Determinants of Family Planning
uptake among Female Sex
Workers Enrolled in a HIV
incidence study in Eldoret
Kenya.
Authors:
J. Kipyego, E. Kaguiri, G. Mungai, A.
Komen, J.Sawe, G.Kutwa, JB Ballidawa,
P. Ayuo, E. Were.
1st Dec 2015
Background
• Female sex workers (FSWs) have limited access to reproductive
health services due to marginalization and stigmatization.
• This poses the risk of unintended pregnancies, HIV acquisition
and transmission and vertical transmission.
• In Kenya, Family Planning services are free and so maximum
uptake is expected
• The Contraceptive Prevalence rate (CPR) in Kenya is 58%
2014)
1
(KDHS,
Objectives
• To identify the FP methods used by FSWs operating in
Eldoret, Kenya.
• To determine the levels of FP uptake among FSWs in Eldoret.
• To determine the factors associated with uptake of FP
services in the group.
2
Methods
• Setting –
Eldoret; Urban area in Western Kenya
• Population – FSWs operating within Eldoret urban area, Peer
identified between June and December 2013
• Design Cross-sectional, Data was collected prospectively.
• Procedure - Abstract data on demographics and FP
• Ethics -
Approved by Moi Teaching and Referral Hospital- IRB
• Analysis - Descriptive statistics, cross tabulation and multiple
regression done. Proportions, OR & CI reported.
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FINDINGS
Demographic characteristics the FSWs (N=734)
•
•
•
•
•
Mean (SD) age in years was 28.2 (6.78);median (IQR) of 26.9 (23.5-31.9)
173(23.6%) were HIV positive
62(8.4%) had no Children
27(3.7%) were married
427 (58% had up to primary level of education; 71(9.7%) had no
education
• Mean(SD) monthly income in Kshs was 10346.45 (9688.38) ;median
(IQR) 7000 (4000-14000)
• 471(64.2%) reported Alcohol intake
• 386 (52.6%) reported to have a regular sexual partner
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Figure 1 : Distribution of FSW using different FP methods (N=734).
61.7%
contraceptive uptake rate
1.1%
Tubal ligation
2.9%
Progestin only pill
38.3%
None
0.7%
Intrauterine device
35.9%
Injections
7.5%
Implants
0.7%
E pills
8.6%
Condoms
4.4%
Combined oral contraceptive
0.0%
10.0%
20.0%
30.0%
5
40.0%
50.0%
60.0%
70.0%
Table 2:Factors associated with FP uptake (1) N=734
Variable
FP uptake
Unadjusted
Adjusted
No
Freq (%)
Yes
Freq (%)
P value
OR
95%CI
OR
95%CI
Age in years
Mean (std)
29.1 (8.1)
27.7 (5.7)
0.28
0.97
0.95 - 0.99
0.95
0.93 - 0.98
HIV status
N/A
Negative
Positive
5 (55.6)
204 (37)
73 (42.2)
4 (44.4)
348 (63)
100 (57.8)
0.88 - 2.11
0.44 - 1.59
1
1.09
0.79
0.69 - 1.73
0.40 - 1.55
Have Children?
No
Yes
40 (64.5)
242 (36)
22 (35.5)
430 (64)
<0.001
1.88 - 5.59
1
4.65
2.58 - 8.39
Married
No
Yes
265 (37.5)
17 (63)
442 (62.5)
10 (37)
<0.001
0.16 - 0.78
1
0.38
0.17 - 0.87
0.19
6
1
1.36
0.83
1
3.24
1
0.35
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Table 2:Factors associated with FP uptake (2) N=734
Variable
Education level
None
Primary
Secondary
Post Secondary
Income
Mean (std)
Median (IQR)
Alcohol intake
No
Yes
Regular Partner
No
Yes
FP uptake
No
Freq (%)
26 (36.6)
164 (38.4)
87 (38.8)
5 (41.7)
P value
Yes
Freq (%)
45 (63.4)
263 (61.6)
137 (61.2)
7 (58.3)
0.093
Unadjusted
OR
95%CI
1
0.93
0.90
Adjusted
OR
95%CI
0.55 - 1.57
0.52 - 1.57
1
1.04
1.10
0.61 - 1.78
0.62 - 1.94
0.65 - 1.22
1
0.83
0.59 - 1.14
0.53 - 0.96
1
0.78
0.57 - 1.06
0.55
10630 (9873.7)
8000 (4000-14000)
10169.2 (9577.4)
6000(4000-15000)
0.5
97 (36.9)
185 (39.3)
166 (63.1)
286 (60.7)
1
0.89
0.03
148 (42.5)
134 (34.7)
200 (57.5)
252 (65.3)
1
0.71
7
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Conclusion & Recommendations
• The contraception prevalence rate in this study is slightly higher than the
national prevalence in Kenya.
• Those with children were almost 5 times as likely to be on FP compared
to those without children
• Older age and being married were found to be associated with low
uptake of FP services.
• Focused counseling messages should be developed to target FSWs who
are older, married and those with no children.
• Effort should also be geared towards provision of long acting FP
methods.
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Acknowledgements
• All the participants who participated in this study.
• Staff at Moi University PIPS clinic for their support.
• EDCTP for funding the study.
THANK YOU
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