Mussie Alemayehu

Bio: Mussie Alemayehu is an academic researcher from College of Health Sciences, Bahrain. The author has contributed to research in topics: Family planning & Public health. The author has an hindex of 4, co-authored 5 publications receiving 47 citations.

Factors associated with contraceptive use in Tigray, North Ethiopia

Abstract: Family planning interventions are cost-effective and have several cross-cutting benefits. Despite these benefits of family planning, progress in ensuring universal access to family planning to women in developing countries has been slow. In light of this; this study investigated the prevalence and factors associated with contraceptive use in Tigray Region, Northern Ethiopia. A community-based cross-sectional study was conducted among 1966 women of reproductive age group (15–49) in 13 districts (3 urban and 10 rural) from May-June 2015. Multistage sampling technique was employed to approach the study participants. Data were analyzed using SPSS version 20. Multiple variable logistic regression analysis was used to identify the effect of independent variables on utilization of contraceptive use. Out of total 1966 women, 1879 (95.6%) have ever heard about family planning. Depo-Provera (depot medroxyprogesterone acetate, or DMPA) was the most popular contractive method as mentioned by 1757 (93.5%) of the participants. The overall contraceptive prevalence rate among all women was 623 (35.6%) while the contraceptive prevalence rate among married women was 543 (41.0%). Seven-in-ten women had ever used short acting contraceptive. In fact Depo-Provera was the most common type of contraceptive used as mentioned by 402 (64.5%) of the women. The odds of using family planning by married women living in urban areas was two times more than their counterparts (AOR = 2.0, 95% of CI: 1.33, 3.06). Similarly, the odds of using family planning among mothers with primary education was 1.3 times more as compared with no education (AOR = 1.3, 95% of CI: 1.02,1.93). However, as regards to long acting contraceptive methods, the odds of using long acting contraceptive methods use among married women in urban areas was 50% less when compared to rural married women (AOR = 0.5, 95% of CI: 0.3, 0.88). Contraceptive prevalence rate in Tigray region increased almost four fold in just 15 years. However, the increase is not yet enough to meet national and global targets. Further interventions are needed to narrow disparities in contraceptive use among different population groups and increase long acting contraceptive users. Moreover, improving quality of family planning in terms of the content of information provided to clients is crucial.

Utilization and factors associated with antenatal, delivery and postnatal Care Services in Tigray Region, Ethiopia: a community-based cross-sectional study

Abstract: This study aimed to identify the utilization and factors associated with antenatal care, delivery, and postnatal care services in Tigray regional state, Ethiopia. A community-based cross-sectional study was conducted among 667 women of reproductive age group who had children aged 45 days - 6 months in 13 districts (3 urban and 10 rural). Data were collected from May–June 2015. Multistage sampling technique was used. The data were analyzed using SPSS version 20. Multiple variable logistic regression analysis was used to identify the factors associated with the utilization of antenatal care, institutional delivery, and postnatal care services. Of the total, the proportion of women who visited a health facility for antenatal care four or more times (ANC 4+) was 58.2%, those who chose institutional delivery was 87.9%, and those who received postnatal care (PNC) within 42 days of birth at least once was 40.3%. Residing in an urban area, having an electronic media, and having 2–5 children were factors associated with an ANC 4+ visit. Whereas, partner involvement in ANC visit (AOR = 2.4, 95% of CI: 1.37, 4.35) and content of ANC discussed (AOR = 4.0, 95% of CI: 1.08, 14.93), having birth preparedness (AOR = 2.6, 95% of CI: 1.44, 4.97), residing within a distance of less than a 30-min walk to the nearest health facility (AOR = 2.0, 95% of CI: 1.16, 3.64), and having ANC 4+ visits (AOR = 2.4, 95% of CI: 1.39, 4.31) were the factors that were found to be associated with institutional delivery. As regards to PNC visits within 42 days of birth, age of 40–45 years, having 2–5 children, and ANC 4+ visits were found to be significant factors associated with it. The proportion of women who attended antenatal care and gave birth in a health facility was high. However, the proportion of women who attended antenatal and postnatal care was low. Residing in urban areas, having an electronic media, living near a health facility, having partner involvement in decision making, receiving appropriate ANC counseling, having birth preparedness, age of the woman, and number of children could potentially influence maternal health services utilization.

Factors influencing contraceptive use among women of reproductive age from the pastoralist communities of Afar, Ethiopia: a community-based cross-sectional study

Abstract: Background: Contraceptive use is recognized as one of the most cost-effective interventions to reduce maternal and child morbidity and mortality. However, the prevalence of contraceptive use is disproportionately low among women of reproductive age from the pastoralist communities of Ethiopia. Objective: study aimed to assess the factors influencing contraceptive use among women of reproductive age from the pastoralist communities of Afar, Ethiopia. Methods: A community-based cross-sectional study was conducted among 1,978 randomly selected women of reproductive age who had given birth within two years prior to the study. Ten districts, selected by a multistage sampling technique, were included in the study. Five kebeles were randomly selected from each of the 10 districts and then sample size was proportionally allocated to each selected kebele. Households were selected using a systematic random sampling technique. A semi-structured questionnaire was used to collect data on socio-demographic and economic characteristics, reproductive history, and factors influencing for contraceptive use. Data were analyzed using SPSS version 20 software and logistic regression methods. Statistical significance was declared at p-value of less than 0.05. Results: Of the 1,978 respondents, only 149 (7.5%) had ever used modern contraceptives and 107 (5.4%) were current users. The ability to read and write (AOR = 2.4; 95% CI: 1.5-4.1), household asset availability (AOR = 7.9; 95% CI: 3.7-17.0), being the only wife of a husband (AOR = 1.65; 95% CI: 1.1-2.6) and number of children wanted (AOR = 1.1; 95% CI: 1.1-1.2) were significantly associated with current use of contraceptive methods. Conclusions: The proportions of current and ever use for contraceptives are low. Women’s educational attainment may able to give opportunity to read about contraceptive use, and it increased possibility of contraceptive use. Women in polygamies marriage are less likely to use contraceptive, which may imply possible computation of wives to bear more children. Interventions aim to send girls for schools and adult women’s learning may have promising power to contraceptive use. [Ethiop. J. Health Dev. 2018;32(Special Issue):28-33] Key words: Family planning, pastoralist community, Afar region, contraceptive use

Best practices for addressing socio-cultural barriers to reproductive, maternal and neonatal health service utilization among women from pastoralist communities of Afar, Ethiopia:

Abstract: Background: Over the past decade, Ethiopia has shown impressive gains in improving access to reproductive, maternal and neonatal health services for its citizens, Nevertheless, there are striking disparities in the provision of good-quality reproductive, maternal and neonatal health services and the use of such services between regional states. In Afar region, which is home to numerous pastoralist communities, the uptake of reproductive, maternal and neonatal health services is particularly poor, largely due to socio-cultural barriers. However, there is limited scientific and context specific evidence on the best practices that could address the soico-cultural barriers to the uptake of such services in these pastoralist communities. Objective: To describe best practices to address the socio-cultural barrier to the uptake of reproductive, maternal and neonatal health services in the pastoralist communities of Afar, Ethiopia. Methods: This study used a qualitative approach with 12 respondents from Zone 1 of Afar region. Purposive sampling was used to recruit 12 health care providers to participate in the in-depth interviews, which were held between March and June 2016. All interviews were audio recorded and transcribed in English. Categories and codes were weighted for their significance to the research question and recurrence in the interviews. The transcripts were exported to ATLAS7.5.13 software for analysis. Recurring themes were described with accompanying explanatory quotes. Results: The best practices to address the prevailing socio-cultural barriers limiting the uptake of reproductive, maternal and neonatal health services in the Afar setting were identified as strengthening the traditional governance structure; forming volunteer groups and committees; constructive engagement of traditional birth attendants; promoting male involvement in reproductive, maternal and neonatal health services; engaging religious and clan leaders, and influential figures; making maternity waiting homes more culturally acceptable; improving postnatal care; promoting family planning; deploying mobile health teams and clinics; promoting community settlement; and setting priorities. Conclusions: Redirecting public resources to implement the best practices for an improved uptake of reproductive, maternal and neonatal health services needs to be considered in the context of ‘development first’, where women, education and infrastructural development are given priorities. Failing to appreciate the ‘development first’ approach will continue to perpetuate the low uptake of reproductive, maternal and neonatal health services and further widen the health disparities between the agrarian and pastoralist communities in Ethiopia. . [Ethiop. J. Health Dev. 2018;32(Special Issue):4-12] Key words: Afar, best practice, Ethiopia, maternal, neonatal, reproductive

The Levels of utilization of reproductive, maternal and neonatal health services among women from pastoralist communities in Afar, Ethiopia: across-sectional survey

Abstract: Background: Good-quality reproductive, maternal and neonatal health services, as well as their uptake, are key to preventing complications during pregnancy, in childbirth, and after a child is born. However, the uptake of reproductive, maternal and neonatal health services in the Afar region of Ethiopia is low. Objective: The aim of this study to assess the extent to which reproductive, maternal and neonatal services are used by Afar women in pastoralist communities in Ethiopia, and to examine the reasons for the low uptake of these services. Methods: A community-based cross-sectional study was conducted among 1,978 mothers with children up to the age of 24 months. Multistage sampling was employed to recruit the study participants. Multivariate logistic regression analysis was used to identify the effect of independent predictors on the utilization of reproductive, maternal and neonatal health services. Results: The number of women who had four or more antenatal care visits, who had institutional deliveries, who had postnatal visits within seven days of giving birth, and who currently use family planning was 443(22.4%), 322(16.7%), 61(3.1%) and 107(5.4%), respectively. About one third of the women, 686 (34.7%),made good use of reproductive, maternal and neonatal health services. The incidence of using reproductive, maternal and neonatal health services was 2.8 times (AOR = 2.8; 95%CI: 2.0, 3.9) higher among educated women. Women with non-pastoralist husbands and women who could walk from their homes to the health facility within 30 minutes were 2.1 times (AOR = 2.1; 95% CI: 1.6, 2.9) and 2.6 times (AOR = 2.6; 95% CI: 2.1, 3.3), respectively, more likely to use the services than their counterparts. Conclusions: The overall use of reproductive, maternal and neonatal health services was low. Lack of awareness about the importance of using reproductive, maternal and neonatal health services was deeply rooted in the study participants and largely accounts for the low coverage. Reproductive, maternal and neonatal health utilization was not uniform across all zones of the region, and varied depending on the educational status of women, husband’s occupation and distance from the health facility. To increase the use of reproductive, maternal and neonatal health services, suggested measures include empowering women, sharing good experience and devising context-based community-based intervention. [Ethiop. J. Health Dev.2018;32(Special Issue):34-42] Keywords: Reproductive, maternal and neonatal health, pastoralist, Afar, Ethiopia

Factors associated with contraceptive use among young women in Malawi: analysis of the 2015-16 Malawi demographic and health survey data.

Abstract: Although Malawi is one of the countries with highest Contraceptive Prevalence Rate (CPR) in Sub–Saharan Africa, pregnancies and fertility among young women remain high. This suggests low up take of contraceptives by young women. The aim of this study was to investigate the factors associated with contraceptive use among young women in Malawi. This is a secondary analysis of household data for 10,422 young women aged 15–24 years collected during the 2015–16 Malawi Demographic and Health Survey (MDHS). The sample was weighted to ensure representativeness. Descriptive statistics, bivariate and multivariate logistic regressions were performed to assess the demographic, social – economic and other factors that influence contraceptive use among young women. Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) with their corresponding 95% confidence intervals (95% CI) were computed using the Statistical Package for the Social Sciences version 22.0. Of the 10,422 young women, 3219 used contraception representing a prevalence of 30.9%. The findings indicate that age, region of residence, marital status, education, religion, work status, a visit to health facility, and knowledge of the ovulatory cycle are significant predictors of contraceptive use among young women in Malawi. Women who were in the age group 20–24 years (AOR = 1.93; 95% CI = 1.73–2.16), working (AOR = 1.26; 95% CI = 1.14–1.39), currently married (AOR = 6.26; 95% CI = 5.46–7.18), knowledgeable about their ovulatory cycle (AOR = 1.75; 95% CI = 1.50–2.05), and those with primary education (AOR = 1.47; 95% CI = 1.18–1.83) were more likely to use contraceptives than their counterparts. This study has demonstrated that several social demographic and economic factors are associated with contraceptive use among young women in Malawi. These findings should be considered and reflected in public health policies to address issues that could be barriers to the use of contraception by young women. Strengthening access to family planning information and services for young women is highly recommended to reduce pregnancies among young women in Malawi.

Use of traditional and modern contraceptives among childbearing women: findings from a mixed methods study in two southwestern Nigerian states.

Abstract: Contraceptive use has numerous health benefits such as preventing unplanned pregnancies, ensuring optimum spacing between births, reducing maternal and child mortality, and improving the lives of women and children in general. This study examines the level of contraceptive use, its determinants, reasons for non-use of contraception among women in the reproductive age group (18–49 years) in two southwestern Nigerian states. The study adopted an interviewer-administered questionnaire to collect data from 809 participants selected using a 3-stage cluster random sampling technique. We also conducted 46 in-depth interviews. In order to investigate the association between the socio-demographic variables and use of contraceptive methods, we estimated the binary logistic regression models. The findings indicated that knowledge of any methods of contraception was almost universal among the participants. The rates of ever use and current use of contraception was 80 and 66.6%, respectively. However, only 43.9% of the participants had ever used any modern contraceptive methods, considered to be more reliable. The fear of side effects of modern contraceptive methods drove women to rely on less effective traditional methods (withdrawal and rhythm methods). Some women employed crude and unproven contraceptive methods to prevent pregnancies. Our findings show that the rate of contraceptive use was high in the study setting. However, many women chose less effective traditional contraceptive methods over more effective modern contraceptive methods due to fear of side effects of the latter. Patient education on the various options of modern contraceptives, their side effects and management would be crucial towards expanding the family planning services in the study setting.

Intersections of girl child marriage and family planning beliefs and use: qualitative findings from Ethiopia and India

Abstract: Child marriage and subsequent early first birth is a considerable social, economic and health concern, and a pervasive practice in sub-Saharan Africa and South Asia. This study explores barriers and facilitators to family planning among women and girls, and their marital decision-makers subsequent to receipt of child marriage prevention programmes in Ethiopia and India. In-depth interviews with 128 women and girls who were married as minors or who cancelled or postponed marriage as minors and their marital decision-makers were analysed using content analysis. Respondents identified social norms, including child marriage and pressure to have children, and lack of information as barriers to family planning. Benefits included delayed first birth and increased birth spacing, improved maternal and child health and girls' educational attainment. Respondents associated family planning use with delayed pregnancy and increased educational attainment, particularly in Ethiopia. Child marriage prevention programmes were identified as important sources of family planning information. Ethiopia's school-based programme strengthened access to health workers and contraception more so than India's community-based programme. Findings highlight young wives' vulnerability with regard to reproductive control, and support the need for multi-sector approaches across communities, schools and community health workers to improve family planning among young wives.

Trends in contraceptive use, unmet need and associated factors of modern contraceptive use among urban adolescents and young women in Guinea

Abstract: In Guinea, high fertility among adolescents and young women in urban areas remains a public health concern. This study describes trends in contraceptive use, unmet need, and factors associated with the use of modern family planning (FP) methods among urban adolescents and young women in Guinea. We used four Guinea Demographic and Health Surveys (DHS) conducted in 1999, 2005, 2012, and 2018. Among urban adolescents and young women (15–24 years), we examined trends over time in three key indicators: 1. Modern Contraceptive use, 2. Unmet need for FP and 3. Modern contraceptive use among those in need of FP (demand satisfied). We used multivariable logistic regression to examine association between socio-demographic factors and modern FP use on the most recent DHS dataset (2018). We found statistically significant changes over the time period examined with an increase in modern contraceptive use (8.4% in 1999, 12.8% in 2018, p < 0.01) and demand satisfied (29.0% in 1999, 54.1% in 2018, p < 0.001), and a decrease in unmet need for FP (15.8% in 1999, 8.6% in 2018, p < 0.001). Factors significantly associated with modern FP use were; young women aged 20–24 years (AOR 2.8, 95% CI: 1.9–4.1), living in urban areas of Faranah (AOR: 2.6, 95% CI: 1.1–6.5) and Kankan (AOR: 3.6, 95% CI: 1.7–7.8), living in households in the middle (AOR: 7.7, 95% CI: 1.4–42.2) and richer wealth quintiles (AOR: 6.3, 95% CI: 1.0–38.1). Ever-married women (AOR: 0.5, 95% CI: 0.3–0.9) were less likely to use modern FP methods than never married as were those from the Peulh (0.3, 95% CI: 0.2–0.4) and Malinke (0.5, 95% CI: 0.3–0.8) ethnic groups compared to Soussou ethnic group. Despite some progress, efforts are still needed to improve FP method use among urban adolescent and young women. Age, administrative region, wealth index, marital status, and ethnic group are significantly associated with modern FP use. Future policies and interventions should place emphasis on improving adolescents’ reproductive health knowledge, increasing FP availability and strengthening provision. Efforts should target adolescents aged 15–19 years in particular, and address disparities between administrative regions and ethnic groups, and health-related inequalities.