15 research outputs found

    UNDER-5 MORTALITY ESTIMATION IN HUMANITARIAN EMERGENCIES: A COMPARISON OF ESTIMATION METHODOLOGIES USING MICROSIMULATION

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    Complex humanitarian emergencies are characterized by increases in mortality, mass migration, and collapse of infrastructure. Demographic estimation on under-5 mortality in these settings is generally conducted using household surveys. Indirect methods of estimation, collected using summary birth histories, have clear advantages over complete birth histories, as they are faster and require less training to implement. It is unclear, however, how well the analytic techniques developed for summary birth histories perform when mortality patterns fluctuate. Using the Socsim simulation program, one baseline and four emergency scenarios were developed and each was simulated 100 times. Two methods of indirect estimation for child mortality - the Brass methodology and the IHME methodology - and the direct method of under-5 mortality estimation were applied to assess how quickly each method was able to detect rapid changes in mortality, how well the method was able to estimate the underlying level of mortality, and for how long after the crisis period ended the method was affected by the increase in mortality. In general, none of the indirect methods performed well. The Brass method, though able to detect abrupt changes in mortality is inadequate because of its reliance on a reference period. The IHME methods, though able to estimate mortality for the survey year, were generally not able to accurately estimate the level of mortality change in situations with extreme changes. In situations of fluctuating mortality, all indirect methods smoothed fluctuations, eliminating the ability to estimate excess deaths due to conflict. Although more time-consuming, if under-5 mortality is of primary interest, complete birth histories and direct estimation should be used

    Missed opportunities for family planning counselling among postpartum women in eleven counties in Kenya

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    Background: Mothers may access medical facilities for their babies and miss opportunities to access family planning (FP) services. This study was undertaken to describe missed opportunities for FP among women within the extended (0–11months) postpartum period from counties participating in Performance Monitoring and Accountability 2020 (PMA2020) surveys. Design and setting: This study analysed cross-sectional household survey data from 11 counties in Kenya between 2014 and 2018. PMA2020 uses questions extracted from the Demographic and Health survey (DHS) and DHS defnitions were used. Multivariable logistic regression was used for inferential statistics with p-value of \u3c0.05 considered to be signifcant. Participants: Women aged 15-49 years from the households visited. Primary outcome measure: Missed opportunity for family planning/contraceptives (FP/C) counselling. Results: Of the 34,832 women aged 15-49 years interviewed, 10.9% (3803) and 10.8% (3746) were in the period 0–11months and 12–23months postpartum respectively, of whom, 38.8 and 39.6% respectively had their previous pregnancy unintended. Overall, 50.4% of women 0-23months postpartum had missed opportunities for FP/C counselling. Among women who had contact with health care at the facility, 39.2% of women 0-11months and 44.7% of women 12-23months had missed opportunities for FP/C counselling. Less than half of the women 0-11months postpartum (46.5%) and 64.5% of women 12 – 23months postpartum were using highly efcacious methods. About 27 and 18% of the women 0-11months and 12 – 23months postpartum respectively had unmet need for FP/C. Multivariable analysis showed that being low parity and being from the low wealth quintile signifcantly increased the odds of missed opportunities for FP/C counselling among women in the extended postpartum period, p\u3c0.05. Conclusions: A large proportion of women have missed opportunities for FP/C counselling within 2 years postpartum. Programs should address these missed opportunities

    UNDER-5 MORTALITY ESTIMATION IN HUMANITARIAN EMERGENCIES: A COMPARISON OF ESTIMATION METHODOLOGIES USING MICROSIMULATION

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    Complex humanitarian emergencies are characterized by increases in mortality, mass migration, and collapse of infrastructure. Demographic estimation on under-5 mortality in these settings is generally conducted using household surveys. Indirect methods of estimation, collected using summary birth histories, have clear advantages over complete birth histories, as they are faster and require less training to implement. It is unclear, however, how well the analytic techniques developed for summary birth histories perform when mortality patterns fluctuate. Using the Socsim simulation program, one baseline and four emergency scenarios were developed and each was simulated 100 times. Two methods of indirect estimation for child mortality - the Brass methodology and the IHME methodology - and the direct method of under-5 mortality estimation were applied to assess how quickly each method was able to detect rapid changes in mortality, how well the method was able to estimate the underlying level of mortality, and for how long after the crisis period ended the method was affected by the increase in mortality. In general, none of the indirect methods performed well. The Brass method, though able to detect abrupt changes in mortality is inadequate because of its reliance on a reference period. The IHME methods, though able to estimate mortality for the survey year, were generally not able to accurately estimate the level of mortality change in situations with extreme changes. In situations of fluctuating mortality, all indirect methods smoothed fluctuations, eliminating the ability to estimate excess deaths due to conflict. Although more time-consuming, if under-5 mortality is of primary interest, complete birth histories and direct estimation should be used

    Evaluation of the London Measure of Unplanned Pregnancy (LMUP) among a nationally representative sample of pregnant and postpartum women Ethiopia

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    Objectives: Rigorous measurement of pregnancy preferences is needed to address reproductive health needs. The London Measure of Unplanned Pregnancy (LMUP), developed in the UK, has been adapted for low-income countries. Psychometric properties of LMUP items remain uncertain in contexts with limited access to and use of health services. Study design: This cross-sectional study examines the six-item LMUP’s psychometric properties among a nationally representative sample of 2855 pregnant and postpartum women in Ethiopia. Principal components analysis (PCA) and confirmatory factor analysis (CFA) estimated psychometric properties. Hypothesis testing examined associations between the LMUP and other measurement approaches of pregnancy preferences using descriptive statistics and linear regression. Results: The six-item LMUP had acceptable reliability (α = 0.77); two behavioral items (contraception, preconception care) were poorly correlated with the total scale. A four-item measure demonstrated higher reliability (α = 0.90). Construct validity via PCA and CFA indicated the four-item LMUP’s unidimensionality and good model fit; all hypotheses related to the four-item LMUP and other measurement approaches were met. Conclusions: Measurement of women’s pregnancy planning in Ethiopia may be improved through use of a four-item version of the LMUP scale. This measurement approach can inform family planning services to better align with women’s reproductive goals. Implications: Improved pregnancy preference measures are needed to understand reproductive health needs. A four-item version of the LMUP is highly reliable in Ethiopia, offering a robust and concise metric for assessing women’s orientations toward a current or recent pregnancy and tailoring care to support them in achieving their reproductive goals

    Effect of the COVID-19 pandemic on health facility delivery in Ethiopia; results from PMA Ethiopia's longitudinal panel.

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    ObjectivesTo examine the effect of COVID-19 on health facility delivery in Ethiopia.DesignWe used longitudinal data with a pre-post exposure to the pandemic to assess change in facility delivery patterns nationally and by urban and rural strata. We conducted design-based multivariable multinomial logistic regression comparing home, lower-level facility, and hospital delivery with date of birth as a spline term, with a knot indicating births before and on/after April 8, 2020.SettingSix regions in Ethiopia, covering 91% of the population.ParticipantsWomen were eligible to participate if they were currently pregnant or less than six weeks postpartum and were recontacted at six weeks, six months, and one year postpartum. 2,889 women were eligible and 2,855 enrolled. Data used in this paper come from the six-week interview, with a follow-up rate of 88.9% (2,537 women).ResultsIn urban areas, women who delivered during the COVID-19 pandemic had a 77% reduced relative risk of delivering in a hospital relative to women who delivered prior to the pandemic (aRRR: 0.23, 95% CI: 0.07-0.71). There were no significant differences between the pre- and COVID-19 periods within rural strata where the majority of women deliver at home (55.6%). Overall, the effect was non-significant at a national level. Among women who delivered during the COVID-19 pandemic, 20.0% of urban women said COVID-19 affected where they delivered relative to 8.7% of rural women (p-value = 0.01).ConclusionWe found that delivery patterns in urban areas changed during the early months of the COVID-19 pandemic, but there was no evidence of large-scale declines of hospital delivery at the national level. Concerns about COVID-19 transmission in health facilities and ensuring lower-level facilities are equipped to address obstetric emergencies are critical to address. COVID-19 will likely slow progress towards increasing rates of institutional delivery in urban areas in Ethiopia

    Evaluating consistency of recall of maternal and newborn care complications and intervention coverage using PMA panel data in SNNPR, Ethiopia.

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    BackgroundThere is recognition that effective interventions are available to prevent neonatal and maternal deaths but providing reliable and valid coverage estimates remains a challenge. Household surveys rely on recall of self-reported events that may span up to 5 years, raising concerns of recall bias.ObjectiveThis study assessed the reliability of maternal recall of pregnancy, delivery, and postpartum events over a six-month period and identified relevant individual characteristics associated with inconsistent reporting.MethodologyA longitudinal household survey was conducted with 321 pregnant women in 44 enumeration areas in Southern Nationals, Nationalities and People's Region in Ethiopia. Women who were six or more months pregnant were enrolled and interviewed at seven days, six weeks, and six months post-partum using an identical set of questions regarding maternal and neonatal health and receipt of select neonatal care interventions. We compared responses given at 7 days to those reported at 6 weeks and 6 months and conducted sensitivity, specificity, area under receiving operative curve, and Kappa analyses of selected indicators.ResultsWe find that reporting complications is higher at the first interview after birth than at either the six-week or six-month interview. The specificity of the majority of complications is high, however sensitivity is generally much lower. The sensitivity of reporting any complication during pregnancy, delivery, or post-partum ranged from 54.5% to 67.6% at the 6-week interview and from 39.2% to 63.2% at the 6-month interview. Though sensitivity of receipt of neonatal interventions was high, specificity and kappa demonstrate low consistency.ConclusionAs with childbirth, it may be that during the first seven days women note symptoms with higher scrutiny, but if these do not later develop into serious health issues, they may be forgotten over time. Maternal complications and care are likely to be under-reported by women if interviewed for distant events

    Data for local decision-making, not a mere reporting requirement: development of an index to measure facility-level use of HMIS data

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    # Background Well-functioning health management information systems (HMIS) enable decision-making at all health system levels. This study develops an index to measure the use of HMIS data at the facility level. # Methods We used two rounds of cross-sectional data collected from 305 health facilities in Ethiopia in 2019 (pre-COVID-19) and 2020 (post-COVID-19). We constructed a summative, 10-item index using exploratory factor analysis and 2019 index development data; and used Cronbach's alpha to assess reliability. To examine content validity, we mapped items against a previously published conceptual framework and consulted Ethiopian experts. We then employed one-way ANOVA and t-tests comparing the mean index scores overall and by key facility characteristics between 2019 and 2020. # Results The 10-item index loaded on one factor (Cronbach's alpha=0.74), and the index scores did not differ significantly by facility characteristics in 2019. The mean index score increased from 7.2 in 2019 to 7.9 in 2020 (*P*\<0.01). During this period, more facilities received feedback on HMIS reports from facility leadership (19.3% difference); received actionable recommendations on performance targets and resource allocation (7.5% and 12.3% difference, respectively); and reviewed maternal deaths (15.1% difference); conversely, the proportion of facilities that held participatory performance review meetings monthly or more often decreased by 13.8% (all *P* \<0.05). # Conclusions We propose a facility-level HMIS data use index and document an upward trend in HMIS data use in Ethiopia immediately after the COVID-19 pandemic was declared. Future research should further evaluate and refine the proposed index to support the measurement of HMIS data quality and utilization in Ethiopia and like settings

    Missed opportunities for family planning counselling among postpartum women in eleven counties in Kenya

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    Background Mothers may access medical facilities for their babies and miss opportunities to access family planning (FP) services. This study was undertaken to describe missed opportunities for FP among women within the extended (0-11 months) postpartum period from counties participating in Performance Monitoring and Accountability 2020 (PMA2020) surveys. Design and setting This study analysed cross-sectional household survey data from 11 counties in Kenya between 2014 and 2018. PMA2020 uses questions extracted from the Demographic and Health survey (DHS) and DHS definitions were used. Multivariable logistic regression was used for inferential statistics with p-value of < 0.05 considered to be significant. Participants Women aged 15-49 years from the households visited. Primary outcome measure Missed opportunity for family planning/contraceptives (FP/C) counselling. Results Of the 34,832 women aged 15-49 years interviewed, 10.9% (3803) and 10.8% (3746) were in the period 0-11 months and 12-23 months postpartum respectively, of whom, 38.8 and 39.6% respectively had their previous pregnancy unintended. Overall, 50.4% of women 0-23 months postpartum had missed opportunities for FP/C counselling. Among women who had contact with health care at the facility, 39.2% of women 0-11 months and 44.7% of women 12-23 months had missed opportunities for FP/C counselling. Less than half of the women 0-11 months postpartum (46.5%) and 64.5% of women 12 - 23 months postpartum were using highly efficacious methods. About 27 and 18% of the women 0-11 months and 12 - 23 months postpartum respectively had unmet need for FP/C. Multivariable analysis showed that being low parity and being from the low wealth quintile significantly increased the odds of missed opportunities for FP/C counselling among women in the extended postpartum period, p < 0.05. Conclusions A large proportion of women have missed opportunities for FP/C counselling within 2 years postpartum. Programs should address these missed opportunities

    The role of partner influence in contraceptive adoption, discontinuation, and switching in a nationally representative cohort of Ugandan women.

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    BackgroundUnderstanding contraceptive use dynamics is critical to addressing unmet need for contraception. Despite evidence that male partners may influence contraceptive decision-making, few studies have prospectively examined the supportive ways that men influence women's contraceptive use and continuation.ObjectiveThis study sought to understand the predictive effect of partner influence, defined as partner's fertility intentions and support for contraception, and discussions about avoiding pregnancy prior to contraceptive use, on contraceptive use dynamics (continuation, discontinuation, switching, adoption) over a one-year period.MethodsThis study uses nationally representative longitudinal data of Ugandan women aged 15-49 collected in 2018-2019 (n = 4,288 women baseline; n = 2,755 women one-year follow-up). Two analytic sub-samples of women in union and in need of contraception at baseline were used (n = 618 contraceptive users at baseline for discontinuation/switching analysis; n = 687 contraceptive non-users at baseline for adoption analysis). Primary dependent variables encompassed contraceptive use dynamics (continuation, discontinuation, switching, and adoption); three independent variables assessed partner influence. For each sub-sample, bivariate associations explored differences in sociodemographic and partner influences by contraceptive dynamics. Multinomial regression models were used to examine discontinuation and switching for contraceptive users at baseline; logistic regression identified predictors of contraceptive adoption among non-users at baseline.ResultsAmong users at baseline, 26.3% of women switched methods and 31.5% discontinued contraceptive use by follow-up. Multinomial logistic regression, adjusting for women's characteristics, indicated the relative risk of contraceptive discontinuation doubled when women did not discuss pregnancy avoidance with their partner prior to contraceptive use. Partner influence was not related to method switching. Among non-users at baseline, partner support for future contraceptive use was associated with nearly three-fold increased odds of contraceptive adoption.SignificanceThese results highlight the potentially supportive role of male partners in contraceptive adoption. Future research is encouraged to elucidate the complex pathways between couple-based decision-making and contraceptive dynamics through further prospective studies

    Associations between agency and sexual and reproductive health communication in early adolescence: a cross-cultural, cross-sectional study

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    Propósito: Evaluar la medida en que los adolescentes de 10 a 14 años se han comunicado sobre las relaciones sexuales, el embarazo y la anticoncepción y cómo la agencia en forma de voz y toma de decisiones junto con un entorno socioecológico propicio se asocian con la salud sexual y reproductiva (SSR ) comunicación. Métodos: Utilizando datos del Estudio Global de Adolescentes Tempranos, incluimos 1,367, 697 y 1,424 adolescentes en Kinshasa, Cuenca y Shanghai, respectivamente. Los patrones de comunicación de SSR y los niveles de agencia se describieron por sitio y sexo. Las regresiones logísticas multivariables evaluaron las probabilidades de comunicación de SSR primero en relación con las características socioecológicas y segundo con los niveles de agencia, después del ajuste por factores sociales ambientales. Los términos de interacción probaron las diferencias de sexo en las asociaciones. Resultados: Las experiencias de comunicación de SSR variaron de uno de cada diez en Kinshasa a aproximadamente la mitad en Cuenca. El embarazo fue el tema de SSR más discutido. Los factores socioecológicos relacionados constantemente con la comunicación de SSR incluyeron la edad avanzada y el inicio de la pubertad, mientras que otros variaron según el contexto. En análisis multivariables, la voz se vinculó a todas las formas de comunicación de SSR en Kinshasa y Cuenca con odds ratios ajustados que van de 1.6 a 2.2, pero no en Shanghai. En Cuenca, la toma de decisiones se asoció con un aumento del 50% y 60% en las probabilidades de comunicación sobre el embarazo y la anticoncepción, respectivamente. En Kinshasa, se observó una asociación más fuerte entre la voz y las discusiones sobre el embarazo para las niñas que para los niños. Conclusiones: Las características del desarrollo y la voz se vincularon con la comunicación sobre SSR entre los adolescentes jóvenes en dos contextos. Los resultados sugieren que la agencia puede desempeñar un papel en la formación de antecedentes, como la comunicación, de los comportamientos sexuales. © 2020 Sociedad para la Salud y Medicina del AdolescentePurpose: To assess the extent to which adolescents aged 10–14 have communicated about sexual relationships, pregnancy, and contraception and how agency in the form of voice and decision-making along with an enabling socioecological environment are associated with sexual and reproductive health (SRH) communication. Methods: Using data from the Global Early Adolescent Study, we included 1,367, 697, and 1,424 adolescents in Kinshasa, Cuenca, and Shanghai, respectively. Patterns of SRH communication and agency levels were described by site and sex. Multivariable logistic regressions assessed odds of SRH communication first in relation to socioecological characteristics and second with levels of agency, after adjustment for social environmental factors. Interaction terms tested sex differences in associations. Results: Experiences of SRH communication ranged from one in ten in Kinshasa to about half in Cuenca. Pregnancy was the most discussed SRH topic. Socioecological factors consistently related to SRH communication included older age and pubertal onset, while others varied by context. In multivariable analyses, voice was linked to all forms of SRH communication in Kinshasa and Cuenca with adjusted odds ratios ranging from 1.6 to 2.2, but not in Shanghai. In Cuenca, decision-making was associated with a 50% and 60% increase in odds of communication about pregnancy and contraception, respectively. In Kinshasa, a stronger association between voice and pregnancy discussions was observed for girls than boys. Conclusions: Developmental characteristics and voice were linked to communication about SRH among young adolescents across two contexts. Results suggest agency may play a role in shaping antecedents, like communication, to sexual behaviors. © 2020 Society for Adolescent Health and Medicin
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