Achieving reductions in the unmet need for contraception with postpartum family planning counselling in Ethiopia, 2019-2020: a national longitudinal study.

BACKGROUND: An unmet need for contraception is associated with unintended pregnancy and adverse maternal and childhood outcomes. Family planning counselling is linked with reduced unmet need for contraception. However, evidence is lacking in Ethiopia on the impact of integrated family planning counselling on the unmet need for contraception. This study aimed to examine the association between family planning counselling and the unmet need for contraception in Ethiopia. METHODS: We used community-based prospective cohort study data from a nationally representative survey conducted by Performance Monitoring for Action Ethiopia between 2019 and 2020. Women who had received three maternal and child health (MCH) services (n = 769) - antenatal care (ANC), facility delivery and child immunisation - were included in this study. The primary exposure variable was family planning counselling provided during the different MCH services. A weighted modified Poisson regression model was used to estimate the adjusted relative risk (aRR) of the unmet need for contraception. RESULTS: The prevalence of family planning counselling during ANC, prior to discharge, and child immunisation was 22%, 28%, and 28%, respectively. Approximately one-third (34%) of the women had an unmet need for contraception. Family planning counselling prior to discharge from the facility was associated with reductions in the unmet need for contraception (aRR 0.88; 95% CI 0.67, 1.16). The risk of unmet need for contraception was 31% (aRR 0.69; 95% CI 0.48, 0.98) less likely among women who had received family planning counselling during child immunisation services. However, family planning counselling during ANC was associated with an increased unmet need for contraception (aRR 1.24; 95% CI 0.93, 1.64). CONCLUSION: Strongest evidence was observed for moderate associations between reductions in the unmet need for contraception and family planning counselling during the provision of child immunisation services in Ethiopia.

Assessing the association between an early and recommended number of focused antenatal care visits and the number of prenatal care content received before delivery in Ethiopia.

BACKGROUND: Early and frequent antenatal care (ANC) has been linked to better pregnancy outcomes. This study assessed whether having at least four ANC contacts was associated with increased prenatal care content if the first visit was started in the first trimester in Ethiopia. METHODS: Data from the 2019 Ethiopia Mini Demographic and Health Survey on 2894 women aged 15-49 who received ANC during their last pregnancy were analyzed. The sum of women's responses to six questions about ANC components (blood pressure taken, urine sample taken, blood sample taken, provided or bought iron tablet, counselling by a health worker on nutrition, and told about pregnancy complications) was used to construct a composite score of routine ANC components. The main predictor was a combination of the timing of the first contact and the number of ANC contacts before birth. RESULTS: We found that 28.7% of women who began ANC early made at least four ANC contacts. More than one-third (36%) received all six components, with blood pressure monitoring being the most common (90.4%). After adjusting for potential confounding factors, women who had at least four contacts and booked early were substantially more likely than their counterparts to get a factor-of-one increase in the number of components received (IRR = 1.08; 95% CI: 1.03, 1.10). CONCLUSION: We found a strong association between increased prenatal care content and early ANC with at least four contacts. However, less than a third of women in the study setting had at least four contacts, with the first occurring in the first trimester. In addition, less than half of women received essential prenatal care interventions before delivery. The findings suggest that the WHO's new guidelines for ANC frequency and timing may be challenging to implement in some countries, such as Ethiopia, that already have low coverage of four or more contacts. If the recommendations are adopted, effective strategies for increasing early starts and increasing contacts are required.

Multilevel analysis of individual and community level factors associated with the application of cow dung and oil on the umbilical cord stump in Ethiopia.

Background: Hygienic umbilical cord care is one of the essential interventions advocated to reduce neonatal mortality. However, traditional cord care measures-applying cow dung and oil-that have harmful health consequences are commonly practiced in Ethiopia. Hence, in this study, it was planned to analyze individual and community-level factors associated with the application of cow dung and oil on the umbilical cord stump in Ethiopia. Methods: Data from the 2016 Ethiopian demographic and health survey were used to identify individual and community level factors associated with women's practice of applying cow dung and oil on the umbilical cord stump of their neonate. Taking into account for the hierarchical structure of the data; multilevel binary logistic regression analysis has been employed to a nationally representative weighted sample of 7,168 women. Results: In Ethiopia, 780 (10.88%) with 95% CI (10.18-11.62) women apply oil and/or cow dung on the neonate's umbilical cord stump. Age increase by one year [AOR = 0.97; 95% CI (0.94-0.99)] and giving birth in a health facility [AOR = 0.61; 95% CI (0.42-0.89)] were individual-level factors that reduced women's practice of applying cow dung and oil on the umbilical cord stump of their neonate. Whereas, rural residence [AOR = 2.54; 95% CI (1.28-5.06)] was the predictor at the community level that raised the practice of applying cow dung and oil on the neonate's umbilical cord stump. Conclusion: This nationwide study revealed that a significant number of mothers in Ethiopia still apply cow dung and/or oil on the umbilical cord stump of their neonates. Both the individual and community level characteristics: maternal age, place of delivery, and residence were found to have significant influence on the practice of applying cow dung and/or oil on the umbilical cord stump in Ethiopia. Thus, to reduce neonatal mortality due to avoidable umbilical cord infections, clean cord care practice strategies should be designed by considering these factors.

Short interpregnancy interval and its predictors in Ethiopia: implications for policy and practice.

Introduction: interpregnancy interval (IPI) is the time elapsed between the birth of one live child and the conception of subsequent pregnancies. Several studies in Ethiopia indicated a high prevalence of a short interbirth interval - a proxy indicator of IPI. However, these studies were prone to selection bias as they did not include women who did not go on to have another pregnancy. Therefore, this study estimated the incidence of short IPI (< 24 months) and its risk factors among women who had at least one child in Ethiopia. Methods: we used a retrospective analysis of a cross-sectional study from the nationally representative Ethiopian Mini Demographic and Health Survey (EMDHS) conducted in 2019. The event was defined as the conception of the subsequent pregnancy within 24 months following the last child. A weighted Cox Proportional Hazard model was used to estimate the adjusted hazard ratios (aHR) and 95% confidence intervals (CIs). Results: the incidence of short IPI was 6%. Rural residence, being young age, low educational attainment, having the last child died and having female last birth were the risk factors for short IPI. However, having higher parity, attending Antenatal Care (ANC) visits, being delivered at a health facility, and receiving Postnatal Care (PNC) visits were the protective factors for short IPI. Conclusion: the incidence of short IPI in Ethiopia was considerable. Sociodemographic and health service-related factors determine the short IPI. Hence, considering the immediate and long-term health and socioeconomic consequences of short IPI, the Ethiopian government should implement holistic and multisectoral interventions.

Interbirth interval and maternal anaemia in 21 sub-Saharan African countries: A fractional-polynomial analysis.

BACKGROUND: Maternal anaemia is a global public health problem contributing to adverse maternal and perinatal outcomes. In addition to other risk factors, interbirth interval has been identified as a potentially modifiable risk factor of maternal anaemia. However, the current evidence for the association between interbirth interval and maternal anaemia remains inconclusive. Hence, this study examined the association between the interbirth interval and maternal anaemia in sub-Saharan Africa. METHODS: We conducted a multinational cross-sectional study of interbirth interval (time between two singleton live births) and maternal anaemia (haemoglobin levels < 12 g/dl for non-pregnant women, < 11 g/dl for pregnant women) for 21 sub-Saharan African countries using the most recent nationally representative Demographic and Health Surveys, 2010-2017. A weighted multivariable fractional polynomial function was used to estimate the non-linear relationship between interbirth interval and maternal anaemia, considering interbirth interval as a continuous variable and adjusting for potential confounders. Analyses were stratified by reproductive classification (non-pregnant and pregnant women). RESULTS: There were 81,693 women included in the study (89.2% non-pregnant, 10.8% pregnant). Of all women, 32.2% were in their postpartum period. Overall, 36.9% of women had anaemia (36.0% of non-pregnant and 44.3% of pregnant women). Of the participants, 15% had a short interbirth interval (<24 months), and 16% had a long interbirth interval (≥ 60 months). We found that both short and longer interbirth intervals were associated with an increased risk of maternal anaemia in a dose-response fashion. Relatively a lower risk of maternal anaemia was observed between 24 and 40 months of interbirth intervals. CONCLUSIONS: Our findings suggest that both short and longer interbirth intervals were associated with an increased risk of maternal anaemia in sub-Saharan Africa.

Trends of and Factors Associated with Maternal Near-Miss in Selected Hospitals in North Shewa Zone, Central Ethiopia.

Maternal near-miss (MNM) refers to a woman who nearly died but survived a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy. Studies in Ethiopia showed an inconsistent proportion of MNM across time and in different setups. This study is aimed at assessing the magnitude, trends, and correlates of MNM at three selected hospitals in North Shewa Zone, Central Ethiopia. A hospital-based cross-sectional study was conducted among 905 mothers who gave birth from 2012 to 2017 in three hospitals using the WHO criteria for MNM. Medical records of the study subjects were selected using a systematic sampling technique. Data were retrieved using a pretested data extraction tool. Association between MNM and independent variables was assessed by using a binary logistic regression model. An odds ratio with a 95% confidence interval (CI) and p value of <0.05 were used to declare the level of significance. Of the 905 medical records reviewed, the prevalence of MNM was 14.3% (95%CI = 11.9 - 16.6) and similar over the last six years (2012-2017). The magnitude of life-threatening pregnancy complications was found to be 12.7%; severe preeclampsia (31%) and postpartum hemorrhage (26%) account for the highest proportion. Admission at a higher level of obstetric care like referral hospital (AOR = 4.85; 95% CI: 1.82-12.94) and general hospital (AOR = 3.76; 95% CI: 1.37-10.33), not using partograph for labor monitoring (AOR = 1.89; 95% CI: 1.17-3.04), history of abortion (AOR = 2.52; 95% CI: 1.18-5.37), and any other pregnancy complications (AOR = 6.91; 95% CI: 3.89-12.28) were factors significantly associated with higher MNM. Even though lower than the national figure, the proportion of MNM in the study area was very high, and there were no significant changes over the last six consecutive years. Giving special emphasis to women with prior history of pregnancy complications, hypertensive disorders of pregnancy, and obstetric hemorrhage with strict and quick management protocols and the use of partograph for labor monitoring are recommended to reduce the burden of severe maternal outcomes in the study area and Ethiopia.

Does family planning counselling during health service contact improve postpartum modern contraceptive uptake in Ethiopia? A nationwide cross-sectional study.

OBJECTIVE: This study examined the association between family planning counselling receipt during the 12 months preceding the survey and postpartum modern contraceptive uptake in Ethiopia. We hypothesised that receiving family planning counselling either within the community setting by a field health worker or at a health facility by a healthcare attendant during the 12 months preceding the survey improves postpartum modern contraceptive uptake. DESIGN: We used a cross-sectional study of the Ethiopian Demographic and Health Survey conducted in 2016. SETTING: Ethiopia. PARTICIPANTS: A total of 1650 women who gave birth during the 12 months and had contact with service delivery points during the 12 months preceding the survey. PRIMARY OUTCOME: A weighted modified Poisson regression model was used to estimate an adjusted relative risk (RR) of postpartum modern contraceptives. RESULTS: Approximately half (48%) of the women have missed the opportunity to receive family planning counselling at the health service contact points during the 12 months preceding the survey. The postpartum modern contraceptive uptake was 27%. Two hundred forty-two (30%) and 204 (24%) of the counselled and not counselled women used postpartum modern contraceptive methods, respectively. Compared with women who did not receive counselling for family planning, women who received counselling had higher contraceptive uptake (RR 1.32, 95% CI 1.04 to 1.67). CONCLUSION: Significant numbers of women have missed the opportunity of receiving family planning counselling during contact with health service delivery points. Modern contraceptive uptake among postpartum women was low in Ethiopia. Despite this, our findings revealed that family planning counselling was associated with improved postpartum modern contraceptive uptake.

The role of family planning counselling during maternal and child health services in postpartum modern contraceptive uptake in Ethiopia: A national longitudinal study.

Family planning counselling can help improve the postpartum modern contraceptive uptake. However, studies in Ethiopia indicate inconsistent effects of integrated family planning counselling on postpartum modern contraceptive uptake. This study aimed to determine the extent of family planning counselling and its role in improving postpartum contraceptive uptake among women in Ethiopia. We used the Performance Monitoring for Action (PMA) Ethiopia panel survey data, a community-based prospective cohort study. Randomly selected pregnant women were recruited at the baseline interview and followed by six weeks and six months postpartum. A weighted generalised linear model fitted with a Poisson distribution and a log link function was used to estimate the adjusted relative risk (aRR) and 95% Confidence Interval (CI) of modern contraceptive uptake. The coverages of family planning counselling provision during ANC, prior to discharge and child immunisation were 20%, 27% and 23%, respectively. The modern contraceptive uptakes by six weeks and six months postpartum were 18% and 36%, respectively. Family planning counselling prior to discharge from the facility was associated with increased modern contraceptive uptake by six weeks (aRR 1.25; 95% CI 0.94, 1.65) and six months postpartum periods (aRR 1.07; 95% CI 0.90, 1.27). Moreover, women who received family planning counselling during child immunisation were 35% more likely to use modern contraceptives by six months postpartum (aRR 1.35;95% CI 1.12, 1.62). However, counselling during ANC visits was not associated with modern contraceptive uptake by either six weeks or six months postpartum. A significant proportion of women had missed the opportunity, and the postpartum modern contraceptive uptake was low. Despite these, family planning counselling prior to discharge from the facility and during child immunisation improved the postpartum modern contraceptive uptake. However, our finding revealed insufficient evidence that family planning counselling during ANC is associated with postpartum modern contraceptive uptake.