Utilization of birth companionship and its associated factors among laboring mothers during facilities birth in sub-Saharan Africa. Systematic review and meta-analysis.

Introduction: Birth companionship is one strategy for improving maternal and neonatal quality of care, as well as their outcomes. It is a low-cost and effective care that provide mothers with evidence-based practices throughout labor and delivery in health facilities. WHO has suggested that birth companionship can be given by a family member, spouse, friend, and doula. They support laboring mothers by offering comfort via touch, massage, warm baths, encouraging mobility, promoting fluid intake and output, supplying information about the status of labor and suggestions for coping strategies, and providing a communication channel between mothers and their caregivers that helps to reduce mother and newborn mortality on a globally and regionally. Despite this benefit, no systematic review and meta-analysis studies have been conducted on this topic in study area. Therefore, this study may give the pooled utilization and associated factors of birth companionship among laboring mothers during facility birth in Sub-Saharan Africa. Methods and materials: A systematic review and meta-analysis was conducted using preferred reporting items for systematic review and meta-analysis guidelines. Data base such as PubMed with Medline, Cochrane library, direct science, google scholar and different gray works of literature/email were used on the utilization of birth companionship and associated factors of studies from 2010 to 2023 in sub-Saharan Africa. A weighted inverse variance random effect model with DerSimonian-Laird method was used to estimate pooled utilization of birth companionship Cochrane Q-test, I 2, and p-value were computed to detect heterogeneity. Egger test and funnel plot were used to detect the evidence of publication bias. We did subgroup analysis, sensitivity analysis, and meta regression to identify source heterogeneity. The protocol has been registered in PROSPERO database "CRD42024503048." Results: In sub-Saharan Africa, laboring mothers giving delivery in a facility utilized birth companionship at a rate of 34% (95% CI: 26-42, I 2 = 98.90%, p < 0.01). Subgroup analysis revealed that South Africa had the largest pooled utilization of birth companionship (49%), while Rwanda had the lowest (14.5%). Having ANC (AOR = 2.69, 95% CI: 1.66-3.73, I 2 = 10.36%), having an obstetric complication (AOR = 2.55, 95% CI: 1.69-3.4, I 2 = 0%), desiring birth companionship (AOR = 2.46, 95% CI: 1.17-3.74, I 2 = 38.46%), and being prime para (AOR = 2.51, 95% CI: 1.83-3.19, I 2 = 0%) were significantly associated with pooled utilization of birth companionship. Conclusions: There is low pooled utilization of birth companionship among laboring mothers giving delivery in an institution in sub-Saharan Africa. Factors linked to the use of birth companionship included being primipara, having antenatal care, having complications during pregnancy, and desiring companionship. The management team and healthcare personnel must take the initiative to educate mothers during antenatal care about the benefits of having a birth companion.

Determinants of early discontinuation of long-acting and reversible contraceptive methods among women within childbearing age attending health facilities in Ethiopia, 2019.

Objective: This study aimed to identify the determinants of early discontinuation of long-acting and reversible contraceptive methods among women within childbearing age in Ethiopia, 2019. Methods: The institutional-based case-control study design was implemented from June to August 2019. Eligible study participants were sampled using systematic random sampling technique. Data were collected using structured and pre-tested questionnaire and entered into Epi Info and exported to SPSS version 20 for further analysis. All variables with a p value of <0.05 at odds ratio of 95% confidence interval in multivariable logistic regression analysis were considered as determinants of early discontinuation of long-acting and reversible contraceptive methods. Results: A total of 825 study participants (206 cases and 619 controls) were included in the study. Decision-making on the use of contraception (adjusted odds ratio: 4.8, 95% confidence interval: 1.4-16.8 and adjusted odds ratio: 5.6, 95% confidence interval: 1.7-18.8), the women who got counseled about side effects of contraceptive methods being 84% less likely to discontinue long-acting and reversible contraceptive methods compared to the women of their counterpart (adjusted odds ratio: 0.16, 95% confidence interval: 0.15-0.4), having two or more children (adjusted odds ratio: 10, 95% confidence interval: 3.7-28), and desire to be pregnant (adjusted odds ratio = 0.15 95% confidence interval: 0.06-0.4) were determinants of early discontinuation of long-acting and reversible contraceptive methods. Conclusion: According to the findings of this study, decision-maker on utilization of contraceptive methods, being counseled on side effects of contraception, number of children, and desire of woman to be pregnant were found to be determinants of discontinuation of long-acting and reversible contraceptive methods. Health care providers should strengthen providing pre-insertion counseling in accordance with the national guideline for family planning services, with an emphasis on potential contraceptive side effects and consideration of counseling on decision-making.