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Background: Contraceptive usage has been associated with improved maternal and child health (MCH) outcomes. Despite significant resources being allocated to programs, there has been sub-optimal uptake of contraception, especially in the developing world. It is important therefore, to granulate factors that determine uptake and utilization of contraceptive services so as to inform effective programming. Methods: Between March and December 2015, we conducted a cross-sectional survey among women of reproductive age (WRA) from the Digo community residing in Kwale County, Kenya. The study aimed to describe the pattern and determinants of contraceptive usage in this population. Respondents were selected using stratified, systematic sampling and completed a household sexual and reproductive health (SRH) questionnaire. Results: We interviewed 745 respondents from 15 villages in 2 out of 4 sub-counties of Kwale. Their median (interquartile range, IQR) age was 29 (23-37) years. 568 (76%) reported being currently in a marital union. Among these, 308 (54%) were using a contraceptive method. The total unmet need, unmet need for spacing and for limiting was 16%, 8% and 8%, respectively. Determinants of contraceptive usage were education [adjusted Odds Ratio, aOR = 2.1, 95% confidence interval, CI: 1.4-3.4, P = 0.001]; having children [aOR = 5.0, 95% CI: 1.7-15.0, P = 0.004]; having attended antenatal care (ANC) at last delivery [aOR = 4.0, 95% CI: 1.1-14.8, P = 0.04] as well as intention to stop or delay future birth [aOR = 6.7, 95% CI: 3.3-13.8, P < 0.0001]. Conclusions: We found high levels of contraceptive usage among WRA from the Digo community residing in Kwale. To further improve uptake and utilization of contraception in this setting, programs should address demand-side factors including ensuring female educational attainment as well as promotion of ANC and skilled birth attendance.
This was a cross-sectional household survey conducted between March and December 2015 within the framework of two MCH projects funded by the European Commission and implemented in 2 out of 4 sub-counties of Kwale County. The MOMI project was implemented in Matuga sub-county while the MNM II project was implemented initially in Msambweni and later, in Lungalunga sub-counties. Data collection involved administration of a structured SRH questionnaire to female respondents aged 18–45 years in their households (Additional file 1). We estimated a sample size of 700 respondents based on a previously reported CPR of 30% in this setting; a sample design effect of 2.5; Z-statistic of 1.96 for a 95% confidence level in the estimation; 10% non-response rate and a 5% margin of error. Respondents were selected using stratified, systematic random sampling. Each sub-county was stratified into constituent wards, sub-locations and further into villages within each sub-location. From each village, we obtained a list of all households from the headman and randomly selected households to visit using a random number generator. The number of households selected was based on the proportion of households in that village relative to the total number of households in each sub-location with a sampling interval of 12 households. In each household, we administered the questionnaire to all female respondents who reported being from the Digo community and who were resident in the study area for more than 6 months. We excluded those who did not provide consent, those who were not resident in the study area and women aged 45 years old. Prior to any data collection activities, we held a series of meetings with community gatekeepers including religious leaders, village headmen, chiefs, sub-county commissioners and the Kwale county commissioner. This was meant to sensitize them on the proposed data collection procedures and obtain their buy-in. We also used this as an opportunity to introduce our study team consisting of the principal investigator and resident data enumerators who were from the Digo community but residing in different villages within the study area. Ethical approval for the study was obtained from the Research Ethics Committee of the Aga Khan University, Nairobi (2014/REC-51) and the Ethics Review Committee of the University of Nairobi and Kenyatta National Hospital (P502/08/2014). We also obtained a research permit from the National Commission for Science, Technology and Innovation (#4703) to facilitate the conduct of research activities in the community. All participants provided written informed consent. Quantitative data were entered into a Microsoft Access (2010) database (Microsoft Inc. Seattle, WA, USA) and after appropriate data cleaning checks, migrated to Stata version 12 (StataCorp Inc., College Station, TX, USA) for statistical analyses. For the descriptive statistics, we summarized the respondents’ demographic characteristics as counts (N) and percentages (%) for categorical data and median (IQR) for continuous data. We compared these characteristics using Pearson’s chi-squared test for categorical data and Wilcoxon rank-sum test for continuous data. For the inferential statistics, the outcome of interest was current usage of any contraceptive method. We calculated the odds of current contraceptive usage among women with each determinant of interest versus the reference group using multivariable logistic regression models and report the adjusted ORs and 95% CIs for each. All statistical tests were evaluated using a 2-sided α-value of 0.05.
