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BMC Research Notes

Open Access

Family planning need of people living with HIV/AIDS in antiretroviral therapy clinics of Horro Guduru Wollega zone, Ethiopia

BMC Research Notes201710:581

https://doi.org/10.1186/s13104-017-2914-0

Received: 8 August 2017

Accepted: 3 November 2017

Published: 9 November 2017

Abstract

Objective

The purpose of this study was to identify factors associated with family planning needs among people living with human immunodeficiency virus (HIV) in Ethiopia.

Results

Three hundred twenty-one participants provided information on family planning methods and associated factors. Forty-six-point four percent of respondents reported using at least one form of family planning method; injectables (50.3%) and condoms (70.2%) were the most commonly used type of family planning method before and after HIV diagnosis, respectively. Age, the desire to have children, and the desire to have more than two children were significantly associated with the use of family planning methods.

Keywords

Family planningPeople living with HIV (PLWH)Horro Guduru WollegaMother to child transmission

Introduction

By the end of 2015, the number of people living with HIV had reached an estimated 33.3 million. Women account for half of the estimated adults living with HIV and AIDS worldwide, the majority of whom are in their reproductive years [1, 2]. With increased access to treatment for PLHIV, there has been a consequent decrease in mortality among PLHIV and subsequent increase in normal functioning including sexual activity [3].

Many women are at risk for unintended pregnancy and HIV infection at the same time. In a number of African countries the rate of unintended pregnancy among women living with HIV range from 51 to 84% [4]. Family planning has a major impact on improving the overall health of a woman as well as that of her children by delaying first births, reducing the total number of children born to a woman, and preventing unintended pregnancies. Nearly one-third of maternal deaths could be prevented by meeting unmet need for family planning [5, 6].

Despite these benefits, in sub Saharan Africa, family planning among PLWH is not widely used [4]. A national survey conducted in Malawi among HIV positive women revealed that 51.2% of the respondents were using family planning methods and unmet need of FP methods were 21.9% [7]. According to a cross-sectional survey conducted in Tigray region, Ethiopia, 44.3% of the respondents were using contraceptive methods at time of survey [8]. A cross sectional study conducted in West Shewa zone, Ethiopia also revealed that less than half (43.1%) of study participants were using family planning during the study period [9].

Factors associated with low utilization of family planning among PLWH vary across the countries and study sites. In the study area there is no available evidence on the use of family planning methods among PLWH. Thus, this study was done to explore factors associated with family planning needs among PLWH in Horro Guduru Wollega zone, Ethiopia.

Main text

Methods

Study site

The study was conducted in Horro Guduru Wollega (HGW) Zone, Oromia National Regional State. HGW is one of twenty zones of the region which has ten districts with different climatic conditions. This zone has a total population of 570,040 (285,515 male and 284,525 female) of which 11.36% of the population were urban inhabitants [10]. Shambu is the capital town of the zone and found 310 km from country’s capital, Addis Ababa.

Study population and design

The study involved cross sectional institution based study among randomly selected PLWHA who were in reproductive age and had taken at least one visit at antiretroviral therapy (ART) care from the selected ART care unit from March 31 to April 30, 2012. There were ten health care institutions (one hospital and nine health centers) providing ART services in HGW Zone. Among these, one hospital and two health centers were randomly selected. The source population was all PLWH (men and women) following ART care unit in selected HGW zone ART care units during the study period. Study populations were randomly selected who were in reproductive age and had taken at least one visit at ART care from the selected ART care unit during the study period. Those who were critically ill and could not provide informed consent were excluded from the study.

Sample size determination and sampling technique

The sample size was determined using single population proportion formula taking the proportion of HIV positive individuals who received ART treatment and had the desire to have children is 40% from study done in Addis Ababa [11], 5% marginal error, 95% confidence interval. A total of 1050 eligible participants were identified. Since the total number of people living with HIV/AIDS who were following ART clinics in HGW zone in ten ART clinics was < 10,000, correction formula was used. To compensate the non-response rate, 10% of the determined sample was added up on the calculated sample size and the final sample size was 323. Then the study participants were selected by systematic random sampling of every 3rd person from three study sites proportional their size. The dependent variable was family planning need, and the independent variables were socio-demography, fertility desire, and number of children desired.

Data collection methods and tools

Data was collected using structured questionnaire with closed and open ended questions. The questionnaire was adapted from different literatures [9, 11] (Additional file 1). The questionnaires were prepared in English, translated into Afan Oromo (working language of Oromia region), and then retranslated back to English by people who are proficient in both languages to maintain the consistency of the questionnaires. The questionnaire contained questions on socio-demographic characteristics, information about family planning use, choice and demand, and sexual behavior and condom use. Six data collectors were selected from the study site. Training was given for 2 days about the objective and relevance of the study, confidentiality of information, respondents’ rights, informed consent and techniques of interview. Three supervisors were also selected from each site and closely followed the data collection process with principal investigator. Field questionnaires were reviewed each night and any issues encountered during data collection procedures were addressed accordingly.

Data processing and analysis

The data cleaning was done, entered into a computer by using EPI Info version 6.5. The data were then exported to SPSS windows version 20.0 for further analysis. The descriptive analyses such as proportions, percentages, frequency distribution and measures of central tendency were conducted. Bivariate analysis of demographic variables and family planning need was described. Odds ratio was used to check significant association between dependent and independent variables. Then all variables found to be significant at bivariate level (p value < 0.05) were entered into multivariate analysis using the logistic regression model to test the significance of the association.

Results

Socio demographic characteristics of study participants

Three hundred twenty-one respondents participated in the study among 323 eligible clients in the selected ARV care units, giving a response rate of 99.4%. The majority 156 (48.6%) of the respondents were between 30 and 39 years of age. The mean age (SD) of females and males were 31.4 (± 5.8) and 35.6 (± 7.9) respectively. The age range of the respondents was from 19 to 58 years. The majority more than half of the respondents were orthodox (51.4%) in religion. Nearly one-third (29.65) of the study participants can’t read and write (see Table 1).
Table 1

Socio demographic characteristics of respondents attending ART treatment units, Horro Guduru Wollega zone, Ethiopia, 2012

Characteristics

Frequency

Percentage (%)

Age (years)

 18–29

106

33

 30–39

156

48.6

 ≥ 40

59

18.4

Sex

 Female

195

60.7

 Male

126

39.3

Religion

 Orthodox

165

51.4

 Protestant

136

42.4

 Muslim

13

4

 Others

7

2.2

Educational status

 Can’t read and write

95

29.6

 Read and write

100

31.2

 Primary

57

17.7

 Secondary

52

16.2

 Post secondary

17

5.1

Ethnicity

 Oromo

272

84.7

 Amhara

45

14

 Othersa

4

1.3

Marital status

 Married

186

57.9

 Single/never married

57

17.8

 Widowed

40

12.5

 Divorced

38

11.8

Occupation

 House wife

135

42.1

 Farmer

51

15.8

 Daily laborers

46

14.3

 Government/private employee

33

10.3

 Jobless

33

10.3

 Merchants

23

7.2

Income

 No regular income

126

39.3

 ≤ 445

147

46.0

 > 445

48

14.7

aGuraghe, Tigre

Family planning need, choice and use

One hundred forty-nine (46.4%) were using different types of family planning methods during the survey period. Among these 120 (80.5%) and 50 (33.6%) were using condom and injectables respectively. Out of those who were not using family planning method at the time of survey period, only 58 (33.7%) of them have intended to use family planning methods in the future (Table 2).
Table 2

Distributions of study participants by current use and future need of family planning methods in Horro Guduru Wollega zone, Ethiopia, 2012

Contraceptive use n (%)

Current use n (%)

Future need to use n (%)a

Yes

149 (46.4)

58 (33.7)

No

172 (53.6)

114 (66.3)

Contraceptive methods

Currentb

Futurec

Injectables

50 (33.6)

18 (31)

Condom

120 (80.5)

31 (53.4)

OCPs

5 (3.3)

4 (6.9)

Implants

9 (6)

9 (15.5)

Others

1 (0.7)

1 (1.7)

aAmong current contraceptive non users (n = 172)

bAmong current contraceptive users (n = 149) and more than one FP methods were reported use

cAmong those who want to use contraceptive in the future (n = 58) and more than one FP methods were reported need in the future

Sexual behavior and condom use

One hundred ninety-six (61.1%) of the study participants were sexually active within the past 6 months. Among these 128 (65.3%) reported using condoms while 68 (34.7%) did not use. Out of those who reported condom use, the majority 115 (89.8%) used it regularly. The most common reason for condom use was advice from health professionals 57 (44.5%) while wanting to have child 39 (57.3%) was the most common reason for non condom use.

Factors associated with family planning need

From multivariate analysis, those ages group 18–29 were more likely want to use family planning methods than those above thirties (AOR: 2.5, 95% CI 1.18–5.46). Study subjects who desired children were more likely to want to use family planning in the future than those who did not desire children (adjusted OR: 2.8, 95% CI 1.2–6.6). On the other hand those who desired to have less than two children were less likely to use any family planning in the future than their counter parts (adjusted OR: 0.26, 95% CI 0.1–0.8) (Table 3).
Table 3

Association of future family planning need by selected variables among PLWH following ART unit, Horro Guduru Wollega zone, Ethiopia, 2012

Characteristics

Need for future FP N (%)

Do not need for future FP N (%)

Crude OR (95% CI)

Adjusted OR (95% CI)

Age

 18–29

26 (55.3)

27 (28.4)

3.1 (1.5, 6.5)

2.5 (1.18, 5.46)

 30–39

21 (44.7)

68 (71.6)

1

1

Sex

 Male

25 (43.9)

33 (28.2)

2 (1.03, 3.89)

1.6 (0.7, 3.8)

 Female

32 (56.1)

84 (71.8)

1

1

Marital status

 Married

25 (43.9)

40 (34.2)

1.5 (0.8, 2.9)

 Single/divorced/widowed

32 (56.1)

77 (65.8)

1

1

Educational status

 Illiterate/read and write

38 (66.7)

80 (68.4)

0.9 (0.5, 1.8)

 Primary and above

19 (33.3)

37 (31.6)

1

 

Future child desire

 Yes

41 (71.9)

46 (39.3)

4 (2.0, 7.9)

2.8 (1.2, 6.6)

 No

16 (28.1)

71 (60.7)

1

1

Number of children desired

 ≥ 2

32 (78)

23 (50)

3.6 (1.4, 9.1)

3.8 (1.25, 11.7)a

 < 2

9 (22)

23 (50)

1

1

Italic shows significant association at p < 0.05

Discussion

The current study was undertaken to describe family planning need among people living with HIV/AIDS in Horro Guduru Wollega zone, Ethiopia. In this study about 44.5% of the respondents had used at least one method of family planning methods before HIV diagnosis and this number was increased to 57.6% after HIV diagnosis. This finding was similar with a study conducted among HIV positive women in South Gondar and North Wollo zone, Ethiopia and South Africa [12, 13]. The reason for increased utilization of family planning may be attributed to the counseling services they got from their ART providers to prevent unintended pregnancies and prevention of HIV re-infection from their partners. Among those who were not currently using, only 33.7% did want to use family planning in the future; indicating that counseling for family planning for these people still needs to be addressed.

Sixty-one point one percent of the study participants were sexually active 6 months preceding the survey. This finding was higher than study conducted in Bahir Dar city (50.4%) of Ethiopia but lower compared to study conducted among serodiscordants in Henan, China (83.6%) [14, 15]. The increase in sexual activity among PLWH could be attributed to improved quality of life because of antiretroviral therapy, opportunistic infection prophylaxis and other health care packages [3]. With increased access to ART made possible by global and national initiatives, more HIV positive people are increasingly becoming healthier and more sexually active [3, 16].

Of those who were sexually active, the majority 128 (65.3%) reported using condom while 68 (34.7%) never used at all and among who reported using condoms, over 10% inconsistently used them. These findings were similar to study conducted in Malawi (65.8%) and Nepal (65.8%) reported condom use but lower compared to study conducted in Uganda (77.6%) [1719]. The results appear to indicate significant proportions of PLWH were increasingly practicing risky sexual behavior which has a greater risk of horizontal HIV transmission. So counseling regarding the importance of condom usage in conjunction with more effective modern contraceptive methods must continue to be reinforced over the course of ongoing ART treatment to prevent both infection and pregnancy. Oral pre-exposure prophylaxis (PrEP) for heterosexual HIV discordant couples has proven feasible to reduce HIV transmission and this may be considered as possible additional intervention for the uninfected partner [20].

This study identified many factors like age; desire to have children and number of children desired as important factors associated with future family planning need. Those who were age group between 18 and 29 were more likely to use family planning than those above thirties which was similar to study conducted in Uganda and Tigray region [21, 22]. This may be attributed to the possible need of these populations to prevent unintended pregnancy, and delay to have children as their age is comparably younger than their counter parts. However, according to study conducted in Addis Ababa, age has no significant association with future family planning need.

The other factor associated with future family planning use was future desire for children. Those who desired children were three times more likely to use future family planning than those who did not desire children. Similarly study conducted in Addis Ababa, North Shewa (unpublished) and West Shewa zones of Ethiopia identified that those who desired children were more likely to use family planning in the future than their counter parts [9, 11]. This may be again the possible need of these populations to limit and space the number of children. But according to study conducted in Kenyan health facility, those expressed fertility desire were less likely to use family planning in the future [23].

Number of children desired was another factor for future family planning need identified in this study; those who desired two and above children were more likely to use family planning methods than those who desired one. This may be again due to the possible desire of these populations to limit and space births as their desired number of children increases. This finding was comparable with the study conducted in slums of Nairobi, Tigray region and Debre Markos of Ethiopia [8, 24, 25] as respondents who have one or more living children were more likely to use contraceptive compared with those with no child.

Limitation of the study

  • The cross-sectional nature of the data could not allow the causal effect relationships of dependent and independent factors.

  • In this study, sexually active refers to sexual relationship between male and female only. Men sex with men (MSM) was not included as it is culturally inappropriate in the study area.

  • Even though data collectors were trained on respondent’s confidentiality, respondents may still provide desired answers by data collectors especially on sexual behaviors. Thus, social desirability bias may not be totally avoidable.

  • Despite these limitations, the data being gathered possess a better description of family planning need of PLWH in the study area.

Abbreviations

AIDS: 

acquired immune deficiency syndrome

ART: 

antiretroviral therapy

HGW: 

Horro Guduru Wollega

HIV: 

human immunodeficiency virus

PLWH: 

people living with HIV

SPSS: 

Statistical Packages for the Social Sciences

Declarations

Acknowledgements

I am grateful to acknowledge Addis Ababa University for funding this project. I would also like to acknowledge supervisors, data collectors, and study participants.

Competing interests

The author declare that he has no competing interests.

Availability of data and materials

All relevant data are within the manuscript.

Consent for publication

Not applicable.

Ethics approval and consent to participate

Ethical clearance was obtained from the Addis Ababa University Ethical Review Committee (Protocol No: 26/12/NURS). Permission was also obtained from Shambu Hospital, Wayu Health Center and Fincha Health Center by formal letter. Written informed consent was obtained from the study participants after telling purpose of the study and importance of their participation. The anonymity of the participants was respected by the use of codes rather than the name of the participants. The names of the participants were not reported in the findings of the study to ensure confidentiality.

Funding

This research was funded by Addis Ababa University.

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Authors’ Affiliations

(1)
Department of Nursing and Midwifery, College of Health Sciences, Wollega University

References

  1. UNAIDS. Global AIDS update. Geneva: UNAIDS; 2016.Google Scholar
  2. WHO. Global health sectors strategy on HIV2016–2021 towards ending AIDS. Geneva: World Health Organisation; 2016.Google Scholar
  3. Pearson CR, Kurth AE. Change in sexual activity 12 months after ART initiation among HIV-positive Mozambicans. AIDS Behav. 2012;15(4):778–87.View ArticleGoogle Scholar
  4. GBCHealth. Family planning and HIV services: increased efficiency and impact through integration. 2012. http://archive.gbchealth.org/asset/family-planning-and-hiv-services-together-increase-efficiency-and-impact--issue-brief/. Accessed 16 Sept 2017.
  5. UNAIDS/WHO. HIV and hormonal contraception: frequently asked questions. 2012. http://www.unaids.org/sites/default/files/media_asset/JC2309_HIV_hormonal_contraception_en_0.pdf. Accessed 22 July 2017.
  6. FHI360. Preventing unintended pregnancies and HIV. 2015. https://www.fhi360.org/sites/default/files/media/documents/PMTCTbrief.pdf. Accessed 22 July 2017.
  7. Habte D, Namasasu J. Family planning use among women living with HIV: knowing HIV positive status helps-results from a national survey. Reprod Health. 2015;12:1–11.View ArticleGoogle Scholar
  8. Melaku YA, Zeleke EG. Contraceptive utilization and associated factors among HIV positive women on chronic follow up care in Tigray Region, northern Ethiopia: a cross sectional study. PLoS ONE. 2014;9(4):1–10.View ArticleGoogle Scholar
  9. Ejeta E, Abebe M. Fertility intention and family planning use among people living with HIV/AIDS in follow up care Western Shoa Zone (ART treatment unit). Am J Nurs Sci. 2009;2015(4):9–15.Google Scholar
  10. Federal Democratic Republic of Ethiopia population census commission. Summary and statistical report of 2007 population and housing census: population size by age and sex. Population Census Policy: Addis Ababa; 2008.Google Scholar
  11. Tamene W, Fantahun M. Fertility desire and family-planning demand among HIV-positive women and men undergoing antiretroviral treatment in Addis Ababa, Ethiopia. Afr J AIDS Res. 2007;6(3):223–7.View ArticlePubMedGoogle Scholar
  12. Abeje G, Motbaynor A. Demand for family planning among HIV positive women on ART: the case of South Gondar and North Wollo Zones Amhara region. BMC Res Notes. 2016;9(43):1–6.Google Scholar
  13. Oni EE, Ross A, Van der Linde S. Contraceptive practices amongst HIV-positive women on antiretroviral therapy attending an ART clinic in South Africa. Afr J Prim Health Care Fam Med. 2013;5(1):1–6.View ArticleGoogle Scholar
  14. Yalew E, Zegeye DT, Meseret S. Patterns of condom use and associated factors among adult HIV positive clients in North Western Ethiopia: a comparative cross sectional study. BMC Public Health. 2012;12:308.View ArticlePubMedPubMed CentralGoogle Scholar
  15. Lu W, Zeng G, LUO J, Duo S. HIV transmission risk among serodiscordant couples: a retrospective study of former plasma donors in Henan, China. J Acquir Immune Defic Syndr. 2011;55(2):232–8.Google Scholar
  16. Wilson TE, Gore ME, Greenblatt R, Cohen M, Minkoff H, Silver S, et al. Changes in sexual behavior among HIV-infected women after initiation of HAART. Am J Public Health. 2004;94(7):1141–6.View ArticlePubMedPubMed CentralGoogle Scholar
  17. Haddad LB, Feldacker C, Jamieson DJ, Tweya H, Cwiak C, Chaweza T, et al. Pregnancy prevention and condom use practices among HIV-infected women on antiretroviral therapy seeking family planning in Lilongwe, Malawi. PLoS ONE. 2015;10(3):1–14.View ArticleGoogle Scholar
  18. Mishra SR, Joshi MP, Khanal V. Family planning knowledge and practice among people living with HIV in Nepal. PLoS ONE. 2014;9(2):1–8.View ArticleGoogle Scholar
  19. Musinguzi G, Bwayo D, Kiwanuka N, Coutinho S, Mukose A, Kabanda J, et al. Sexual behavior among persons living with HIV in Uganda: implications for policy and practice. PLoS ONE. 2014;9(1):1–10.View ArticleGoogle Scholar
  20. WHO. Guidance on pre-exposure oral prophylaxis for serodiscordant couples, men and transgender women who have sex with men at high risk of HIV. Geneva: WHO; 2012.Google Scholar
  21. Kakaire O, Kaye DK, Osinde MO. Contraception among persons living HIV with infection attending an HIV care and support centre in Kabale, Uganda. J Public Health Epidemiol. 2010;2(8):180–8.Google Scholar
  22. Berhane Y, Berhe H, Abera GB, Berhe H. Utilization of modern contraceptives among HIV positive reproductive age women in Tigray, Ethiopia: a cross sectional study. ISRN AIDS. 2013;2013:319724. http://dx.doi.org/10.1155/2013/319724.View ArticlePubMedPubMed CentralGoogle Scholar
  23. Njuguna E, Ilovi S, Muiruri P, Mutai K, Kinuthia J, Njoroge P. Factors influencing the utilization of family planning services among HIV infected women in a Kenyan health facility. Int J Reprod Contracept Obstet Gynecol. 2017;6(5):1746–52.View ArticleGoogle Scholar
  24. Egzeabher SG, Bishaw MA, Tegegne TK, Boneya DJ. Modern family planning utilization and associated factors among HIV positive reproductive age women in Debre Markos Referral Hospital Northwest Ethiopia, 2014. Open J Epidemiol. 2015;5:32–40.View ArticleGoogle Scholar
  25. Wekesa E, Coast E. Contraceptive need and use among individuals with HIV/AIDS living in the slums of Nairobi, Kenya. Int J Gynecol Obstet. 2015;130:E31–6. https://doi.org/10.1016/j.ijgo.2015.05.001.View ArticleGoogle Scholar

Copyright

© The Author(s) 2017

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