week, and visiting health facilities in the last 12 months were associated with higher odds of being informed on contraceptive methods. Being affiliated with other religious groups, primary education only, having a husband employed in agriculture, being unskilled, with an unknown job, living in Amhara and Oromia regions, watching television at least once a week, and receiving the service from private clinics and pharmacies were associated with lower odds of being informed on contraceptive methods. CONCLUSION A substantial proportion of reproductive-age women in Ethiopia were inadequately informed about side effects or other methods. This varied by socio-demographic factors, sources of contraception, method, and frequency of visiting health institutions. This study suggests that interventions that increase family-planning counseling to the level that clients understand the methods are needed. Private health facilities also need to focus on delivering essential messages about methods they provide and assure women's rights and choices.
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Affiliation(s)
- Simegnew Handebo
- Department of Health Education and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Onoja J, Sanni O, Ogedengge C, Onoja S, Abiodun P, Abubakar A. Regional variation of family planning services in Nigerian health facilities. MGM JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/mgmj.mgmj_21_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mekonnen DA, Roets L. Integrating HIV and Family Planning Services: The Pros and Cons. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:879-886. [PMID: 33324113 PMCID: PMC7733375 DOI: 10.2147/hiv.s281997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/20/2020] [Indexed: 11/23/2022]
Abstract
Background The integration of HIV and family planning services as a one-stop service is a cost-effective way of service delivery, but it has advantages and disadvantages. Methods A cross-sectional study design was applied to conduct this research in Ethiopia from June 2015 to November 2018. Two-stage sampling was applied: 1) a simple random sampling method was used to select 31 public health centers, and 2) 403 clients and 305 service providers were selected by using a stratified simple random sampling. A self-administrator questionnaire was developed to collect the data from service providers, and an interview questionnaire was used to collect data from clients. The data were statistically computed using bi-variate and multivariate logistic regression. Results Integrated HIV and family planning services allow for the enhancement of the competencies of healthcare workers, client satisfaction, mobilization of fiscal resources, provision of infrastructures, and adequate numbers of human resources available. It can also mobilize additional resources for health education and improve awareness on HIV and family planning services. Despite the mentioned advantages, shortages of human resources, HIV drugs and contraceptives, funding and long waiting times were identified as the disadvantages of HIV and family planning service integration. There was a risk of nine times lower chance of intention to use an integrated HIV and family planning services, if a client waited for more than 1 hour and 6 times risk waited for 30-60 minutes. Conclusion The advantages of offering an integrated service at a one-stop facility by far outweighing the disadvantages. It might be relevant to develop a strategic action plan for stakeholders to facilitate the integration of HIV and family planning services with the aim to improve service utilization and to reduce maternal and child morbidity and mortality.
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Affiliation(s)
- Dessie Ayalew Mekonnen
- Department of Health Studies, College of Human Sciences, University of South Africa, Addis Ababa, Ethiopia
| | - Lizeth Roets
- Department of Health Studies, College of Human Sciences, University of South Africa, Addis Ababa, Ethiopia
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Emiru AA, Alene GD, Debelew GT. Women's satisfaction with the quality of antenatal care services rendered at public health facilities in Northwest Ethiopia: the application of partial proportional odds model. BMJ Open 2020; 10:e037085. [PMID: 32948558 PMCID: PMC7500293 DOI: 10.1136/bmjopen-2020-037085] [Citation(s) in RCA: 3] [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: 11/10/2022] Open
Abstract
OBJECTIVES The study was aimed: (1) to describe the quality of antenatal care (ANC) at public health facilities in Northwest Ethiopia, including dimensions of the structure, process and outcome; and (2) to assess the relationship between ANC satisfaction and structure and process dimension of ANC quality. DESIGN Cross sectional. SETTING Healthcare facilities providing ANC services in Northwest Ethiopia. PARTICIPANTS 795 pregnant women attending the antenatal clinics at 15 public health facilities and 41 health workers working for the surveyed facilities. OUTCOME MEASURES The outcome variable, women's satisfaction with ANC, was constructed from multiple satisfaction items using principal component analysis on an ordered, categorical and three-point Likert scale. The key hypothesised factors considered were structural and process aspects of care. Data were analysed using the partial proportional odds model with 95% CI. RESULTS The result revealed that only 30.3% of the pregnant women were highly satisfied, whereas 31.7% had a lower satisfaction level. The findings showed that process quality indicators better predicted client satisfaction. In relation to this, better scores in history taking (aOR1=aOR2; 1.81 (95% CI 1.25 to 2.60)), counselling (aOR1 = aOR2; 1.89 (95% CI 1.33 to 2.69)) and screening (aOR1= aOR2; 18.10 (95% CI 11.52 to 28.39)) were associated with achieving higher satisfaction. We also observed a significant but lower satisfaction among women in the late trimester of pregnancy (aOR1 = aOR2; 0.87 (95% CI 0.78 to 0.97)). However, we did not see any significant relationship between structural variables and client satisfaction. CONCLUSIONS The study demonstrated that women's satisfaction with ANC was low. The contents of ANC services covered during client-provider interaction were the main factors affecting client satisfaction. This suggests that efforts are required to improve the competencies of health professionals to make them more effective while dealing with clients.
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Affiliation(s)
- Amanu Aragaw Emiru
- Reproductive Health and Population Studies, Bahir Dar University, Bahir Dar, Ethiopia
| | - G D Alene
- Epidemiology and Biostatistics, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gurmesa Tura Debelew
- Department of Population and Family Health, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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Siyoum M, Astatkie A, Tenaw Z, Abeje A, Melese T. Respectful family planning service provision in Sidama zone, Southern Ethiopia. PLoS One 2020; 15:e0238653. [PMID: 32886923 PMCID: PMC7473780 DOI: 10.1371/journal.pone.0238653] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/20/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Disrespect and abusive care is a violation of women's basic human rights and it is serious global problem that needs urgent intervention. Poor quality client-provider interaction is commonly reported from family planning programmes. In Ethiopia, disrespect and abusive care is very common (21-78%) across health facilities. OBJECTIVE To assess the status of respectful family planning service (client-provider interaction) in Sidama zone, south Ethiopia. METHODOLOGY Health facility-based cross-sectional study was conducted from June to August 2018. Data were collected from 920 family planning clients recruited from 40 randomly selected health facilities. The Mother on Respect index (MORi) questionnaire was used to collect the data through client exit interview. Partial proportional odds ordinal regression was employed to identify determinants of respectful family planning service. RESULT Among family planning clients, the level of respectful family planning service was found to be zero (0%) in the very low respect category, 75(18.5%) in the low respect category, 382(41.52%) in moderate respect category and 463(50.33%) in high respect category. Being a short acting method client (AOR = 0.30, 95%CI [0.12, 0.72]), being an uneducated client (AOR = 0.39, 95%CI [0.25, 0.61]) or a client with elementary education (AOR = 0.41, 95%CI [0.23, 0.73]), client's poverty (AOR = 0.75, 95%CI [0.56, 0.99]), and long waiting time (AOR = 0.46, 95%CI [0.30, 0.69])significantly reduced the odds of moderate and high respect compared to low respect. Conversely, preference of male service providers, service providers' work satisfaction and health workers' prior training on respectful care significantly increased the odds of moderate and high respect. CONCLUSION Considering the current strategy of zero tolerance for disrespect and abuse in Ethiopia, the level of respectful care in this study is sub-optimal. Short term training for service providers on respectful care seems valuable to enhance the level of respectful care for family planning clients irrespective of their socioeconomic background.
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Affiliation(s)
- Melese Siyoum
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- * E-mail:
| | - Ayalew Astatkie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Zelalem Tenaw
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Abebaw Abeje
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Teshome Melese
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Yirgu R, Wood SN, Karp C, Tsui A, Moreau C. "You better use the safer one… leave this one": the role of health providers in women's pursuit of their preferred family planning methods. BMC WOMENS HEALTH 2020; 20:170. [PMID: 32787924 PMCID: PMC7425019 DOI: 10.1186/s12905-020-01034-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 07/26/2020] [Indexed: 02/02/2023]
Abstract
Background Universal access to quality sexual and reproductive health (SRH) services is pivotal to ensuring gender equality. In high-income countries, patient-provider interactions have been shown to shape women’s decisions about contraception, with poor exchanges decreasing method uptake and satisfaction. While significant progress has been made to increase women’s access to SRH services, in low- and middle-income countries, little is known about the quality of family planning patient-provider interactions. The primary objective of this analysis was to explore the role of health care providers in women’s family planning decision-making in Ethiopia. Methods From July to August 2017, 10 focus group discussions (n = 80) and 30 in-depth interviews were conducted with women aged 15–49 and men aged 18+ recruited via purposive sampling from urban and rural sites in Ethiopia. Semi-structured interview guides explored women’s and girls’ empowerment in SRH surrounding sex, childbearing, and contraception. All interviews were conducted in Amharic, audio-recorded, and transcribed verbatim into English. Inductive thematic analysis was used to analyze data. Eleven codes specific to provider services for family planning were reviewed and matrixes creates for synthesis. Results Three primary themes emerged: the role of providers in women’s awareness of and demand for family planning services; selection and uptake of contraceptive methods; and discontinuation and switching of contraceptive methods. Results indicate that health extension workers were central to women’s awareness of family planning, and health providers’ endorsements were instrumental in decisions to adopt methods. The majority of respondents described positive interactions with providers and appreciated thorough counseling when considering using or switching methods. Some women, however, described health providers directing them toward long-acting methods by communicating inaccurate information or emphasizing disadvantages of short-acting methods. A few women described provider reluctance or resistance to switching methods, especially from implants. Conclusions Women shared many narratives about the central roles health providers played in their awareness and decision-making for family planning. Those narratives also included provider bias against women’s preferred methods. Further research and program assessments are needed to ascertain the extent to which these biases hinder women’s decision-making autonomy in using contraception.
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Affiliation(s)
- Robel Yirgu
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Celia Karp
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Amy Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Soins et Santé primaire, CESP Centre for Research in Epidemiology and Population Health U1018, Inserm, F-94805, Villejuif, France
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15
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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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16
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Fekadu GA, Omigbodun AO, Roberts OA, Yalew AW. Factors associated with early long-acting reversible contraceptives discontinuation in Ethiopia: evidence from the 2016 Ethiopian demographic and health survey. Arch Public Health 2020; 78:36. [PMID: 32626577 PMCID: PMC7329387 DOI: 10.1186/s13690-020-00419-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Ethiopia is struggling to achieve the 2020 family planning target. But the current contraceptive prevalence uptake is low and dominated by short-acting methods. Contraceptive discontinuation rate is also high. This analysis was done to identify the reasons and factors associated with long-acting and reversible contraceptives (LARC) discontinuation in Ethiopia. Methods The unit of analysis was LARC-use episodes in the 5 years preceding the survey, generated from the 2016 Ethiopian Demographic and Health Survey data. A total of 1385 LARC episodes were included. Data analysis was done using STATA 15. The event file generated from the contraceptive calendar was merged to the original data set to identify factors associated with LARC discontinuation. Univariate, bivariate and inferential analyses were done for 12 months LARC discontinuation. Result Approximately 82% of LARC episodes were implants. About 45% of intrauterine device (IUD) and 61% of implant episodes were discontinued by 36 months. Side effects and the desire to become pregnant were the main reasons for discontinuation. Women aged 25–34 (HR = 0.26; 95% CI: 0.20–0.35) and those aged 35–49 (HR = 0.17; 95%CI: 0.11–0.26), women who participated in decision-making partially (HR = 0.53; 95%CI: 0.37–0.78), or fully (HR = 0.55; 95%CI: 0.40–0.74) and primiparous women (HR = 0.53, 95%CI: 0.33–0.86) had a lower hazard of discontinuing LARCs. On the other hand, women who had only primary education (HR = 1.32; 95%CI: 1.02–1.72) and women who were not sure about their fertility intention (HR = 2.11; 95%C: 1.28–3.46) had a higher likelihood of discontinuing these methods. Conclusion Majority of LARC episodes were discontinued early, mainly due to the desire for pregnancy or experience of side effects. Older women, particularly those involved in household decision-making, and primipara were less likely to discontinue LARC. Women with only primary education and those uncertain about their fertility intention had a higher likelihood of discontinuation. Family planning service providers should focus on fertility intention and side effects when counseling women for contraceptive choice. Improving women’s participation in household decision-making may decrease LARC discontinuation in Ethiopia.
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Affiliation(s)
- Gedefaw Abeje Fekadu
- Pan African University, Institute of Life and Earth Sciences (including Health and Agriculture), University of Ibadan, Ibadan, Nigeria.,College of Medicine and Health Sciences, School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | | | | | - Alemayehu Worku Yalew
- School of Public health, College of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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17
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Hrusa G, Spigt M, Dejene T, Shiferaw S. Quality of Family Planning Counseling in Ethiopia: Trends and determinants of information received by female modern contraceptive users, evidence from national survey data, (2014- 2018). PLoS One 2020; 15:e0228714. [PMID: 32040485 PMCID: PMC7010283 DOI: 10.1371/journal.pone.0228714] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/21/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Family planning counseling is critical for women to make informed reproductive and sexual health decisions. Despite Ethiopia's success in expanding access to family planning services, information on the quality of family planning counseling is limited. The objectives of this study were to assess whether the quality of counseling from the female client´s perspective has changed over time (2014 to 2018) and to investigate determinants associated with the quality of counseling to provide a more nuanced understanding of disparities in sexual and reproductive health outcomes in Ethiopia. METHODS Data were obtained from five rounds of the Ethiopian Performance Monitoring and Accountability 2020 female survey questionnaire. Quality of counseling was categorized into four levels based on the responses of the questions that compose the Method Information Index, a core Family Planning 2020 indicator that serves as a proxy for quality of counseling and reflects the extent to which women are informed about side effects and alternate methods. The proportion of female contraceptive users that received good counseling were examined over time by each region, demographic characteristics, and contraception method type and source. Ordinal logistic regression was applied to the last survey round (2018) to investigate determinants associated with counseling quality. RESULTS The proportion of female contraception users that reported receiving information on all three questions did not significantly change over the period 2014 to 2018. Overall quality of counseling on family planning was low, with only 30% of women reporting receiving sufficient information during counseling. The likelihood of good quality counseling was the least among those who had no formal schooling when compared to those who had higher educational attainment (OR = 0.70, 95% CI: 0.50, 0.97). Women from the wealthiest quintile were 1.72 times more likely (95% CI: 1.10, 2.69) to receive good quality counseling when compared to women in the lower wealth quintile. Women from rural areas were 1.51 times more likely to have received good counseling when compared to those in urban areas (95% CI: 1.04, 2.18). Amhara residents were less likely to receive good counseling when compared to the SNNPR (OR: 0.51, 95% CI: 0.32, 0.81). Women who acquired their method from the private sector had worse counseling (OR: 0.31, 95% CI: 0.23, 0.41) when compared to the public sector. Those using short-acting methods were more at risk of receiving lesser quality counseling when compared to users of long-acting methods (OR: 0.58, 95% CI: 0.46, 0.72). CONCLUSION The results of this analysis indicated that Ethiopia's overall progress in modern contraceptive use has not been accompanied by a corresponding increase in the quality of family planning counseling. Improving the quality of contraception counseling for women across all demographics, including wealth quintiles and education, is a crucial strategy to support positive reproductive health outcomes with a rights-based focus. Based on the findings of this study, it is essential to emphasize the need to do proper counseling for all methods including short-acting methods especially for those working the private sector and some of the regions which have lower prevalence of good counseling. Further community-based participatory and qualitative research should focus on understanding the root causes and barriers to the delivery of high-quality counseling in Ethiopia.
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Affiliation(s)
- Gili Hrusa
- Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - Mark Spigt
- Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Community Medicine, General Practice Research Unit, the Arctic University of Norway, Tromsø, Norway
| | - Tariku Dejene
- Center for Population Studies, College of Development Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Shiferaw
- Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Gebreyesus A. Determinants of client satisfaction with family planning services in public health facilities of Jigjiga town, Eastern Ethiopia. BMC Health Serv Res 2019; 19:618. [PMID: 31477100 PMCID: PMC6721189 DOI: 10.1186/s12913-019-4475-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 08/28/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Client satisfaction is the best indicator of quality service provision and has been found to correlate with continuity of care perceived by the client. The measurement of client satisfaction helps in understanding willingness and decisions to return for future services. Thus, this study aimed at assessing the level and factors associated with client satisfaction of FP services among family planning users. METHODS An institutional based cross-sectional study was conducted on 492 family planning users in Public health facilities of Jigjiga town, Eastern Ethiopia from February 10 to March 10, 2017. Participants were chosen by systematic random sampling and interviewed immediately after having received family planning service using via a structured and pre-tested questionnaire. The data were entered into Epi Info 7 and then exported to SPSS 20 for analysis. All associations with client satisfaction were tested for statistical significance with alpha set at the 0.05 level. RESULT The findings of this study showed that the overall client satisfaction with FP services among FP users of public health facilities of Jigjiga town was 41.7% with 95% CI of (37 - 46.1%). Knowledge on FP [adjusted odds ratio, AOR (95% CI) = 0.037 (0.019-0.072)], demonstrate how to use the method [AOR (95% CI) = 16.1 (8.4-30.7)], describing side effect of the method [AOR (95% CI) = 2.4 (1.41-4.23)] and distance of FP user's home to health facility [AOR (95% CI) = 0.24 (0.14-0.42)] were found to be significantly associated with the client satisfaction of FP services. CONCLUSIONS The overall client satisfaction with FP services was relatively low. Knowledge of FP, demonstrating how to use the method, describing the side effect of the method and distance of FP user's home to health facilities were found to be factors that influence client satisfaction with family planning services. Thus, efforts should be made to improve on client interaction especially on the information given and knowledge of clients.
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Affiliation(s)
- Aregawi Gebreyesus
- School of Public Health, Department of Epidemiology, Mekelle University, P.O.Box 1871, Mekelle, Ethiopia.
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19
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Asrat W, Mekonnen T, Bedimo M. Assessment of women's satisfaction with family planning service at public health facilities in Northwest Region of Ethiopia: a cross sectional study. Contracept Reprod Med 2018; 3:25. [PMID: 30546915 PMCID: PMC6282313 DOI: 10.1186/s40834-018-0079-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 10/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ethiopia is a Sub Saharan African country with an estimated contraceptive prevalence rate of 36% and 22% unmet need for family planning service among married women. Client satisfaction influences the use of Family Planning and other reproductive health services. There is limited information on satisfaction with family planning service among Family planning users particularly in the northern part of Ethiopia. Hence, this study aimed to provide information on client satisfaction and its determinant among women in Public Health facilities of Northwestern Ethiopia. METHODS A Facility based cross-sectional study was conducted from March 1, 2017, to March 30, 2017. An exit interview using structured pretested questionnaire was conducted on randomly selected 490 women attending family planning service in Bahir Dar city, Public Health facilities of Northwest, Ethiopia. The data was cleaned, coded and entered into Epi info™ 7 statistical software and then exported and analyzed using SPSS Version 20 statistical software. A multivariable binary logistic regression model was fitted to identify factors associated with Client satisfaction. Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI) was calculated to show the strength of association. RESULTS A total of 490 family planning service users were approached for an interview and making a response rate of 99.8%. The overall client satisfaction with the family planning services was found to be 66.1%. Clients who were merchants were more likely to be satisfied with the family planning service than government employees [AOR = 2.5, P-value = 0.007). In addition, house wife's more likely to be satisfied with the family planning service than government employees AOR = 2.4, P-value = 0.007). Daily laborers were also found to be more likely to be satisfied with the FP service as compared with governmental employees AOR = 3.9, P-value = 0.007). New Family Planning user clients were more likely to be satisfied with the family planning service than repeat users [AOR = 2.3, P-value = 0.004).Family planning service waiting time also affects client satisfaction, in which those having awaiting time of less than half an hour's (AOR = 9.7, (P-value =001), One to half an hour (AOR = 6.4, (P-value =001), One hour to two hours (AOR = 4.6, (P-value =001) were more likely to be satisfied with the family planning service delivered at the facility than those who had waited for more than two hours. In addition, those whose privacy was maintained during counseling were more likely to be satisfied with the family planning service delivered than whose privacy was not maintained (AOR = 3.2, P-Value = < 0.001). Those having convenient service hour were more likely to be satisfied with the family planning service delivered than those who don't have convenient service hour (AOR = 2.4, p-value = 0.002). CONCLUSION The finding of this study concludes that nearly two -third of the clients were satisfied with the family planning service delivered at Public Health facilities of Northwest of Ethiopia. New family planning service users, waiting time for the service, Maintaining privacy during counseling, having convenient service hour and occupational status of the clients were the predictors for client satisfaction with family planning service delivered at Public Health facilities in Bahir Dar city.
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Affiliation(s)
| | - Teferi Mekonnen
- Public Health Nutrition department, School of Public Health, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia
| | - Melkamu Bedimo
- Department of Epidemiology and Biostatistics’, School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
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20
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Slater AM, Estrada F, Suarez-Lopez L, de la Vara-Salazar E, Campero L. Overall user satisfaction with family planning services and associated quality care factors: a cross-sectional analysis. Reprod Health 2018; 15:172. [PMID: 30314514 PMCID: PMC6186057 DOI: 10.1186/s12978-018-0615-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies of user satisfaction with family planning services (FPSs) have been conducted in different countries, and have been employed to identify ways of improving health, reducing costs and implementing reforms. The present work is the first-ever study undertaken in Mexico on the subject. Our objective was to identify how overall user satisfaction with FPSs in Mexico was related to: healthcare logistics, the functional value of services and the quality of interpersonal relations. METHODS Users of 18 public clinics were surveyed in 2015. Data collected referred to their past and present use of FPSs, as well as to their perceptions of the services provided. We built a logistic regression model with potentially influential variables in order to assess their association with overall satisfaction. RESULTS According to the self-reports of the 722 users interviewed, the following factors were decisive in their overall satisfaction with services: receiving sufficient information during visits (OR = 3.38; 95% CI:1.88-6.06), feeling that their opinions were taken into consideration by clinic staff (OR = 2.58; 95% CI:1.14-5.85), feeling that the motives for their visits were addressed (OR = 2.71; 95% CI:1.29-5.71), being assigned enough time for consultation (OR = 2.35; 95% CI:1.26-4.37), having the opportunity to ask questions and clarify doubts (OR = 2.31; 95% CI:1.21-4.43), experiencing no or few interruptions during their medical consultations (OR = 1.97;95% CI:1.10-3.51), and feeling satisfied with the contraceptive method provided (OR = 1.79; 95% CI:1.03-3.11). CONCLUSIONS Service providers must be kept well informed on the perspective of users concerning user expectations. Taking into account the cultural context and perceived needs of users while providing service would improve the quality of care and, hence, the overall satisfaction of users.
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Affiliation(s)
| | - Fatima Estrada
- Cátedras CONACYT- Instituto Nacional de Salud Pública, 7a. Cerrada de Fray Pedro de Gante #50, Col. Sección XVI, Tlalpan, C.P. 14080, Ciudad de México, Mexico.
| | - Leticia Suarez-Lopez
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Elvia de la Vara-Salazar
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Lourdes Campero
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
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Fruhauf T, Zimmerman L, Kibira SPS, Makumbi F, Gichangi P, Shiferaw S, Seme A, Guiella G, Tsui A. Measuring family planning quality and its link with contraceptive use in public facilities in Burkina Faso, Ethiopia, Kenya and Uganda. Health Policy Plan 2018; 33:828-839. [PMID: 30010860 PMCID: PMC6097453 DOI: 10.1093/heapol/czy058] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2018] [Indexed: 11/14/2022] Open
Abstract
The individual impacts of several components of family planning service quality on contraceptive use have been studied, but the influence of a composite measure synthesizing these components has not been often investigated. We (1) develop a composite score for family planning service quality based on health facility data from Burkina Faso, Ethiopia, Kenya and Uganda and (2) examine the influence of structural quality on contraceptive practice in these four countries. We used nationally representative cross-sectional survey data of health facilities and women of reproductive age. First, we constructed quality scores for facilities using principal component analysis to integrate 18 variables. Second, we linked women to their closest facility using geo-coordinates. Third, we estimated multivariable logistic regression models to calculate women's odds ratios for modern contraceptive use adjusting for facilities' quality and other factors. In Burkina Faso, Ethiopia and Uganda, the odds of using a modern method of contraception was greater if the nearest facility provided high- or medium-quality services compared with low quality in the univariable model. After controlling for possible confounders, the adjusted odds ratios were significant for high quality (aOR: 3.12, P value: 0.005) and medium quality (aOR: 2.57, P value: 0.009) in Ethiopia and in the hypothesized direction but not statistically significant in Uganda or Burkina Faso, and in the opposite direction in Kenya. A process quality measure-having been visited by a community health worker-was statistically significantly associated with modern contraceptive use in three of the four countries (Burkina Faso aOR: 2.18, P value: 0.000; Ethiopia aOR: 1.78, P value: 0.000; Uganda aOR: 1.96, P value: 0.012). These results suggest that service quality in public facilities may be less relevant to contraceptive use in environments where the universe and reach of providers changes actively. Programs promoting contraception therefore need to consider quality within facility types and their service environments.
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Affiliation(s)
- Timothee Fruhauf
- Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, USA
| | - Linnea Zimmerman
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E4531, Baltimore, USA
| | - Simon Peter Sebina Kibira
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, New Mulago Hill Road, Kampala, Uganda
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, New Mulago Hill Road, Kampala, Uganda
| | - Peter Gichangi
- University of Nairobi and Ghent University, Nairobi, Kenya
| | - Solomon Shiferaw
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Assefa Seme
- Department of Reproductive Health and Health Service Management, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population, Université Ouaga 1 Pr Joseph Ki-Zerbo, Burkina Faso
| | - Amy Tsui
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E4546, Baltimore, USA
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Tolefac PN, Nana TN, Yeika EV, Awungafac NS, Ntsama Y, Njotang PN. Trends and patterns of family planning methods used among women attending family planning clinic in a rural setting in sub-Sahara Africa: the case of Mbalmayo District Hospital, Cameroon. BMC Res Notes 2018; 11:541. [PMID: 30068386 PMCID: PMC6071381 DOI: 10.1186/s13104-018-3658-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/27/2018] [Indexed: 11/25/2022] Open
Abstract
Objective Family planning enables women to prevent unwanted pregnancies and control family sizes. Provision of family planning services is an essential human right. This study aimed to describe the trends and patterns of contraceptive use in a family planning clinic in a rural district hospital setting. Results A total 313 participants who used contraceptives between March 2016 and August 2017 were included this study given a. Their mean age was 32.4 ± 1.8 years with an age range of 18–48 years. The index study estimates the rate of contraceptive use at 17.4 contraceptives per month. The most commonly used contraceptive methods were implants and IUD in 29.4 and 28.4% of the participants respectively while the least used was condoms in 8.3% of the participants. Contraceptive used are highest among those 21–40 years (83.1%) and least among adolescents less than 20 years (6.7%).
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Affiliation(s)
- Paul Nkemtendong Tolefac
- Mbalmayo District Hospital, Mbalmayo, Cameroon. .,Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
| | | | | | | | | | - Phillipe Nana Njotang
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
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Client satisfaction with family planning services in the area of high unmet need: evidence from Tanzania Service Provision Assessment Survey, 2014-2015. Reprod Health 2018; 15:127. [PMID: 30012151 PMCID: PMC6048714 DOI: 10.1186/s12978-018-0566-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 06/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Client satisfaction has been found to be an important factor for the uptake and continuation of family planning services. This study aimed to examine the current status of and factors associated with client's satisfaction with family planning services in Tanzania, which has a high unmet need for family planning. METHODS The study used data from the Tanzania Service Provision Assessment survey of 2014-2015. A facility was classified as having high service readiness for FP if it scored at least 67.7% on a composite score based on three domains (staff training and guidelines, basic diagnostic equipment, and basic medicines), following criteria developed by the World Health Organization. The exit interview questionnaire was used to collect information from women about their level of satisfaction, whether "very satisfied," "more or less satisfied," or not satisfied with the services received. The response was dichotomized into "Yes" if the woman reported being very satisfied with services received otherwise coded as "No". Unadjusted and adjusted logistic regression models were used to assess the association between the client satisfaction and covariate variables; service readiness, facility type, managing authority, location, management meetings, supervision, provider's sex, and working experience, clients' age and education. All analyses were weighted to correct for non-response, disproportionate and complex sampling by using the "SVY" command in Stata 14. RESULTS Out of the 1188 facilities included in the survey, 427 (35.9%) provided family planning services. A total of 1746 women participated in observations and exit interviews. Few (22%) facilities had a high readiness to provide family planning services. While most facilities had the recommended equipment available, only 42% stocked contraceptives (e.g. oral pills, injectable contraceptives and/or condoms). Further, trained staff and clinical guidelines were present in only 30% of services. Nevertheless, the majority (91%) of clients reported that they were satisfied with services. In the multivariate analysis, a high service readiness score [AOR = 2.5, 95% CI; 1.1-6.0], receiving services from private facilities [AOR = 2.3, 95% CI; 1.1-5.0], and being in the age group 20 to 29 years [AOR = 0.3, 95% CI; 0.1-0.7] were all significantly associated with clients' satisfaction with family planning services. CONCLUSION There is a high level of client satisfaction with family planning services in Tanzania. Maintaining and exceeding this level will require improvements in the provision of staff training and the availability of contraceptives in existing services.
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Leslie HH, Spiegelman D, Zhou X, Kruk ME. Service readiness of health facilities in Bangladesh, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Uganda and the United Republic of Tanzania. Bull World Health Organ 2017; 95:738-748. [PMID: 29147054 PMCID: PMC5677617 DOI: 10.2471/blt.17.191916] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 08/14/2017] [Accepted: 08/14/2017] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the service readiness of health facilities in Bangladesh, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Uganda and the United Republic of Tanzania. Methods Using existing data from service provision assessments of the health systems of the 10 study countries, we calculated a service readiness index for each of 8443 health facilities. This index represents the percentage availability of 50 items that the World Health Organization considers essential for providing health care. For our analysis we used 37–49 of the items on the list. We used linear regression to assess the independent explanatory power of four national and four facility-level characteristics on reported service readiness. Findings The mean values for the service readiness index were 77% for the 636 hospitals and 52% for the 7807 health centres/clinics. Deficiencies in medications and diagnostic capacity were particularly common. The readiness index varied more between hospitals and health centres/clinics in the same country than between them. There was weak correlation between national factors related to health financing and the readiness index. Conclusion Most health facilities in our study countries were insufficiently equipped to provide basic clinical care. If countries are to bolster health-system capacity towards achieving universal coverage, more attention needs to be given to within-country inequities.
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Affiliation(s)
- Hannah H Leslie
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States of America (USA)
| | - Donna Spiegelman
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA
| | - Xin Zhou
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States of America (USA)
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Mpunga D, Lumbayi JP, Dikamba N, Mwembo A, Ali Mapatano M, Wembodinga G. Availability and Quality of Family Planning Services in the Democratic Republic of the Congo: High Potential for Improvement. GLOBAL HEALTH: SCIENCE AND PRACTICE 2017; 5:274-285. [PMID: 28588047 PMCID: PMC5487089 DOI: 10.9745/ghsp-d-16-00205] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 02/28/2017] [Indexed: 11/20/2022]
Abstract
A few facilities provided good access to and quality of family planning services, particularly urban, private, and higher-level facilities. Yet only one-third offered family planning services at all, and only 20% of these facilities met a basic measure of quality. Condoms, oral contraceptives, and injectables were most available, whereas long-acting, permanent methods, and emergency contraception were least available. Responding to the DRC's high unmet need for family planning calls for substantial expansion of services. Objective: To determine the availability and quality of family planning services within health facilities throughout the Democratic Republic of the Congo (DRC). Methods: Data were collected for the cross-sectional study from April 2014 to June 2014 by the Ministry of Public Health. A total of 1,568 health facilities that reported data to the National Health Information System were selected by multistage random sampling in the 11 provinces of the DRC existing at that time. Data were collected through interviews, document review, and direct observation. Two dependent variables were measured: availability of family planning services (consisting of a room for services, staff assigned to family planning, and evidence of client use of family planning) and quality of family planning services (assessed as “high” if the facility had at least 1 trained staff member, family planning service delivery guidelines, at least 3 types of methods, and a sphygmomanometer, or “low” if the facility did not meet any of these 4 criteria). Pearson's chi-square test and odds ratios (ORs) were used to test for significant associations, using the alpha significance level of .05. Results: We successfully surveyed 1,555 facilities (99.2%) of those included in the sample. One in every 3 facilities (33%) offered family planning services as assessed by the index of availability, of which 20% met all 4 criteria for providing high-quality services. Availability was greatest at the highest level of the health system (hospitals) and decreased incrementally with each health system level, with disparities between provinces and urban and rural areas. Facilities in urban areas were more likely than in rural areas to meet the standard for high-quality services (P<.001). Public facilities were less likely than private facilities to have high-quality services (P=.02). Among all 1,555 facilities surveyed, 14% had at least 3 types of methods available at the time of the survey; the most widely available methods were male condoms, combined oral contraceptive pills, and progestin-only injectable contraceptives. Conclusion: Availability and quality of family planning services in health facilities in the DRC remain low, with inequitable distribution of services throughout the country. To improve access to and use of family planning, efforts should focus on improving availability and quality at lower health system levels and in rural areas where the majority of the population lives.
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Affiliation(s)
- Dieudonné Mpunga
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo (DRC).
| | | | - Nelly Dikamba
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo (DRC)
| | - Albert Mwembo
- Lubumbashi School of Public Health, Faculty of Medicine, University of Lubumbashi, Lubumbashi, DRC
| | - Mala Ali Mapatano
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo (DRC)
| | - Gilbert Wembodinga
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo (DRC)
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Tessema GA, Mahmood MA, Gomersall JS, Assefa Y, Zemedu TG, Kifle M, Laurence CO. Client and facility level determinants of quality of care in family planning services in Ethiopia: Multilevel modelling. PLoS One 2017. [PMID: 28622376 PMCID: PMC5473535 DOI: 10.1371/journal.pone.0179167] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Over the last two decades, while contraceptive use has improved in Ethiopia, the contraceptive prevalence rate remains low. In addition to socio-demographic and cultural factors, the quality of care in Family Planning (FP) services is an important determining factor of FP utilization. However, little research exists on the determinants of quality of care in FP services in Ethiopia. This study aims to identify the client and facility level determinants of quality of care in FP services in Ethiopia. METHODS This study was based on the first Ethiopian Services Provision Assessment Plus (ESPA+) survey conducted in 2014. A total of 1247 clients nested in 374 health facilities were included in the analysis. Multilevel mixed-effects logistic regression modelling was conducted. The outcome variable, client satisfaction, was created using polychoric principal component analysis using eleven facets that reflect client satisfaction. RESULTS The results showed that both client-level and facility-level factors were associated with quality of care in FP services in Ethiopia. At the client-level; provision of information on potential side effects of contraceptive method (AOR = 5.22, 95% CI: 2.13-12.80), and number of history and physical assessments (AOR = 1.19, 95% CI: 1.03-1.34) were positively associated with client satisfaction, whereas waiting times of 30 minutes to two hours (AOR = 0.11, 95% CI: 0.03-0.33) was negatively associated with client satisfaction. At the facility-level; urban location (AOR = 4.61, 95% CI: 1.04-20.58), and availability of FP guidelines/protocols for providers (AOR = 4.90, 95% CI: 1.19-20.19) had positive significant effect on client satisfaction. CONCLUSION Quality improvement programs in FP services in Ethiopia should focus on shortening waiting times and provision of information about the potential side effects of contraceptive methods. It is also important to improve health providers' skills in thorough client history taking and physical assessment. Further distribution and implementation of best practice guidelines for providers working in the FP services must be a priority.
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Affiliation(s)
- Gizachew Assefa Tessema
- School of Public Health, The University of Adelaide, Adelaide, Australia
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | | | | | - Yibeltal Assefa
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Theodros Getachew Zemedu
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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Villalobos A, Allen-Leigh B, Salazar-Alberto J, De Castro F, Barrientos-Gutiérrez T, Leyva-López A, Rojas-Martínez R. Quality of reproductive healthcare for adolescents: A nationally representative survey of providers in Mexico. PLoS One 2017; 12:e0173342. [PMID: 28273129 PMCID: PMC5342221 DOI: 10.1371/journal.pone.0173342] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 02/20/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Adolescents need sexual and reproductive health services but little is known about quality-of-care in lower- and middle-income countries where most of the world's adolescents reside. Quality-of-care has important implications as lower quality may be linked to higher unplanned pregnancy and sexually transmitted infection rates. This study sought to generate evidence about quality-of-care in public sexual and reproductive health services for adolescents. METHODS This cross-sectional study had a complex, probabilistic, stratified sampling design, representative at the national, regional and rural/urban level in Mexico, collecting provider questionnaires at 505 primary care units in 2012. A sexual and reproductive quality-of-healthcare index was defined and multinomial logistic regression was utilized in 2015. RESULTS At the national level 13.9% (95%CI: 6.9-26.0) of healthcare units provide low quality, 68.6% (95%CI: 58.4-77.3) medium quality and 17.5% (95%CI: 11.9-25.0) high quality reproductive healthcare services to adolescents. Urban or metropolitan primary care units were at least 10 times more likely to provide high quality care than those in rural areas. Units with a space specifically for counseling adolescents were at least 8 times more likely to provide high quality care. Ministry of Health clinics provided the lowest quality of service, while those from Social Security for the Underserved provided the best. CONCLUSIONS The study indicates higher quality sexual and reproductive healthcare services are needed. In Mexico and other middle- to low-income countries where quality-of-care has been shown to be a problem, incorporating adolescent-friendly, gender-equity and rights-based perspectives could contribute to improvement. Setting and disseminating standards for care in guidelines and providing tools such as algorithms could help healthcare personnel provide higher quality care.
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Affiliation(s)
- Aremis Villalobos
- Public Health Methods Department, Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico
| | - Betania Allen-Leigh
- Public Health Methods Department, Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico
| | | | - Filipa De Castro
- Public Health Methods Department, Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico
| | - Tonatiuh Barrientos-Gutiérrez
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico
| | - Ahideé Leyva-López
- Gender and Health Department, Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Rosalba Rojas-Martínez
- Public Health Methods Department, Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico
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Tessema GA, Streak Gomersall J, Mahmood MA, Laurence CO. Factors Determining Quality of Care in Family Planning Services in Africa: A Systematic Review of Mixed Evidence. PLoS One 2016; 11:e0165627. [PMID: 27812124 PMCID: PMC5094662 DOI: 10.1371/journal.pone.0165627] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/15/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Improving use of family planning services is key to improving maternal health in Africa, and provision of quality of care in family planning services is critical to support higher levels of contraceptive uptake. The objective of this systematic review was to synthesize the available evidence on factors determining the quality of care in family planning services in Africa. METHODS Quantitative and qualitative studies undertaken in Africa, published in English, in grey and commercial literature, between 1990 and 2015 were considered. Methodological quality of included studies was assessed using standardized tools. Findings from the quantitative studies were summarized using narrative and tables. Client satisfaction was used to assess the quality of care in family planning services in the quantitative component of the review. Meta-aggregation was used to synthesize the qualitative study findings. RESULTS From 4334 records, 11 studies (eight quantitative, three qualitative) met the review eligibility criteria. The review found that quality of care was influenced by client, provider and facility factors, and structural and process aspects of the facilities. Client's waiting time, provider competency, provision/prescription of injectable methods, maintaining privacy and confidentiality were the most commonly identified process factors. The quality of stock inventory was the most commonly identified structural factor. The quality of care was also positively associated with privately-owned facilities. The qualitative synthesis revealed additional factors including access related factors such as 'pre-requisites to be fulfilled by the clients and cost of services, provider workload, and providers' behaviour. CONCLUSION There is limited evidence on factors determining quality of care in family planning services in Africa that shows quality of care is influenced by multiple factors. The evidence suggests that lowering access barriers and avoiding unnecessary pre-requisites for taking contraceptive methods are important to improve the quality of care in family planning services. Strategies to improve provider behavior and competency are important. Moreover, strategies that minimize client waiting time and ensure client confidentiality should be implemented to ensure quality of care in family planning services. However, no strong evidence based conclusions and recommendations may be drawn from the evidence. Future studies are needed to identify the most important factors associated with quality of care in family planning services in a wider range of African countries.
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Affiliation(s)
- Gizachew Assefa Tessema
- School of Public Health, The University of Adelaide, Adelaide, Australia
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Atuyambe LM, Baingana RK, Kibira SPS, Katahoire A, Okello E, Mafigiri DK, Ayebare F, Oboke H, Acio C, Muggaga K, Mbalinda S, Nabaggala R, Ruzaaza G, Arubaku W, Mary S, Akera P, Tumwine JK, Peters DH, Sewankambo NK. Undergraduate students' contributions to health service delivery through community-based education: A qualitative study by the MESAU Consortium in Uganda. BMC MEDICAL EDUCATION 2016; 16:123. [PMID: 27114073 PMCID: PMC4843200 DOI: 10.1186/s12909-016-0626-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/05/2016] [Indexed: 05/22/2023]
Abstract
BACKGROUND It has been realised that there is need to have medical training closer to communities where the majority of the population lives in order to orient the trainees' attitudes towards future practice in such communities. Although community based education (CBE) has increasingly been integrated into health professions curricula since the 1990s, the contribution students make to service delivery during CBE remains largely undocumented. In this study, we examined undergraduate health professions students' contribution to primary health care during their CBE placements. METHODS This was a qualitative study involving the Medical Education for Equitable Services to All Ugandans consortium (MESAU). Overall, we conducted 36 Focus Group Discussions (FGDs): one each with youth, men and women at each of 12 CBE sites. Additionally, we interviewed 64 community key-informants. All data were audio-recorded, transcribed and analysed using qualitative data analysis software Atlas.ti Ver7. RESULTS Two themes emerged: students' contribution at health facility level and students' contribution at community level. Under theme one, we established that students were not only learning; they also contributed to delivery of health services at the facilities. Their contribution was highly appreciated especially by community members. Students were described as caring and compassionate, available on time and anytime, and as participating in patient care. They were willing to share their knowledge and skills, and stimulated discussion on work ethics. Under the second theme, students were reported to have participated in water, sanitation, and hygiene education in the community. Students contributed to maintenance of safe water sources, educated communities on drinking safe water and on good sanitation practices (hand washing and proper waste disposal). Hygiene promotion was done at household level (food hygiene, hand washing, cleanliness) and to the public. Public health education was extended to institutions. School pupils were sensitised on various health-related issues including sexuality and sexual health. CONCLUSION Health professions students at the MESAU institutions contribute meaningfully to primary health care delivery. We recommend CBE to all health training programs in sub-Saharan Africa.
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Affiliation(s)
- Lynn M. Atuyambe
- />Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, College of Health Sciences, New Mulago Hospital Complex-School of Public Health Building Suite nr 307, P.O. Box 7072, Kampala, Uganda
| | - Rhona K. Baingana
- />School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Simon P. S. Kibira
- />Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, College of Health Sciences, New Mulago Hospital Complex-School of Public Health Building Suite nr 307, P.O. Box 7072, Kampala, Uganda
| | - Anne Katahoire
- />School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Elialilia Okello
- />School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David K. Mafigiri
- />School of Social Sciences, Makerere University College of Humanities and Social Sciences, Kampala, Uganda
| | - Florence Ayebare
- />Office of the Principal, Makerere University College of Health Sciences, Kampala, Uganda
| | - Henry Oboke
- />Faculty of Medicine, Gulu University, Kampala, Uganda
| | - Christine Acio
- />Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- />School of Health Sciences, Kampala International University Western Campus, Bushenyi, Uganda
| | - Kintu Muggaga
- />Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- />School of Health Sciences, Kampala International University Western Campus, Bushenyi, Uganda
| | - Scovia Mbalinda
- />School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ruth Nabaggala
- />Office of the Principal, Makerere University College of Health Sciences, Kampala, Uganda
| | - Gad Ruzaaza
- />Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Wilfred Arubaku
- />Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Samantha Mary
- />Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Peter Akera
- />Faculty of Medicine, Gulu University, Kampala, Uganda
| | - James K. Tumwine
- />School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David H. Peters
- />Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Nelson K. Sewankambo
- />Office of the Principal, Makerere University College of Health Sciences, Kampala, Uganda
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