Introuction: The sub-Saharan Africa (SSA) region is making progress in its contraceptive policies that allow for the provision of long-acting reversible contraceptives (LARC). Despite this, the overall utilisation of contraception, especially LARC is low while the burden of unintended pregnancies remains high. Unintended pregnancies pose a significant threat to global public health with far-reaching consequences. There is a need to explore all the reasons for the low uptake of effective LARC methods. The objectives of this systematic review and meta-analysis, was therefore to determine the state of knowledge, attitudes, and perceptions of LARCs among healthcare workers (HCW) in sub-Saharan Africa.
Methods: A systematic review and meta-analysis were conducted of published qualitative and quantitative studies. A search strategy was developed and applied to three major databases (PubMed, Ovid (Medline), and Scopus). Studies of both a qualitative and quantitative nature were included if they assessed either the knowledge, attitude, perception or a combination of the concepts among HCWs toward a LARC method. Data were extracted using a pre-determined data extraction form to conduct a qualitative synthesis using a thematic content analysis framework using ATLAS.ti version 8. In addition to this, data was specifically extracted relating to 11 pre-determined questions to conduct proportion meta-analyses using Stata version 15. Heterogeneity was further explored using the I2-statistic and publication bias using funnel plots and Egger’s tests.
Results: A total of 3616 records were screened, of which 3510 were excluded. From 106 full-text articles assessed for eligibility, 50 were included for qualitative synthesis and 21 included in the meta-analysis. From the studies, a total of 12 356 participants were included in the analysis. From the meta-analysis, the overall proportion of HCWs with training in family planning was 62% (95% CI: 48%, 76%) while 60% (95% CI: 41%, 80%) reported providing family planning counselling to their clients. Forty-one percent (95% CI: 20%, 61%) of HCWs had received IUCD insertion training with 63% (95% CI: 44%, 81%) expressing a desire for additional training. Only 27% of HCWs (95% CI: 18%, 36%) deemed IUCD appropriate for HIV-infected women. Moreover, restrictions for IUCD and injectables based on a minimum age were imposed by 56% (95% CI: 33%, 78%) and 60% (95% 41 CI: 36%, 84%) of HCWs, respectively. Lastly, minimum parity restrictions were also observed among 29% (95% CI: 9%, 50%) of HCWs for IUCDs and 36% (95% CI: 16%, 43 56%) for injectable contraceptives.
Conclusion: The study revealed that there is a gap in knowledge of HCWs regarding family planning counselling and LARC provision. In addition to this, the results indicate that unnecessary provider-imposed restrictions may hinder the uptake of LARC methods by women in sub-Saharan Africa. With the deadline for the Family Planning 2020 initiative and the 2030 SDGs quickly approaching, there is a need to address these issues. / Dissertation (MSc)--University of Pretoria, 2020. / School of Health Systems and Public Health (SHSPH) / MSc (Epidemiology) / Unrestricted
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:up/oai:repository.up.ac.za:2263/75541 |
| Date | January 2020 |
| Creators | Rouncivell, Laura |
| Contributors | Takuva, Simbarashe G., laura.rouncivell@gmail.com, Ledibane, N.R.T., Leong, Trudy D. |
| Publisher | University of Pretoria |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Dissertation |
| Rights | © 2019 University of Pretoria. All rights reserved. The copyright in this work vests in the University of Pretoria. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of the University of Pretoria. |
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