ETD Collection

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    Factors associated with pregnancy in women taking part in a phase III microbocide trial in Johannesburg
    (2011-11-23) Walaza, Sibongile
    Introduction This was a secondary data analysis of a prospective cohort of women enrolled in a phase III microbicide trial between October 2005 and August 2008. The study aimed to assess the pregnancy incidence rates and factors associated with pregnancy in women using barrier method and hormonal contraception, enrolled in the trial. Methods A total of 2508 participants were enrolled in the trial and followed up for up to 12 months. Of these 2437 were included in the pregnancy incidence analysis and 2171 participants were included in the multivariate analysis. Data on the main exposure, contraception, were collected by structured interview. The main outcome of interest was pregnancy, which was measured by detection of human chorionic gonadotrophin in urine using Quick Vue® test and confirmed by laboratory based testing. The incidence rate of pregnancy was calculated as number of pregnancies per 100 women years of follow up. Kaplan Meier Survival analysis was used to determine average time to first pregnancy. Univariate and multivariate analyses were conducted using Cox regression models to asses the factors associated with incident pregnancies. Data was analysed using Stata® version 10. Results A total of 2248 women years of follow up were recorded. A total of 238 pregnancies occurred resulting in pregnancy incidence of 11 per 100 women-years of follow up (95% CI: 9.32 to 12.02). The incidence of pregnancy increased with time in the study; 98 per 100 women years of follow up (95% CI: 85.09 to 112.35) in the last 3 months compared to 2 per 100 women-years of follow up (95% CI: 0.94 to 2.92) in the first 3 months of follow up. Older age and hormonal contraception use were significantly associated with a decreased risk of pregnancy. Women 35 years and older were 49% less likely to fall pregnant compared to those who were younger than 25 years, adjusted hazard ratio (AHR) 0.51(95% CI: 0.30 to 0.88, p=0.016). Women who used hormonal contraception had a reduced risk of falling pregnant AHR 0.66(95% CI: 0.46 to 0.94, p=0.02). There was no difference between the two types of hormonal contraception (injectable vs oral) with respect to pregnancy risk. Conclusion: The incidence of pregnancy increased with time in the study. Women who used hormonal contraception and who were older were less at risk of pregnancy. There was no significant difference in pregnancy risk by type of hormonal contraception (i.e. oral contraception vs injectable contraception) used.
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    Contraceptive study: an assessment of contraceptive use in patients requesting termination of pregnancy at Chris Hani Baragwanath hospital
    (2009-11-12T11:52:55Z) Nyakoe, Robert Barasa
    The aim of this study was to assess the demographic characteristics and contraceptive practices of women requesting termination of pregnancy (TOP) at Chris Hani Baragwanath Hospital (CHBH). The study will provide insight into the reasons for contraceptive „failure‟ or non-use. Methods This is a cross sectional questionnaire survey. Subjects for the study were recruited from clients requesting TOP at the Gynaecology clinic (ward 54), CHBH. They included women between 13 to 49 years, who were referred from their local clinic or General practitioner with a positive pregnancy test or a pregnancy confirmed on sonar, and were less than 20 weeks pregnant. Consenting women completed a self-administered questionnaire which assessed their demographic details, current contraceptive use, past contraceptive experience, future contraceptive plans, knowledge of emergency contraceptive pill, and the current status of the relationship, initial intention with regard to the pregnancy, and the number of sexual partners they had in the last year. The data was analysed using the Epi Info 6 software programme. Results There were 780 requests for TOP during the study period. Two hundred and twenty nine women were approached to participate in the study and 203 questionnaires were analysed, i.e. an 89% analysable response rate. The mean age of the respondents was 25 years (range 13 - 42 years), the mean parity was 1.3 (range 0 to 9), 35% were still in school, 28% were unemployed and 70% were financially dependent on their parents, partners, or other relatives. A total of 56% of the respondents reported that they were using contraception when they conceived. Only 11% of the respondents knew of the emergency contraception pill. Eighty two percent of the respondents knew where to obtain contraceptives and only 7% had experienced actual difficulty in obtaining contraception. However, 46% thought they received „too little‟ information about contraception at their local clinic and 26% said that the contraceptive method they received was the healthcare provider‟s choice. Up to 47% of the respondents were either unsure of the contraceptive method they would use or would not use any contraception following the TOP. However, 43% would use a highly reliable contraceptive method (the oral contraceptive pill, injectable contraceptive, or sterilisation). Regarding the status of the relationship which resulted in the pregnancy, 44% were no longer in a permanent relationship (41% were and 11% never were). Twenty two percent of the respondents initially wanted the pregnancy. Conclusions Twenty two percent of the respondents initially wanted the pregnancy and would not have been helped by better provision of contraception. A large number of respondents reported contraceptive failure. Knowledge of emergency contraception was poor, and its use should be better promoted for cases of contraceptive failure. It is alarming that up to 47% of the clients could not use contraception in the future. Perhaps more time should be spent on contraceptive counselling and initiation of a method on site, with referral and follow-up at primary health clinics to improve uptake of contraception. Only 2.5% of the respondents were having a repeat TOP.
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    Intention to use contraception and subsequent contraceptive behavior
    (2008-07-09T12:09:48Z) Joseph, Maurice Mutisya
    Abstract Context: Estimating demand for contraception from married women only may misrepresent unmet need for family planning; given that unmarried women, who are often young, are equally if not more exposed to unwanted pregnancy and have good reasons to practice contraception. Past studies mainly focused on married women, which limits the ability to estimate demand among all women; specifically it is unclear if intention to use contraception among married women predicts use among all women. Methods: The study site is a rural, marginalized district in northern Ghana, where contraceptive use is low based on the complex interplay of culture, preferences and contraceptive availability. The district is a site under demographic surveillance since 1993. Using data collected longitudinally from 1995 to 2003, this study examines if intention to use contraception among all women can be used to predict their actual use. The study also describes the main contraceptive methods used and reasons for non-use in the district. A panel survey was introduced to monitor changes in fertility and contraceptive use following the introduction of a community health and family planning intervention project. Data from the 2001 and 2003 panel survey were used for the analysis. The sample consisted of 2827 non-users of contraception in the baseline year (2001). Logistic regression analysis was used to calculate the adjusted effect of contraceptive intention on future use. Results: About two thirds (65%) of the respondents were in a marital union while 23% had never been married. Among all women, those who expressed the need to use contraception were more than twice as likely to have used contraception when compared with those without such intentions (OR 2.04; CI: 1.47; 2.82). Among the married women, those with intention to use contraception were close to two times as likely to have used contraception compared to those without (OR 1.88; CI: 1.31; 2.72). The main family planning methods used were injectables (55%) followed by prolonged abstinence (22%) and the pill (10%). More than half of the women not using a method reported not being at risk as the main reason for non-use. Results for all women and for married women alone demonstrate that, in this setting, intention can be used to predict future use. Conclusion: Stated contraceptive intention is a significant determinant and measure of future family planning needs when the needs of unmarried women as well as married women are considered. Unmarried women and not only married women should therefore be a focus in family planning studies for their intentions count in determining who is in need of contraception and the nature and scale of that need.