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Sadore AA, Kebede Y, Birhanu Z. Effectiveness of engaging religious leaders in maternal health education for improving maternal health service utilization in Ethiopia: cluster randomized controlled trial. Front Public Health 2024; 12:1399472. [PMID: 39135926 PMCID: PMC11317292 DOI: 10.3389/fpubh.2024.1399472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/17/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction High mortality rates for pregnant women and their new-borns are one of Africa's most intractable public health issues today, and Ethiopia is one of the countries most afflicted. Behavioral interventions are needed to increase maternal health service utilizations to improve outcomes. Hence, this trial aimed to evaluate effectiveness of trained religious leaders' engagement in maternal health education on maternal health service utilization. Methods The study employed a cluster-randomized controlled community trial that included baseline and end-line measurements. Data on end points were gathered from 593 pregnant mothers, comprising 292 and 301 individuals in the intervention and control groups, respectively. In the intervention group, the trained religious leaders delivered the behavioral change education on maternal health based on intervention protocol. Unlike the other group, the control group only received regular maternal health information and no additional training from religious leaders. Binary generalized estimating equation regression analysis adjusted for baseline factors were used to test effects of the intervention on maternal health service utilization. Results Following the trial's implementation, the proportion of optimal antenatal care in the intervention arm increased by 21.4% from the baseline (50.90 vs. 72.3, p ≤ 0.001) and the proportion of institutional delivery in the intervention group increased by 20% from the baseline (46.1% vs. 66.1%, p ≤ 0.001). Pregnant mothers in the intervention group significantly showed an increase of proportion of PNC by 22.3% from baseline (26% vs. 48.3%, p ≤ 0.001). A statistically significant difference was observed between in ANC4 (AOR = 2.09, 95% CI: 1.69, 2.57), institutional delivery (AOR = 2.36, 95% CI: 1.94, 2.87) and postnatal care service utilization (AOR = 2.26, 95% CI: 1.79, 2.85) between the intervention and control groups. Conclusion This research indicated that involving religious leaders who have received training in maternal health education led to positive outcomes in enhancing the utilization of maternal health services. Leveraging the influential position of these religious leaders could be an effective strategy for improving maternal health service utilization. Consequently, promoting maternal health education through religious leaders is advisable to enhance maternal health service utilization.Clinical trial registration: [https://clinicaltrials.gov/], identifier [NCT05716178].
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Affiliation(s)
- Abinet Arega Sadore
- Department of Health, Behaviour, and Society, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaina, Ethiopia
| | - Yohannes Kebede
- Department of Health, Behaviour, and Society, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Zewdie Birhanu
- Department of Health, Behaviour, and Society, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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Wambete SN, Serwaa D, Dzantor EK, Baru A, Poku-Agyemang E, Kukeba MW, Bashiru Y, Olayemi OO. Determinants for male involvement in family planning and contraception in Nakawa Division, Kampala, Uganda; An urban slum qualitative study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003207. [PMID: 38820444 PMCID: PMC11142587 DOI: 10.1371/journal.pgph.0003207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 04/15/2024] [Indexed: 06/02/2024]
Abstract
Current evidence shows that male involvement in family planning (FP) is crucial to women's contraceptive use decisions. This study explored the reasons for male involvement in FP and contraception in slum areas in Nakawa Division, Kampala, Uganda. A qualitative study was conducted among sexually active males in a slum area in Nakawa Division, Kampala. A purposive sampling technique was utilised to recruit 40 men for a Focus Group Discussion (FGDs), and 2 key informants (KI) for critical perspective interviews. A semi-structured FGDs and interview guides were used to collect the data. The FGDs were conducted in both English and the local language, Luganda. All interviews were recorded and transcribed verbatim. Transcripts for both FGDs and KI interviews were imported into the NVivo Qualitative Data Analysis Software version 10 application, and thematic data analysis was conducted. The findings show that males' involvement in FP and its decisions were minimal. The findings also show that several factors emerged as contributing to male's participation in FP and utilisation of contraceptives. Inadequate understanding of FP and contraceptives, lack of clarity on males' role in FP, unfriendly healthcare environment and community members' perceptions of male involvement in FP were reported as reasons contributing to male participation in FP and contraction. There is limited involvement of males in FP. There is a need for renewed efforts that will positively alter the factors that impact male involvement favourably. Promotion and education about FP for males will significantly address issues of limited understanding and clarity of males' role in FP services.
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Affiliation(s)
- Sarah Namee Wambete
- Faculty of Public Health, Department of Public Health, Nursing and Midwifery, Save The Mothers East Africa, Uganda Christian University, Mukono, Uganda
- Slum and Rural Health Initiative Network/Uganda, Kampala, Uganda
| | - Dorcas Serwaa
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, Australia
| | - Edem Kojo Dzantor
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- Research and Innovation Unit, College of Nursing and Midwifery, Nalerigu, North-East Region, Ghana
| | - Ararso Baru
- College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia
- Slum and Rural Health Initiative Network/Ethiopia, Addis Ababa, Ethiopia
| | - Evelyn Poku-Agyemang
- Department of Nursing and Midwifery, Methodist Health Training Institute, Afosu, Eastern Region, Ghana
| | - Margaret Wekem Kukeba
- Department of Nursing, School of Nursing and Midwifery, CKT-University of Technology and Applied Sciences, Navrongo, Upper-East Region, Ghana
| | - Yussif Bashiru
- Department of Nursing and Midwifery, Methodist Health Training Institute, Afosu, Eastern Region, Ghana
| | - Oladapo O. Olayemi
- Faculty of Clinical Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Mwakisole AH, Lambert VJ, Nzali A, Aristide C, Laizer E, Cordeiro AA, Gregory L, Mwakisole N, Nicol CEW, Paul N, Kalluvya SE, Kihunrwa A, Downs DJ, Wamoyi J, Downs JA, Lee MH. Partnerships with religious leaders to promote family planning in rural Tanzania: an open-label, cluster randomised trial. Lancet Glob Health 2023; 11:e1943-e1954. [PMID: 37973342 DOI: 10.1016/s2214-109x(23)00453-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Family planning benefits maternal-child health, education, and economic wellbeing. Despite global efforts, an unsatisfied demand for family planning persists in sub-Saharan Africa. Based on previous successful partnerships, the aim of this study was to determine whether an educational intervention for religious leaders would increase community knowledge, demand for, and ultimately uptake of family planning. METHODS In this open-label, cluster randomised trial in Tanzania, 24 communities were randomised (1:1) to intervention or control arm. Communities, defined as the catchment area of a single public health facility, were eligible if they were at least 15 km from Mwanza City and had not previously participated in a health intervention for religious leaders. Random allocations were determined by coin toss and were not revealed to clinicians at health facilities in intervention and control communities, nor to the data entry team; however, due to the nature of the intervention, masking of religious leaders in the intervention communities was not possible. All Christian religious institutions were invited to send four leaders to an educational intervention that incorporated cultural, theological, and medical teaching about family planning. The primary outcome was contraceptive uptake at the community health facility during the year post intervention versus the year before the intervention. This trial was registered at clinicaltrials.gov, NCT03594305. FINDINGS 75 communities in three districts were assessed for eligibility. 19 communities were excluded and 56 were eligible for study inclusion and were placed in random order to be invited to participate. The first 24 communities that were invited agreed to participate and were randomly assigned to receive the educational intervention either during the trial or after trial completion. Between July 10, 2018 and Dec 11, 2021, we provided the intervention in 12 communities and compared contraceptive uptake with 12 control communities. All were followed up for 12 months. In intervention communities, contraceptive uptake increased by a factor of 1·47 (95% CI 1·41-1·53) in the post-intervention (prospective) versus pre-intervention (historical) year (geometric mean of contraceptive uptake, 466 in the prospective year vs 312 in the historical year), versus 1·24 (95% CI 1·20-1·29) in control communities (geometric mean, 521 in the prospective year vs 429 in the historical year). The rate of change in contraceptive uptake was greater in intervention communities (between-group ratio of geometric mean ratios over time, 1·19 [95% CI 1·12-1·25]; p<0·0001). The COVID-19 pandemic was associated with decreased contraceptive uptake (geometric mean, 365 during the pandemic in communities that had the majority of their prospective 12-month data collection periods occur after March 16, 2020, vs 494 before the pandemic; geometric mean ratio, 0·72 [95% CI 0·57-0·90]; p=0·0040). INTERPRETATION This intervention offers a scalable model, leveraging influence of trusted religious leaders to increase knowledge and uptake of family planning. New strategies such as this could help to overcome setbacks that occurred during the COVID-19 pandemic. FUNDING John Templeton Foundation and Weill Cornell Medicine Dean's Diversity and Healthcare Disparity Award. TRANSLATION For the Kiswahili translation of the abstract see Supplementary Materials section.
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Affiliation(s)
| | | | - Aneth Nzali
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
| | | | | | | | | | | | - Cecilia E W Nicol
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Ndalloh Paul
- Department of Emergency Medicine, Bugando Medical Centre, Mwanza, Tanzania
| | | | - Albert Kihunrwa
- Department of Obstetrics and Gynaecology, Bugando Medical Centre, Mwanza, Tanzania
| | - David J Downs
- Faculty of Theology and Religion, University of Oxford, Oxford, UK
| | - Joyce Wamoyi
- National Institute for Medical Research, Mwanza, Tanzania
| | - Jennifer A Downs
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA; Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania.
| | - Myung Hee Lee
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
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Orwa J, Gatimu SM, Ariho P, Temmerman M, Luchters S. Trends and factors associated with declining lifetime fertility among married women in Kenya between 2003 and 2014: an analysis of Kenya demographic health surveys. BMC Public Health 2023; 23:718. [PMID: 37081486 PMCID: PMC10116796 DOI: 10.1186/s12889-023-15620-z] [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: 09/21/2022] [Accepted: 04/06/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Globally, fertility has declined in the last three decades. In sub-Saharan Africa Including Kenya, this decline started more recent and at a slower pace compared to other regions. Despite a significant fertility decline in Kenya, there are disparities in intra- and interregional fertility. Reduction in lifetime fertility has health benefits for both the mother and child, thus it is important to improve women and children health outcomes associated with high fertility. The study, therefore evaluated the factors associate with change in lifetime fertility among married women of reproductive age in Kenya between 2003 and 2014. METHODS The study used the Kenya Demographic and Health Survey (KDHS) datasets of 2003, 2008 and 2014. Analysis of variance (ANOVA) was used to calculate the mean number of children ever born and to assess the change in fertility across different factors. Poisson regression model with robust standard errors was used to study the relationship between number of children ever born (lifetime fertility) and independent variables. A Poisson-based multivariate decomposition for the nonlinear response model was performed to identify and quantify the contribution of demographic, socioeconomic and reproductive correlates, to the change in lifetime fertility between 2003 and 2014. RESULTS The study included 3,917, 4,002, and 7,332 weighted samples of women of reproductive age in 2003, 2008, and 2014, respectively. The mean number of children born declined from 3.8 (95% CI: 3.6-3.9) in 2003 to 3.5 (95% CI: 3.4--3.7) in 2008 and 3.4 (95% CI: 3.3-3.4) in 2014 (p = 0.001). The expected number of children reduced with the age at first sexual intercourse, the age at first marriage across the survey years, and household wealth index. Women who had lost one or more children in the past were likely to have increased number of children. The changes in the effects of women's characteristics between the surveys explained 96.4% of the decline. The main contributors to the change in lifetime fertility was the different in women level of education. CONCLUSION The lifetime fertility declined by one-tenth between 2003 and 2014; majorly as a result of the effects of characteristics of women in terms of level of education. These highlights a need to implement education policies that promotes women education focuses on gender equality and women empowerment. Continuous strengthening of the healthcare systems (access to quality antenatal care, skilled delivery, and postpartum care) to reduce child mortality is essential.
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Affiliation(s)
- James Orwa
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
- Department of Population Health, Aga Khan University, Nairobi, Kenya.
- Department of Population Health Sciences, Aga Khan University, P.O. Box 30270 - 00100, Nairobi, Kenya.
| | - Samwel Maina Gatimu
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Diabetic Foot Foundation of Kenya, Nairobi, Kenya
| | - Paulino Ariho
- Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala, Uganda
| | - Marleen Temmerman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Centre of Excellence for Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Stanley Luchters
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
- Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
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Wachira E, Laki K, Chavan B, Aidoo-Frimpong G, Kingori C. Factors Influencing COVID-19 Prevention Behaviors. JOURNAL OF PREVENTION (2022) 2023; 44:35-52. [PMID: 36536182 PMCID: PMC9763079 DOI: 10.1007/s10935-022-00719-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
COVID-19 remains a public health emergency with prevention guidelines and mitigation strategies being constantly updated to curb the rapid spread of the disease. Despite proven successes of recommended preventive behaviors, there is low uptake of wearing a mask, washing of hands, and social distancing in the United States (US). The purpose of this study was to examine factors that influence COVID-19 preventive behaviors. We used data from the nationally representative COVID-19 Household Impact Survey (n = 19,815) conducted in the US from April to June 2020. Chi-square (χ2) test and bivariate analyses were performed to compare study participants who used all COVID-19 related preventive behaviors and those who did not, and multivariate logistic regressions to determine associations across demographic and social characteristics. Of the 19,815 participants, 79.2% of participants reported practicing the aforementioned COVID-19 preventive behaviors. Further, non-Hispanic white, Spanish speaking, living in urban areas, of older age (60+), being female, having an education above an undergraduate, those with income levels $100K or more, living in the urban northeast region that trust and communicate frequently with family and neighbors were more likely to use all three preventive behaviors. Findings suggest a need for continued provision of information on prevention and vaccination importance, but expand efforts to target adopters of these behaviors and encourage them to share their uptake and adherence efforts. This type of horizontal communication where information is shared within trusted social networks can shape social norms that influence the uptake of COVID-19 preventive behaviors and slowly curb communal spread.
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Affiliation(s)
- Elizabeth Wachira
- Department of Health and Human Performance, Texas A&M University- Commerce, 2600 S Neal Street, 75428 Commerce, TX USA
| | - Kujang Laki
- School of Communication Studies, Scripps College of Communication, Ohio University, 400 Schoonover Center 20 E. Union Street, 45701 Athens, OH USA
| | - Bhakti Chavan
- Assistant Biostatistician, College of Osteopathic Medicine, Ohio University, The Heritage Hall, Medical Education Building 1 454, 45701, 614-793-5649 Athens, OH USA
| | - Gloria Aidoo-Frimpong
- Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, 06510, 203-764-4333 New Haven, CT USA
| | - Caroline Kingori
- Interim Associate Dean for Research, College of Health Sciences and Professions, Ohio University, Grover Center W377, 45701 Athens, OH USA
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