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  • 1.
    Bangoura, Charlotte
    et al.
    Maferinyah National Centre for Training and Research in Rural Health (CNFRSR), Forécariah, Guinea.
    Dioubaté, Nafissatou
    Maferinyah National Centre for Training and Research in Rural Health (CNFRSR), Forécariah, Guinea.
    Manet, Hawa
    Maferinyah National Centre for Training and Research in Rural Health (CNFRSR), Forécariah, Guinea.
    Camara, Bienvenu Salim
    Maferinyah National Centre for Training and Research in Rural Health (CNFRSR), Forécariah, Guinea.
    Kouyaté, Mariama
    Africa Centre of Excellence for Prevention and Control of Transmissible Diseases (CEA-PCMT), University Gamal Abdel Nasser, Conakry, Guinea..
    Douno, Moussa
    Maferinyah National Centre for Training and Research in Rural Health (CNFRSR), Forécariah, Guinea.
    Tetui, Moses
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. School of Pharmacy, Waterloo University, Waterloo, ON, Canada; epartment of Health Policy, Planning, and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    El Ayadi, Alison M.
    Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States.
    Delamou, Alexandre
    Maferinyah National Centre for Training and Research in Rural Health (CNFRSR), Forécariah, Guinea.
    Experiences, Preferences, and Needs of Adolescents and Urban Youth in Contraceptive Use in Conakry, 2019, Guinea2021Ingår i: Epidemiologic Methods, ISSN 2194-9263, E-ISSN 2161-962X, Vol. 2, artikel-id 655920Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.
    Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Chemonges, Dennis
    Department of Programs, Population Services International Uganda, Kampala, Uganda; Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Tetui, Moses
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda; School of Pharmacy, Waterloo University, Waterloo, ON, Canada.
    Baroudi, Mazen
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Namatovu, Fredinah
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Akuze, Joseph
    Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
    Makumbi, Fredrick
    Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Ssekamatte, Tonny
    Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Atuyambe, Lynn
    Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Hernandez, Alison
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Sewe, Maquins Odhiambo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Knowledge and information exposure about family planning among women of reproductive age in informal settlements of Kira municipality, Wakiso district, Uganda2021Ingår i: Epidemiologic Methods, ISSN 2194-9263, E-ISSN 2161-962X, Vol. 2, artikel-id 650538Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.
    Makerere University, Johns Hopkins University Collaboration (MU-JHU), Kampala, Uganda.
    Tetui, Moses
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. School of Pharmacy, Waterloo University, Waterloo, ON, Canada; Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
    Fonseca Rodriguez, Osvaldo
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Atuyambe, Lynn
    Department of Community Health and Behavioural Sciences Makerere University School of Public Health, Kampala, Uganda.
    Makumbi, Fredrick Edward
    Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
    Baroudi, Mazen
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Quality of care in family planning services: differences between formal and informal settlements of Kira municipality, Uganda2021Ingår i: Epidemiologic Methods, ISSN 2194-9263, E-ISSN 2161-962X, Vol. 2, artikel-id 656616Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
    Munakampe, Margarate Nzala
    Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia.
    Namakula, Hilda
    Department of Health Policy, Planning, and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Hernandez, Alison
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Ssekamatte, Tonny
    Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Atuyambe, Lynn M.
    Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, College of Health Sciences New Mulago Hospital Complex, Kampala, Uganda.
    Birabwa, Catherine
    Department of Health Policy, Planning, and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Chemonges, Denis
    Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Namatovu, Fredinah
    Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR). Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Makumbi, Fredrick
    Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Tetui, Moses
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Health Policy, Planning, and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda; School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
    Framing contraceptive use motivations among adolescents and young adults living in informal settlements in Kira municipality, Wakiso district, Uganda2021Ingår i: Epidemiologic Methods, ISSN 2194-9263, E-ISSN 2161-962X, Vol. 2, artikel-id 658515Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. School of Pharmacy, Waterloo University, Waterloo, ON, Canada; Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Baroudi, Mazen
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Ssekamatte, Tonny
    Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Birabwa, Catherine
    Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Kibira, Simon Peter
    Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Atuyambe, Lynn
    Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Delamou, Alexandre
    Africa Center of Excellence for Prevention and Control of Communicable Diseases (CEA-PCMT), Faculty of Science and Health Techniques, Gamal Abdel Nasser University of Conakry, Conakry, Guinea; National Training and Research Center in Rural Health of Maferinyah, Forecariah, Guinea.
    Makumbi, Fredrick Edward
    Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Total Demand, Use and Unmet Need for Modern Contraceptives Among Women Living in Informal Settlements in Kira Municipality, Wakiso District, Uganda: Implications for Urban Health2021Ingår i: Epidemiologic Methods, ISSN 2194-9263, E-ISSN 2161-962X, Vol. 2, artikel-id 655413Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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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  • 6.
    Tetui, Moses
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. School of Pharmacy, Waterloo University, Waterloo, ON, Canada; Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Ssekamatte, Tonny
    Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Akilimali, Pierre
    Department of Nutrition Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
    Sirike, Judith
    Division of Social Development, Intergovernmental Authority on Development, Kampala, Uganda.
    Fonseca-Rodríguez, Osvaldo
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Atuyambe, Lynn
    Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Makumbi, Fredrick Edward
    Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda.
    Geospatial distribution of family planning services in Kira Municipality, Wakiso District, Uganda2020Ingår i: Epidemiologic Methods, ISSN 2194-9263, E-ISSN 2161-962X, Vol. 1, artikel-id 599774Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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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