The following presentation by fourth year medical students (as presented on October 27th 2007) won a prize in the best young presenter category at the University of Zimbabwe Annual

Medical Research Day.

NOTES(The maximum allowable presentation time was 10 minutes)

It would have been apt to present baseline characteristics of participantsOdds ratios were unadjusted

Questions from the questionnaire(s) are available on request from the uploader

TITLE

An investigation of the proportion of unintended pregnancies and associated factors among mothers attending Glenview polyclinic.

Masukume G, Mapondera H, Masuka J, Mhlanga T, Shamu S

(Department of Community Medicine)

PRESENTATION PLAN

1. Introduction

2. Literature review

3. Statement of problem

4. Objectives

5. Methodology

6. Results

7. Conclusion

8. Recommendations

9. Acknowledgements

Introduction

Unwanted Mistimed

Unintended1Unintended1

1World Health Organisation; Sexual and reproductive health; Online [http://www.who.int/whr/2002/chapter4/en/index5.html] Accessed 15-06-2007

Literature review (1)

Table 1. Proportion of unintended pregnanciesC o u n t r y Y e a r P r o p o r t i o n % S e t t i n g U S A 1 9 9 5 5 6 - Z im b a b w e 2 1 9 9 7 4 1 H o s p i t a l - b a s e d I r a n 1 9 9 8 3 3 . 9 H o s p i t a l - b a s e d E g y p t 2 0 0 1 2 3 . 6 C o m m u n i t y - b a s e d

2Mbizvo MT, Bondeulle MM, Chadzuka S, Linmark G, Nystrom L; Unplanned pregnancies in Harare, Zimbabwe: what is the contraceptive history and awareness of the mothers?; Central African Journal of Medicine; 1997 Jul;43(7):200-5.

Literature review (2)

Numerous factors associated with unintended pregnancies3,4,5,6

These include:•not being married

•problems with the partner

•physical violence

•extremes of reproductive age

•spacing of children

•economic issues

•abortion

•low birth weight

3 G Sedgh, A Bankole, B Oye-Adeniran, IF Adewole, S Singh, R Hussain: Unwanted pregnancies and associated factors among Nigerian women; International Family planning perspectives; Vol 32 No 4; December 2006; page 175-185

4 S Jahanfar, SM Hashemi, FR Tehrani: Unwanted pregnancy in Tehran, What are the risk factors?; 1998 Online [http://mwia.regional.org.au/papers/ull/18_jahanfar.htm] Accessed 15-06-2007

Literature review (3)

factors continued...•substance misuse

•emotional neglect during childhood

•unqualified family planning services

•contraception failure (user or method)

•history of previous unintended pregnancy

•complications during pregnancy and delivery

•educational and occupational status of the couple

5 RM Youssef, II Moubarak, YA Gaffar, HY Atta; Correlates of unintended pregnancy in Beheira governorate, Egypt; Eastern Mediterranean Health Journal ; Volume 8, No. 4&5 , September 2002.

6 S Faghihzadeh, GB Rochee, M Lmyian, F Mansourian, P Rezasoltani; Factors associated with unwanted pregnancy; Journal of sex and marital therapy; 2003, vol. 29, No 2, pages 157-164

Statement of problem•Antenatal polyclinic records ~ 35% of women, experienced complications during pregnancy or will have booked late or not at all.

•Were these women really concerned or did they want their pregnancy?

•Could this be the core issue resulting in late booking and subsequently, complications?

•Given the important associations of unintended pregnancies - what was the situation at Glenview polyclinic?

Objectives

1. To determine the proportion of unintended pregnancies.

2. To characterise the proportion of unintended pregnancies according to pregnancy number.

3. To ascertain the level to which certain factors are related to unintended pregnancy.

4. To make recommendations to appropriate stake holders.

Methodology (1)

DESIGN: Descriptive cross-sectional study

SETTING: Glenview polyclinic

SUBJECTS: Mothers attending child

immunisation, growth anddevelopment monitoring

sessions

SAMPLE SIZE: n > (1.96)2 x0.20(1-0.20)

(0.05)2

n > 246

SAMPLING METHOD: Convenience systematicsampling where all

mothers fromwhom informed consent hadbeen obtained were

interviewed

Methodology (2)

METHOD: Face-to-face interview using aquestionnaire

Shona questionnaire - (21 questions)

•Section A, towards mother

•Section B, partner details

Data management

DATA ENTRY: - Tally sheet

QUALITY CONTROL: - Verification between groups

DATA ANALYSIS: - Epi info version 6 analysed as case-referent study:

cases = unintended pregnancies referents = intended pregnancies

PRESENTATION: - PowerPoint descriptive statistics tables graphs

Results (1)

Table 2. Pregnancy results

Num ber Pregnancies 266 Mothers interviewed 135 Unintended pregnancies 84 I ntended pregnancies 182

Mean pregnancies per woman = 1.97

Proportion of unintended pregnancies = 31.6%

Results (2)

•Attributable to contraceptive failure (33/84) = 39.3%

[Attributable to oral contraceptives (29/33) = 87.9%]

•Acquired contraceptives from unregistered sources such as vendors at some point in their lives ~ 10%

Results (3)

Figure 1. Proportion of total unintended pregnancies contributed by each pregnancy number

51.2

22.6

11.9 10.7

2.4 1.20

10

20

30

40

50

60

1 2 3 4 5 6

Per

cen

t

Pregnancy number

Results (4)

Figure 2. Proportion of unintended pregnancies encountered in relation to the total number of pregnancies (unintended + intended) for each pregnancy number

31.9

24.4

33.3

52.950.0 50.0

0

10

20

30

40

50

60

1 2 3 4 5 6

Per

cen

t

Pregnancy number

Figure 3. Comparison of absolute contribution and probability of unintended pregnancies by each pregnancy number

51.2

22.6

11.9 10.7

2.4 1.20

10

20

30

40

50

60

1 2 3 4 5 6

Perc

en

t

Pregnancy number

31.9

24.4

33.3

52.950.0 50.0

0

10

20

30

40

50

60

1 2 3 4 5 6

Perc

en

t

Pregnancy number

Table 3. Factors where p value < 0.05 Odds

ratioConfidence

interval

2

1. Considered abortion 16.76 4.48-73.82 31.912. Not married 8.64 4.31-17.18 52.233. Booked late or not at all 3.14 1.44-6.99 10.14. Age greater than 30 2.76 1.54-6.75 6.325. Age less than 20 2.48 1.37-4.51 10.456. Partner drank alcohol or smoked 2.38 1.34-4.21 10.247. Partner age greater than 30 0.19 0.11-0.33 41.65

8. Complications 1.7 0.95-3.06 3.64 9. Mother dead 1.48 0.81-2.71 1.9 10. Low birth weight 1.87 0.77-4.51 2.33 11. Drank alcohol or smoked 1.19 0.69-5.20 1.93 12. HIV test not done or collected 1.39 0.80-2.42 1.51 13. Partner education greater than Form 4 1.29 0.75-2.22 0.98 14. Education less than Form 4 1.29 0.69-2.41 0.72 15. Partner education less than Form 4 1.64 0.36-7.23 0.53 16. Unemployed 1.2 0.67-216 0.43 17. Partner age less than 20 0.75 0.03-8.20 0.06

Factors where p value > 0.05

Conclusions

•31.6% unintended pregnancies

•?? 2nd pregnancy most desired

•Associated factors:

e.g. considering abortion, not unmarried, age < 20, age > 30 and contraception failure significantly associated

Two major groups affected:

1. Women not married below the age of 20, not using contraception and with a possibly deceased mother.

2. Married women beyond their second pregnancies, who are using contraceptive pills and possibly more than 30 years old.

Recommendations

•ZNFPC - encourage use of other methods beyond 2nd pregnancy.

•Ministry of Health – Prevent sales of contraceptives from unregistered sources.

•Participants

•Nurses and staff at Glenview Polyclinic

•Supervisor - Mr S. Shamu

•Mr Ngulube – Shona translation

•Community Medicine Department

Acknowledgements and thanks

THANK YOU!!!