| 1. |
- Bangoura, Charlotte, et al.
(författare)
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Experiences, Preferences, and Needs of Adolescents and Urban Youth in Contraceptive Use in Conakry, 2019, Guinea
- 2021
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Ingår i: Epidemiologic Methods. - : Frontiers Media S.A.. - 2194-9263 .- 2161-962X. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The use of contraceptive methods is very low in Guinea, particularly among adolescents and young people. The purpose of this study is to analyze the experiences and expectations of adolescents and young people regarding the use of contraceptive methods in 2019 in Conakry, Guinea.Methods: We conducted a 6-month qualitative and descriptive study. Data were collected through individual in-depth interviews and focus group discussions with adolescents and young people, health providers and health policy makers. Two approaches of deductive and inductive analysis were used to synthesize the main insights from the data.Findings: Twenty-six participants were included in this study. Adolescents and young people have personal, family and community experiences that positively or negatively influence their contraceptive needs and preferences. Positive experiences include the relative cost of injectable forms, perceived absence of side effects of implants, proven efficacy and duration of action of the modern method used (implants and injectable form). Negative experiences included cost of implants remain high (15 Euros), perceived side effects including weight gain, pill compliance, method indiscretion, and low sensation of sexual pleasure for the condom. The preferences of the young participants were dominated by Implants and injectable forms that better meet their contraceptive needs. In terms of needs, the expectations expressed revolved around needs related to the health system, including sex education, reduction in the cost of some contraceptives (implants), availability of contraceptive methods, and equity in the provision of family planning services to adolescents and young people.Conclusion: Exploring the contraceptive experiences, needs and preferences of adolescents and young people reveals decision-making dilemmas. Adolescents and young people expressed their experiences in terms of the cost of preferred contraceptives (implants), side effects, proven efficacy, and duration of action. However, their decisions are still influenced by availability, equity in service delivery, and the involvement of parents and religious leaders in sex education. Decision-makers should then place particular emphasis on improving health service delivery, adolescent sexual and reproductive health, availability of preferred contraceptive methods at affordable cost, and a program on sexuality education with the involvement of parents and religious leaders and the promotion of condom use.
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| 2. |
- Birabwa, Catherine, et al.
(författare)
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Knowledge and information exposure about family planning among women of reproductive age in informal settlements of Kira municipality, Wakiso district, Uganda
- 2021
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Ingår i: Epidemiologic Methods. - : Frontiers Media S.A.. - 2194-9263 .- 2161-962X. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: A high unmet need for family planning (FP) prevails in sub-Saharan Africa. Knowledge, awareness creation, and ensuring accessibility are frequently used to increase FP uptake. However, evidence on knowledge or information dissemination about FP among marginalized populations in urban settings in Africa is limited. This study explored the knowledge of FP methods, media exposure, and contact with FP providers among women from an informal settlement in Uganda.Methods: Using a cross-sectional study design, we interviewed 626 women aged 15–49 years living in informal settlements of Kira municipality, selected through multistage sampling. Using a standard questionnaire, data was collected on socioeconomic characteristics, knowledge of FP methods, and access to media FP messages among others. Binomial log-linear regression was used to assess disparities in exposure to media FP messages or provider information. Data were analyzed using STATA version 14, at a 5% level of statistical significance.Results: Nearly all women in the survey were aware of FP methods (99.7%). On average, each woman was aware of 10 FP methods. The most commonly known methods were male condoms (98.2%), injectables (97.4%), and the oral contraceptive pill (95.2%). Use of any contraceptive was found among 42.7% of respondents. Exposure to media was found in 70.6% of the respondents, mostly through television (58.5%) and radio (58.3%). Discussing FP with a provider was significantly associated with media exposure (aPR 1.4, 95% CI: 1.24–1.56). Less than 50% of women who were not using FP had contact with an FP provider. Women in union (aPR 1.6, 95% CI: 1.01–2.68) and those with access to media messages (aPR 2.5, 95% CI: 1.37–4.54) were more likely to have contact with a provider to discuss FP.Conclusion: There is high general awareness about FP methods and media exposure, but method use was low. Further exploration of women's understanding of FP methods and the fit between existing education programs and FP knowledge needs in this urban setting should be conducted. The potential for mobile health solutions in this urban population should be explored. Future studies should focus on the knowledge and understanding of FP among unmarried and nulliparous women and those with no access to media information.
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| 3. |
- Lukyamuzi, Zubair, et al.
(författare)
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Quality of care in family planning services : differences between formal and informal settlements of Kira municipality, Uganda
- 2021
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Ingår i: Epidemiologic Methods. - : Frontiers Media S.A.. - 2194-9263 .- 2161-962X. ; 2
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Tidskriftsartikel (refereegranskat)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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| 4. |
- Mulubwa, Chama, et al.
(författare)
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Framing contraceptive use motivations among adolescents and young adults living in informal settlements in Kira municipality, Wakiso district, Uganda
- 2021
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Ingår i: Epidemiologic Methods. - : Frontiers Media S.A.. - 2194-9263 .- 2161-962X. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The use of contraceptives among adolescents and young adults is one of the most cost-effective strategies to address many sexual and reproductive health (SRH) challenges, including unintended pregnancies, early marriages, and sexually transmitted infections. Despite a high burden of SRH challenges, uptake and unmet needs of modern contraceptives remain low in Uganda, especially among adolescents and young adults in informal settlement settings. This study aimed to explore the motivations of adolescents and young people to use modern contraceptives (or not).Methods: We analysed qualitative data from eight focus group discussions with 88 adolescents and young people aged 18-24 years residing in informal settlements of urban communities in Kira Municipality of Wakiso district, Uganda.Results: Motivations for use (or not) of modern contraceptives were framed by two interrelated constructs, sources of information on contraception and the unacceptable use of contraceptives among adolescents widespread in the community. These two, in turn, formed the scope of knowledge upon which adolescents and young people based their decision on whether or not to access and use modern contraceptives.Conclusion: To be more effective, sexual and reproductive health programs and interventions that aim to motivate the use of modern contraceptives among adolescents and young people in informal settings should be more comprehensive and focused on alleviating individual, health systems, social, religious factors that reinforce negative health-seeking behaviours towards contraceptive use. In addition, there is a need to support adolescents and young people with socio-economic empowering strategies that equip them with sufficient resources to choose contraceptives of their choice.
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| 5. |
- Tetui, Moses, et al.
(författare)
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Geospatial distribution of family planning services in Kira Municipality, Wakiso District, Uganda
- 2020
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Ingår i: Epidemiologic Methods. - : Frontiers Media S.A.. - 2194-9263 .- 2161-962X. ; 1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Access to family planning (FP) services remains a challenge, particularly in informal urban settlements. The unmet need for FP in these settings is high, with a correspondingly high prevalence of unintended pregnancies that may lead to unsafe abortions. However, there is a paucity of quality data on the distribution of FP services in such settings in Uganda. This paper described the geospatial distribution of FP services in Kira Municipality, Wakiso District, Uganda.Methods: This was a cross-sectional study in which we determined the availability and distribution of FP services in Kira Municipality. Community mapping and analysis were conducted using ArcGIS (version 10.1) and ArcGIS Online. Stata version 13.1 was used for data analysis. Chi-square test was used to compare the contraceptive provision and availability among facilities from informal and formal settlements.Results: Of the 176 healthcare facilities surveyed, only 42% (n = 74) offered contraceptives in informal settlements. The majority of the facilities were privately owned small clinics (95%). At least 80% of the facilities provided three or more modern contraceptive methods, with no difference (p = 0.107) between facilities in informal and formal settlements. Only 30.7% (p = 0.001) of the facilities provided at least one long-acting contraceptive. Similarly, 20 and 12% (p = 0.001) of the facilities had implants and intrauterine devices (IUDs) on the day of the survey. Almost 25% of the facilities did not offer contraceptive services (counseling and commodities) to unmarried adolescents.Conclusions: Most facilities were small privately-owned clinics, offering at least three modern contraceptive methods. The unavailability of long-acting reversible methods in the informal settings may affect the quality of FP services due to limited choice. The inequity in service provision that disfavors the unmarried adolescent may increase unwanted/unintended pregnancies. We recommend that local governments and partners work toward filling the existing commodities gap and addressing the discrimination against unmarried adolescents in such settings.
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| 6. |
- Tetui, Moses, et al.
(författare)
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Total Demand, Use and Unmet Need for Modern Contraceptives Among Women Living in Informal Settlements in Kira Municipality, Wakiso District, Uganda : Implications for Urban Health
- 2021
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Ingår i: Epidemiologic Methods. - : Frontiers Media SA. - 2194-9263 .- 2161-962X. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Update and utilization of modern contraceptives has public health benefits including reduction of unintended pregnancies, unsafe abortions, and related maternal mortality. However, paucity of evidence on key indicators of family planning in the informal settlements abounds. Data are usually collapsed within the larger urban communities that tend to mask peculiarities of informal settlements. This study determined the proportion of women using modern contraceptives, the unmet need for modern contraceptives and the total demand in informal settlements of an urban municipality.Methods: A cross-sectional study conducted among 626 women in the reproductive age (15–49 years) in the informal settlements of Kira municipality (part of metropolitan Kampala). Multi-stage sampling was applied in the selection of the respondents. Descriptive and log-binomial regression analysis were conducted to determine percentage of women using modern contraceptives, unmet need, and total demand with their associated factors. All analyses were conducted using STATA version 15.0.Results: The total demand for modern contraceptives was 84.9%, modern contraceptive prevalence was 47.4% nearly meeting the national target of 50%, however the unmet need was 37.3%, which much higher than the national target of 10%. Lower total demand for contraceptives was associated with higher women’s education status and preference to have another child, while higher total demand was associated with having at least one living child. Higher modern contraceptives use was associated with older age, having at least one living child and high decision-making power, while lower modern contraceptives use was associated with higher education and undetermined fertility preference. Lower unmet need for modern contraceptives was associated with older age (PR 0.68, 95% CI: 0.48–0.97) and high decision-making power (PR 0.64, 95% CI: 0.50–0.81), while higher unmet need was found among those who having at least one living child (PR 1.40, 95% CI: 1.01–1.93) and undetermined fertility preference (PR 1.70, 95% CI: 1.24–2.34).Conclusions: Total demand and contraceptive use were found to be higher in the informal settlements of Kira municipality, however, the unmet need was much higher among this population as compared to the national urban estimates. This indicates a much higher demand for contraceptives and the need to consider the diverse socio-demographic characteristics of urban spaces. Development of Interventions need to critically consider the diverse urban space, associated explanatory variables and a collaborative systems lens to achieve sustained improvements.
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| 7. |
- Wemrell, Maria, et al.
(författare)
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Attitudes Toward the Copper IUD in Sweden : A Survey Study
- 2022
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Ingår i: Epidemiologic Methods. - : Frontiers Media S.A.. - 2194-9263 .- 2161-962X. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Background: While the efficacy and safety of the contraceptive copper intrauterine device (IUD) have been affirmed, alongside its importance for the prevention of unintended pregnancies, some studies have pointed to negative attitudes toward the device. In recent years, social media communication about it has included claims about systemic side effects, unsubstantiated by medical authorities. Research from the Swedish context is sparse. This study investigates attitudes toward the copper IUD and any correlations between negative attitudes toward or experiences of the device, and (1) sociodemographic characteristics, (2) the evaluation of the reliability of different sources of information, and (3) trust in healthcare and other societal institutions.Methods: A survey was distributed online to adult women in Sweden (n = 2,000). Aside from descriptive statistics, associations between negative attitudes toward or experiences of the copper IUD and sociodemographic and other variables werec alculated using logistic regressions and expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs). Open survey responses (n = 650) were analyzed thematically.Results: While many reported positive attitudes toward and experiences of the IUD, 34.7% of all respondents reported negative attitudes and 45.4% of users reported negative experiences. Negative attitudes were strongly correlated with negative experiences. Negative attitudes and experiences were associated with low income, but no conclusive associations were identified with other socioeconomic variables. Negative attitudes and experiences were associated with lower levels of confidence in and satisfaction with healthcare, as well as lower self-assessed access and ability to assess the origin and reliability of information about the IUD. In open responses, negative comments were prevalent and included references to both common and unestablished perceived side-effects. Respondents pointed to problematic aspects of information and knowledge about the copper IUD and called for improved healthcare communication and updated research.Conclusion: Healthcare provider communication about the copper IUD should promote reproductive autonomy and trust by providing clear information about potential side effects and being open to discuss women’s experiences and concerns. Further research on copper IUD dissatisfaction and ways in which health professionals do and may best respond to it is needed.
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| 8. |
- Zetterstrom, Stina, 1994-
(författare)
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Bounds for selection bias using outcome probabilities
- 2024
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Ingår i: Epidemiologic Methods. - : Walter de Gruyter. - 2194-9263 .- 2161-962X. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Determining the causal relationship between exposure and outcome is the goal of many observational studies. However, selection of subjects into the study population, either voluntary or involuntary, may result in estimates that suffer from selection bias. To assess the robustness of the estimates as well as the magnitude of the bias, bounds for the bias can be calculated. Previous bounds for selection bias often require the specification of unknown relative risks, which might be difficult to provide. Here, alternative bounds based on observed data and unknown outcome probabilities are proposed. These unknown probabilities may be easier to specify than unknown relative risks.Methods: I derive alternative bounds from the definitions of the causal estimands using the potential outcomes framework, under specific assumptions. The bounds are expressed using observed data and unobserved outcome probabilities. The bounds are compared to previously reported bounds in a simulation study. Furthermore, a study of perinatal risk factors for type 1 diabetes is provided as a motivating example.Results: I show that the proposed bounds are often informative when the exposure and outcome are sufficiently common, especially for the risk difference in the total population. It is also noted that the proposed bounds can be uninformative when the exposure and outcome are rare. Furthermore, it is noted that previously proposed assumption-free bounds are special cases of the new bounds when the sensitivity parameters are set to their most conservative values.Conclusions: Depending on the data generating process and causal estimand of interest, the proposed bounds can be tighter or wider than the reference bounds. Importantly, in cases with sufficiently common outcome and exposure, the proposed bounds are often informative, especially for the risk difference in the total population. It is also noted that, in some cases, the new bounds can be wider than the reference bounds. However, the proposed bounds based on unobserved probabilities may in some cases be easier to specify than the reference bounds based on unknown relative risks.
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| 9. |
- Zetterstrom, Stina, 1994-, et al.
(författare)
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Selection bias and multiple inclusion criteria in observational studies
- 2022
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Ingår i: Epidemiologic Methods. - : Walter de Gruyter. - 2194-9263 .- 2161-962X. ; 11:1, s. 1-21
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Spurious associations between an exposure and outcome not describing the causal estimand of interest can be the result of selection of the study population. Recently, sensitivity parameters and bounds have been proposed for selection bias, along the lines of sensitivity analysis previously proposed for bias due to unmeasured confounding. The basis for the bounds is that the researcher specifies values for sensitivity parameters describing associations under additional identifying assumptions. The sensitivity parameters describe aspects of the joint distribution of the outcome, the selection and a vector of unmeasured variables, for each treatment group respectively. In practice, selection of a study population is often made on the basis of several selection criteria, thereby affecting the proposed bounds.Methods: We extend the previously proposed bounds to give additional guidance for practitioners to construct i) the sensitivity parameters for multiple selection variables and ii) an alternative assumption free bound, producing only logically feasible values. As a motivating example we derive the bounds for causal estimands in a study of perinatal risk factors for childhood onset Type 1 Diabetes Mellitus where selection of the study population was made by multiple inclusion criteria. To give further guidance for practitioners, we provide a data learner in R where both the sensitivity parameters and the assumption-free bounds are implemented.Results: The assumption-free bounds can be both smaller and larger than the previously proposed bounds and can serve as an indicator of settings when the former bounds do not produce feasible values. The motivating example shows that the assumption-free bounds may not be appropriate when the outcome or treatment is rare.Conclusions: Bounds can provide guidance in a sensitivity analysis to assess the magnitude of selection bias. Additional knowledge is used to produce values for sensitivity parameters under multiple selection criteria. The computation of values for the sensitivity parameters are complicated by the multiple inclusion/exclusion criteria, and a data learner in R is provided for their construction. For comparison and assessment of the feasibility of the bound an assumption free bound is provided using solely underlying assumptions in the framework of potential outcomes.
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