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      Perspectives of Muslim Religious Leaders to Shape an Educational Intervention About Family Planning in Rural Tanzania: A Qualitative Study

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          Abstract

          Designing an educational intervention that engages male and female Muslim religious leaders and addresses gaps in knowledge on all contraceptive methods is a promising strategy for increasing family planning uptake in rural Tanzania.

          Abstract

          Key Findings

          • Muslim religious and lay leaders in rural Tanzania interpreted Islamic teachings as accepting of family planning (FP) for birth spacing and uniformly supported spacing through breastfeeding and the calendar method.

          • The need for more FP education in Muslim communities was widely agreed upon, and leaders were open to helping to provide this education.

          • Leaders’ insights yielded recommendations for educating Muslim religious leaders in their communities. These included educating men and women both together and separately depending on context and partnerships between medical and religious leaders to co-teach educational sessions.

          • Muslim religious leaders can be empowered to teach their own communities by receiving education about contraceptive methods, including how the methods work, their efficacy, and potential side effects.

          Key Implication

          • Community education on FP in Muslim communities must engage male and female religious leaders. This study’s findings will guide the design and pilot-testing of an educational intervention for Muslim religious leaders to promote FP knowledge and uptake in rural Tanzania.

          ABSTRACT

          Introduction:

          Uptake of effective contraceptive methods can be hindered by poor understanding and uncertainty about its compatibility with religious beliefs. We sought to understand the perspectives of Muslim religious leaders in rural Tanzania on family planning (FP) and acceptable strategies for providing FP education to leaders and their communities.

          Methods:

          We conducted in-depth interviews with Muslim leaders from 4 communities in northwest Tanzania. Open-ended questions explored leaders’ views on FP in relation to their communities, Muslim texts and teaching, and their experience as leaders. We also investigated how FP education could be provided in their communities and asked practical questions regarding seminar implementation. Interviews were conducted in Kiswahili and transcribed and translated into English. Data were coded independently by 2 investigators using NVivo 1.5.1 and analyzed thematically.

          Results:

          We interviewed 17 male and 15 female Muslim leaders. All leaders supported FP as a concept in which births are spaced, interpreting this as espoused by the Qur’an and a basic right of children raised in Islam. Leaders uniformly endorsed the use of breastfeeding and the calendar method to space births but had divergent and sometimes opposing views on other methods, including condom use, oral contraceptives, and intrauterine devices. All leaders acknowledged the need for FP education among their congregants and were in favor of helping to teach an FP seminar in their communities.

          Conclusion:

          Our data reveal insights into how education for Muslim leaders may equip them to promote birth spacing and enhance understanding of FP in their communities in ways that are concordant with Islamic teaching. Our findings will guide the design and pilot-testing of an educational intervention for Muslim religious leaders to promote knowledge and uptake of FP in rural Tanzania.

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          Most cited references49

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          Thematic Analysis

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            Code Saturation Versus Meaning Saturation: How Many Interviews Are Enough?

            Saturation is a core guiding principle to determine sample sizes in qualitative research, yet little methodological research exists on parameters that influence saturation. Our study compared two approaches to assessing saturation: code saturation and meaning saturation. We examined sample sizes needed to reach saturation in each approach, what saturation meant, and how to assess saturation. Examining 25 in-depth interviews, we found that code saturation was reached at nine interviews, whereby the range of thematic issues was identified. However, 16 to 24 interviews were needed to reach meaning saturation where we developed a richly textured understanding of issues. Thus, code saturation may indicate when researchers have "heard it all," but meaning saturation is needed to "understand it all." We used our results to develop parameters that influence saturation, which may be used to estimate sample sizes for qualitative research proposals or to document in publications the grounds on which saturation was achieved.
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              Birth spacing and risk of adverse perinatal outcomes: a meta-analysis.

              Both short and long interpregnancy intervals have been associated with an increased risk of adverse perinatal outcomes. However, whether this possible association is confounded by maternal characteristics or socioeconomic status is uncertain. To examine the association between birth spacing and relative risk of adverse perinatal outcomes. Studies published in any language were retrieved by searching MEDLINE (1966 through January 2006), EMBASE, ECLA, POPLINE, CINAHL, and LILACS, proceedings of meetings on birth spacing, and bibliographies of retrieved articles, and by contact with relevant researchers in the field. Included studies were cohort, cross-sectional, and case-control studies with results adjusted for at least maternal age and socioeconomic status, reporting risk estimates and 95% confidence intervals (or data to calculate them) of birth spacing and perinatal outcomes. Of 130 articles identified in the search, 67 (52%) were included. Information on study design, participant characteristics, measure of birth spacing used, measures of outcome, control for potential confounding factors, and risk estimates was abstracted independently by 2 investigators using a standardized protocol. A random-effects model and meta-regression analyses were used to pool data from individual studies. Compared with interpregnancy intervals of 18 to 23 months, interpregnancy intervals shorter than 6 months were associated with increased risks of preterm birth, low birth weight, and small for gestational age (pooled adjusted odds ratios [95% confidence intervals]: 1.40 [1.24-1.58], 1.61 [1.39-1.86], and 1.26 [1.18-1.33], respectively). Intervals of 6 to 17 months and longer than 59 months were also associated with a significantly greater risk for the 3 adverse perinatal outcomes. Interpregnancy intervals shorter than 18 months and longer than 59 months are significantly associated with increased risk of adverse perinatal outcomes. These data suggest that spacing pregnancies appropriately could help prevent such adverse perinatal outcomes.
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                Author and article information

                Journal
                Glob Health Sci Pract
                Glob Health Sci Pract
                ghsp
                ghsp
                Global Health: Science and Practice
                Global Health: Science and Practice
                2169-575X
                28 February 2023
                28 February 2023
                : 11
                : 1
                : e2200204
                Affiliations
                [a ]Center for Global Health, Weill Cornell Medicine , New York, NY, USA.
                [b ]Mwanza Christian College , Mwanza, Tanzania.
                [c ]Bugando Medical Centre , Mwanza, Tanzania.
                [d ]Misungwi District Hospital , Mwanza, Tanzania.
                [e ]Nyamagana District Hospital , Mwanza, Tanzania.
                [f ]Catholic University of Health and Allied Sciences , Mwanza, Tanzania.
                [g ]Keble College, University of Oxford , Oxford, United Kingdom.
                Author notes
                Correspondence to Andrea Chalem ( andrea.chalem@ 123456gmail.com ).
                Article
                GHSP-D-22-00204
                10.9745/GHSP-D-22-00204
                9972385
                36853642
                cf55acfb-8889-40ca-bba3-308adb8fce80
                © Chalem et al.

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit https://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-22-00204

                History
                : 12 July 2022
                : 6 December 2022
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