| dc.description.abstract | The associated adverse effects of hormonal/device contraceptives ranging from displaced IUDs, excessive/continuous haemorrhage, pelvic pain, headache, weight gain, osteoporosis, backache, hypertension, deep venous thrombosis amongst others, have contributed to the high unmet need for family planning among women of reproductive age. Unmet need due to lack of safe contraceptives, cultural and religious ideology are part of the factors that have served as threats to the health and well-being of women. In Kisumu County, unmet need for family planning (FP) is 16.4%, depicting lack of safe and adequate contraceptive methods. In line with Sustainable Development Goals (SDGs) 3- target 3.7, addressing unmet need for FP to prevent unintended pregnancies is a high priority for women‘s health, and the symptothermal method (STM) is deemed to be an effective strategy. It is effective, affordable, have no side-effects, accessible and supported by religious/cultural groups. Hitherto, this technique has not been exploited as a better alternative to make up for the unmet need for family planning, as there is no evidence of STM utilization and effectiveness rate in Kisumu County, which therefore requires that field trial be done to test this new method. This study assessed utilization and effectiveness of STM as a strategy to ameliorate unmet need for FP among women of reproductive age (WRA) in Kisumu County. The specific objectives included assessment of baseline knowledge and attitude towards STM; assessment of training (intervention) on knowledge, attitude and satisfaction of STM; to determine the use-effectiveness of STM; and to assess healthcare providers‘ factors influencing usage of STM. This study adopted mixed method (quantitative and qualitative) study design. Quantitative approach adopted quasi-experimental study design, while qualitative approach adopted qualitative research design of two-way focus group discussion (FGD) technique. The quantitative approach (Objective 1, 2, & 3) entailed three phases which were phase 1, recruitment of participants (intervention group-STM, and control group- Oral Contraceptive Pills-OCPs); phase 2, training of participants (intervention group); and phase 3, longitudinal monitoring of participants (intervention and control group). The qualitative study design (Objective 4), employed focus group discussion technique that enabled the application of the phenomenology approach to enquiry. Simple random and purposive non-random sampling techniques were adopted. Simple random sampling technique gave each County and Sub-County an equal chance of being selected, and purposive non random sampling technique enabled only WRA and healthcare providers that met the inclusion and exclusion criteria to participate in the study. Participants consisted WRA 15-49yr and healthcare providers in maternal, reproductive and family planning units. 260 participants comprising 136 STM users (interventional group) and 124 OCPs users (Control group), were recruited. 14 healthcare providers for FGD were also recruited. The intervention was conducted for 3 months with longitudinal monitoring for 12 months. Questionnaires, cycle charts and audio recorder were used for data collection and data analysed using SPSS-IBM 23 and Dedoose 9.2.005 software. Continuous variables were represented as mean, median and interquartile ranges (IQRs) and categorical variables expressed as frequency counts. For comparison of variables between groups, multiple response, Chi-square, Paired sample t-Test and Univariate-ordinal logistic regression models were used at p<0.05. In examining distribution of time to events variables to estimate use-effectiveness of STM, survival analysis of Kaplan–Meier and life table were employed. In analysis of difference between STM and OCPs in the probability of an event (pregnancy) at any point in time, log rank test was performed at significant level of 0.05. A reflexive thematic analysis was performed on FGD transcript data. Objective one; most (87.7%), of participants had very low level of knowledge of STM, established at (Cal. X2 val. 2.853; p-value, 0.808 @ df, 6) and majority (97.0%), of participants had very high positive attitude towards STM, established at (Cal. X2 val. 43.351; p-value, 0.002 @ df, 6). Objective two; Paired sample t-Test established that women have significant (t = -058.716, p = 0.001) knowledge post-training (1.0000 ± .00000) compared to pre-training (.0682 ± .01587) on STM. There was no significant (t= -1.419, p = 0.158) difference in attitude towards STM pre-and-post training. There was significant level of satisfaction (p = 0.001). Objective three; in STM category, no pregnancy occurred. Cumulative survival/ use-effectiveness of STM for 12 months was 100% while in category of OCPs, 3 pregnancies occurred between months 2-5, with use-effectiveness of 97-99% and probability of failure of 1-2%. To establish significant difference between use-effectiveness of STM and OCPs, Log rank test established significance of 0.058 at degree of freedom (df) 1, implying no significant difference between use-effectiveness of STM and OCPs. Objective four; primary strategies for successful integration of STM in healthcare facilities, include training of healthcare providers and creating of community awareness. Conclusively, based on WHO Algorithm (number of unintended pregnancies per 100 women per year), indicating < 1 pregnancy as highly effective, STM is considered to be very effective in ameliorating unmet need for family planning among participants. The study therefore recommends that training of healthcare providers is paramount to foster thorough understanding of STM for effective dissemination of information on STM with clarity and confidence to women/couples who will be needing such services, for sustainability to ameliorate unmet need for family planning. | en_US |
