Prediction of contraceptive discontinuation among reproductive-age women in Ethiopia using Ethiopian Demographic and Health Survey 2016 Dataset: A Machine Learning Approach.

BACKGROUND: Globally, 38% of contraceptive users discontinue the use of a method within the first twelve months. In Ethiopia, about 35% of contraceptive users also discontinue within twelve months. Discontinuation reduces contraceptive coverage, family planning program effectiveness and contributes to undesired fertility. Hence understanding potential predictors of contraceptive discontinuation is crucial to reducing its undesired outcomes. Predicting the risk of discontinuing contraceptives is also used as an early-warning system to notify family planning programs. Thus, this study could enable to predict and determine the predictors for contraceptive discontinuation in Ethiopia. METHODOLOGY: Secondary data analysis was done on the 2016 Ethiopian Demographic and Health Survey. Eight machine learning algorithms were employed on a total sample of 5885 women and evaluated using performance metrics to predict and identify important predictors of discontinuation through python software. Feature importance method was used to select top predictors of contraceptive discontinuation. Finally, association rule mining was applied to discover the relationship between contraceptive discontinuation and its top predictors by using R statistical software. RESULT: Random forest was the best predictive model with 68% accuracy which identified the top predictors of contraceptive discontinuation. Association rule mining identified women's age, women's education level, family size, husband's desire for children, husband's education level, and women's fertility preference as predictors most frequently associated with contraceptive discontinuation. CONCLUSION: Results have shown that machine learning algorithms can accurately predict the discontinuation status of contraceptives, making them potentially valuable as decision-support tools for the relevant stakeholders. Through association rule mining analysis of a large dataset, our findings also revealed previously unknown patterns and relationships between contraceptive discontinuation and numerous predictors.

Health professionals' knowledge and attitude towards patient confidentiality and associated factors in a resource-limited setting: a cross-sectional study.

BACKGROUND: Respecting patients' confidentiality is an ethical and legal responsibility for health professionals and the cornerstone of care excellence. This study aims to assess health professionals' knowledge, attitudes, and associated factors towards patients' confidentiality in a resource-limited setting. METHODS: Institutional based cross-sectional study was conducted among 423 health professionals. Stratified sampling methods were used to select the participants, and a structured self-administer questionnaire was used for data collection. The data was entered using Epi-data version 4.6 and analyzed using SPSS, version 25. Bi-variable and multivariable binary logistic regression analyses were used to measure the association between the dependent and independent variables. Odds ratio with 95% confidence intervals and P value was calculated to determine the strength of association and to evaluate statistical significance. RESULT: Out of 410 participants, about 59.8% with [95% CI (54.8-68.8%)] and 49.5% with [95% CI (44.5-54.5%)] had good knowledge and favorable attitude towards patents confidentiality respectively. Being male (AOR = 1.63, 95% CI [1.03-2.59]), taking training on medical ethics (AOR = 1.73, 95% CI = [1.11-2.70]), facing ethical dilemmas (AOR = 3.07, 95% CI [1.07-8.79]) were significantly associated factors for health professional knowledge towards patients' confidentiality. Likewise, taking training on medical ethics (AOR = 2.30, 95% CI [1.42-3.72]), having direct contact with the patients (AOR = 3.06, 95% CI [1.12-8.34]), visiting more patient (AOR = 4.38, 95% CI [2.46-7.80]), and facing ethical dilemma (AOR = 3.56, 95% CI [1.23-10.26]) were significant factors associated with attitude of health professionals towards patient confidentiality. CONCLUSION: The findings of this study revealed that health professionals have a limited attitude towards patient confidentiality but have relatively good knowledge. Providing a continuing medical ethics training package for health workers before joining the hospital and in between the working time could be recommended to enhance health professionals' knowledge and attitude towards patient confidentiality.