BackgroundWith the focus of global and national family planning initiatives on reaching “additional user” targets, it is increasingly important for programs to assess contraceptive method discontinuation and switching. This analysis calculated the discontinuation rate and method-specific discontinuation rates, examined reasons given for contraceptive discontinuation, and assessed characteristics associated with subsequent contraceptive switching and abandonment among women living in urban areas of Senegal.MethodsData came from the Measurement, Learning & Evaluation project’s 2015 survey of 6927 women of reproductive age living in six urban sites (Dakar, Pikine, Guédiawaye, Mbao, Kaolack and Mbour). Information on contraceptive use and discontinuation for the five years preceding the survey were recorded in a monthly calendar. Single decrement life tables were used to calculate discontinuation rates. Descriptive analyses were used to assess reasons for discontinuation and method switching after discontinuation. A multinomial logistic regression was used to estimate the likelihood of being a non-user in-need of contraception, a non-user not in-need of contraception, or a method switcher in the month after discontinuation, by sociodemographic and other characteristics.ResultsThe 12-month discontinuation rate for all methods was 34.7%. Implants had the lowest one-year discontinuation rates (6.3%) followed by the intrauterine device (IUD) (18.4%) while higher rates were seen for daily pills (38%), injectables (32.7%), and condoms (62.9%). The most common reasons for discontinuation were reduced need (45.6%), method problems (30.1%), and becoming pregnant while using (10.0%). Only 17% of discontinuations were followed by use of another method; most often daily pills (5.2%) or injectables (4.2%). In the multivariate analysis, women with any formal education (primary, secondary or higher) were more than 50% more likely to switch methods than remain in need of contraception after discontinuation than women with no education or Koranic-only education (RRR = 1.59, p-value = 0.004; RRR = 1.55, p-value = 0.031). The likelihood of switching compared to being “in need” was also significantly higher for women who were married and who discontinued traditional methods.ConclusionsTo support increased contraceptive method use, women with no education and unmarried women are priorities for counseling and information about side effects and method switching at the time of method adoption.
Background: The concentration of poverty and adverse environmental circumstances within slums, particularly those in the cities of developing countries, are an increasingly important concern for both public health policy initiatives and related programs in other sectors. However, there is a dearth of information on the population-level implications of slum life for human health. This manuscript describes the 2005 Census and Mapping of Slums (CMS), which used geographic information systems (GIS) tools and digital satellite imagery combined with more traditional fieldwork methodologies, to obtain detailed, up-to-date and new information about slum life in all slums of six major cities in Bangladesh (including Dhaka).
Introduction: Since March 2014, Guinea has been in the midst of the largest, longest, and deadliest outbreak of Ebola Virus Disease ever recorded. Due to sub-optimal health conditions prior to the outbreak, Guinean women and children may have been especially vulnerable to worsening health care conditions. A rapid assessment was conducted to better understand how the delivery and utilization of routine RMNCH services may have been affected by the extraordinary strain placed on the health system and its client population by the Ebola outbreak in Guinea. Methods: Data were collected January-February 2015 in a convenience sample of public and private facilities in areas of the country that were Ebola active, calm and inactive. Monthly data on a number of RMNCH services were collected by facility record abstraction for the period from October 1, 2013 through December 31, 2014. Structured interviews were also held with facility directors and RMNCH service providers. Results: Data on RMNCH services from forty five public facilities were obtained. A statistically significant decline of 31% was seen in outpatient visits between October-December 2013 (before the Ebola outbreak) and October-December 2014 (the advanced stage of the Ebola outbreak). Service declines appeared to be greater in hospitals compared to health centers. Child health services were more affected by the Ebola epidemic than other assessed health areas. For example, the number of children under five seen for diarrhea and Acute Respiratory Infection (ARI) showed a large decrease over the one-year period in both hospitals (60% for diarrhea and 58% for ARI) and health centers (25% and 23%, respectively). Results also suggest that the negative effects on service availability (such as reduced hours, closures, and service suspensions) are likely to be regional and/or facility-specific. Providers reported a number of improved infection control behaviors as a result of the Ebola outbreak, including more frequent hand-washing and the use of disinfectants. Nevertheless, 30% of interviewed staff had not received any training on Ebola infection control. Discussion: Although there may be differences in RMNCH service delivery and availability in selected versus non-selected facilities, a large number of indicators were assessed in order to provide needed information on the effects of the Ebola crisis on routine RMNCH service delivery and uptake in Guinea. This information is an important and timely contribution to ongoing efforts to understand and respond to the adverse effects of the Ebola crisis on essential RMNCH services in Guinea.
Measures of HIV/AIDS knowledge and risk perception are important because they are often linked to behavioral change both in theory and in practice. This study examines knowledge and risk perception by assessing their relationship with demographic characteristics, first source of HIV/AIDS information, and behavioral and cognitive risk exposures among men and women in a rural district of Malawi. The data come from a panel study of 940 women aged 15-34 years and 661 men aged 20-44 years. Descriptive statistics and multivariate regression models are used for the analysis. The results indicate that knowledge of HIV/AIDS does not necessarily translate into perceived risk. In addition, there appears to be a gender difference in the influence of cognitive and behavioral factors on perceived risk.
Context Previous studies have identified positive relationships between geographic proximity to family planning services and contraceptive use but have not accounted for the effect of contraceptive supply reliability or the diminishing influence of facility access as distance increases. Methods We used kernel density estimation to geographically link a woman’s use of injectable contraceptives and demand for birth spacing/limiting in Malawi with routine contraceptive logistics data from family planning service delivery points. Using linear probability models, we estimated the associations between access to services, measured by distance alone and distance adjusted by supply reliability, and injectable use and demand for birth spacing or limiting in rural and urban environments. Results Access to services is an important predictor of injectable use. Women in rural communities with the most access by both measures were over 7 percentage points more likely to report injectable use than women with the least access. In urban environments, women with more reliable contraceptive supplies reported up to 18.3 percentage points higher demand for birth spacing or limiting than women with the least distance-and-supply access. Conclusions Our findings highlight the importance of product availability in the local service environment, and its relationship with demand for and use of family planning. Constructing facility service environments using kernel density estimation provides a refined means of linking women with services that takes into account distance decay and supply reliability. Distinct urban and rural results highlight the importance of considering both urban and rural service environments when working to improve modern contraceptive use.
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