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      Women’s Decision on Contraceptive Use in Ethiopia: Multinomial Analysis of Evidence From Ethiopian Demographic and Health Survey

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          Abstract

          Background:

          Women are left out of the conversation on contraceptive use due to a variety of reasons. One of the reasons women have reported for their nonuse of family planning method is that they do not decide to use or not to use it. This study aimed to assess the women’s decision-making on contraceptive use and identify its associated factors.

          Methods:

          Data for this study were extracted from the national representative 2016 Ethiopian Demographic and Health Survey. Data were collected using 2-stage cluster design, in which enumeration areas forming the first stage and households making the second stage. The analysis was done using multinomial logistic regression using STATA software version 14.

          Results:

          The study revealed that one-fourth (24.3%) 95% CI (23.7%-25.1%) decision was made by women. The multinomial analysis demonstrated women’s decision-making on contraceptive use was influenced by the age of women 15 to 19 years (adjusted odd ratio [AOR] = 0.327, 95% CI: 0.175-0.613), 20 to 24 years (AOR = 0.510, 95% CI: 0.390-0.666), and 25 to 29 (AOR = 0.557 95% CI: 0.460-0.675); place of residence (urban; AOR = 1.637, 95% CI: 1.331-2.015) and region in which the women dwell and husbands education; occupation of both woman and her husband; and number of children ever born were the factors significantly associated with the outcome variable.

          Conclusions:

          Women’s decision-making on contraceptive utilization was low. It was influenced by age, place of residence and region, education, occupation, and number of children ever born.

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          Most cited references 11

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          Married women's decision making power on modern contraceptive use in urban and rural southern Ethiopia

          Background Women in developing countries are either under collective decision making with their partners or completely rely on the male partner's decision on issues that affect their reproductive live. Identifying the major barriers of married women's decision making power on contraceptive use has significant relevance for planning contextually appropriate family planning interventions. The objective of this study was to determine current modern contraceptive practices and decision making power among married women in Tercha Town and surrounding rural areas of Dawro zone, Southern Ethiopia. Methods Community based comparative cross-sectional design with both quantitative and Qualitative study has been employed in March and April 2010. The respondents were 699 married women of child bearing age from urban and rural parts of Dawro zone. After conducting census, we took the sample using simple random sampling technique. Results Current modern contraceptive use among married women in the urban was 293 (87.5%) and 243 (72.8%) in rural. Married women who reside in urban area were more likely to decide on the use of modern contraceptive method than rural women. Having better knowledge about modern contraceptive methods, gender equitable attitude, better involvement in decisions related to children, socio-cultural and family relations were statistically significant factors for decision making power of women on the use of modern contraceptive methods in the urban setting. Better knowledge, fear of partner's opposition or negligence, involvement in decisions about child and economic affairs were statistically significant factors for better decision making power of women on the use of modern contraceptive methods in the rural part. Conclusions High level of current modern contraceptive practice with reduced urban-rural difference was found as compared to regional and national figures. Urban women had better power to make decisions on modern contraceptive than rural women. Modern family planning interventions in the area should be promoted by considering empowering of women on modern contraceptive use decision making.
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            Influence of a husband’s healthcare decision making role on a woman’s intention to use contraceptives among Mozambican women

            Background Previous studies in developing countries suggest that a husband plays an influential role in a woman’s contraceptive use. The influence of a husband/partner’s healthcare decision making power on a woman’s intention to use contraceptives in Mozambique has not been studied. The present study examined this relationship using data from the 2011 Mozambique Demographic and Health Survey (DHS), which included a nationally representative sample of 7,022 women aged 15-49 years. Methods The primary outcome of interest in the study was a woman’s intention to use contraceptives. The primary exposure of interest was the person making decisions about a woman’s healthcare, dichotomized as the husband/partner alone vs. the woman herself or jointly with her husband/partner. Several potential socio-demographic confounders were adjusted for in overall and stratified multivariable logistic regression models. Adjusted odds ratio (AOR) and the associated 95% confidence interval (CI) are reported. Results The mean age of the sample was 30.4 (95% CI: 30.1 - 30.7) years. Overall, a woman who reported her husband/partner usually made the decision about her healthcare was 19% less likely to report an intention to use contraceptives than a woman who reported that she herself or jointly with her husband/partner made the decision (AOR = 0.81, 95% CI 0.71- 0.92). In stratified analyses, the association remained statistically significant among rural women (AOR = 0.75, 95% CI: 0.65 - 0.87); among women with knowledge of modern contraceptive methods (AOR = 0.83, 95% CI: 0.73 - 0.95); and among women with three or more (AOR = 0.81, 95% CI: 0.68 - 0.97) and two or fewer (AOR = 0.79, 95% CI: 0.65 - 0.96) living children. Conclusions A husband/partner’s healthcare decision making power in the relationship had a significant negative effect on a Mozambican woman’s intention to use contraceptives. These findings have implications for addressing the role of men in the design and implementation of successful family planning programs to improve the contraceptive uptake rate among women in Mozambique.
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              Risk factors and a prediction model for lower limb lymphedema following lymphadenectomy in gynecologic cancer: a hospital-based retrospective cohort study

              Background Lower limb lymphedema (LLL) is a chronic and incapacitating condition afflicting patients who undergo lymphadenectomy for gynecologic cancer. This study aimed to identify risk factors for LLL and to develop a prediction model for its occurrence. Methods Pelvic lymphadenectomy (PLA) with or without para-aortic lymphadenectomy (PALA) was performed on 366 patients with gynecologic malignancies at Yaizu City Hospital between April 2002 and July 2014; we retrospectively analyzed 264 eligible patients. The intervals between surgery and diagnosis of LLL were calculated; the prevalence and risk factors were evaluated using the Kaplan-Meier and Cox proportional hazards methods. We developed a prediction model with which patients were scored and classified as low-risk or high-risk. Results The cumulative incidence of LLL was 23.1% at 1 year, 32.8% at 3 years, and 47.7% at 10 years post-surgery. LLL developed after a median 13.5 months. Using regression analysis, body mass index (BMI) ≥25 kg/m2 (hazard ratio [HR], 1.616; 95% confidence interval [CI], 1.030–2.535), PLA + PALA (HR, 2.323; 95% CI, 1.126–4.794), postoperative radiation therapy (HR, 2.469; 95% CI, 1.148–5.310), and lymphocyst formation (HR, 1.718; 95% CI, 1.120–2.635) were found to be independently associated with LLL; age, type of cancer, number of lymph nodes, retroperitoneal suture, chemotherapy, lymph node metastasis, herbal medicine, self-management education, or infection were not associated with LLL. The predictive score was based on the 4 associated variables; patients were classified as high-risk (scores 3–6) and low-risk (scores 0–2). LLL incidence was significantly greater in the high-risk group than in the low-risk group (HR, 2.19; 95% CI, 1.440–3.324). The cumulative incidence at 5 years was 52.1% [95% CI, 42.9–62.1%] for the high-risk group and 28.9% [95% CI, 21.1–38.7%] for the low-risk group. The area under the receiver operator characteristics curve for the prediction model was 0.631 at 1 year, 0.632 at 3 years, 0.640 at 5 years, and 0.637 at 10 years. Conclusion BMI ≥25 kg/m2, PLA + PALA, lymphocyst formation, and postoperative radiation therapy are significant predictive factors for LLL. Our prediction model may be useful for identifying patients at risk of LLL following lymphadenectomy. Providing an intensive therapeutic strategy for high-risk patients may help reduce the incidence of LLL and conserve the quality of life.
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                Author and article information

                Journal
                Health Serv Res Manag Epidemiol
                Health Serv Res Manag Epidemiol
                HME
                sphme
                Health Services Research and Managerial Epidemiology
                SAGE Publications (Sage CA: Los Angeles, CA )
                2333-3928
                8 May 2020
                Jan-Dec 2020
                : 7
                Affiliations
                [1 ]Faculty of Public Health, Department of Epidemiology, Institute of Health, Jimma University, Jimma, Ethiopia
                [2 ]Faculty of Public Health, Department of Health Management and Policy, Institute of Health, Jimma University, Jimma, Ethiopia
                [3 ]Faculty of Health Science, Department of Midwifery, Institute of Health, Jimma University, Jimma, Ethiopia
                Author notes
                Biru Abdissa Mizana, Faculty of Health Science, Department of Midwifery, Institute of Health, Jimma University, P.O. BOX 378, Jimma, Ethiopia. Email: yosan2020@ 123456gmail.com
                Article
                10.1177_2333392820924565
                10.1177/2333392820924565
                7218467
                © The Author(s) 2020

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                Categories
                Original Research
                Custom metadata
                January-December 2020
                ts3

                decision-making, women, multinomial analysis, edhs, ethiopia

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