Knowledge, attitudes and perceptions of long acting reversible contraceptive (LARC) methods among healthcare workers in sub-Saharan Africa : a systematic review and meta-analysis

Abstract

Introuction: The sub-Saharan Africa (SSA) region is making progress in its contraceptive policies that allow for the provision of long-acting reversible contraceptives (LARC). Despite this, the overall utilisation of contraception, especially LARC is low while the burden of unintended pregnancies remains high. Unintended pregnancies pose a significant threat to global public health with far-reaching consequences. There is a need to explore all the reasons for the low uptake of effective LARC methods. The objectives of this systematic review and meta-analysis, was therefore to determine the state of knowledge, attitudes, and perceptions of LARCs among healthcare workers (HCW) in sub-Saharan Africa. Methods: A systematic review and meta-analysis were conducted of published qualitative and quantitative studies. A search strategy was developed and applied to three major databases (PubMed, Ovid (Medline), and Scopus). Studies of both a qualitative and quantitative nature were included if they assessed either the knowledge, attitude, perception or a combination of the concepts among HCWs toward a LARC method. Data were extracted using a pre-determined data extraction form to conduct a qualitative synthesis using a thematic content analysis framework using ATLAS.ti version 8. In addition to this, data was specifically extracted relating to 11 pre-determined questions to conduct proportion meta-analyses using Stata version 15. Heterogeneity was further explored using the I2-statistic and publication bias using funnel plots and Egger’s tests. Results: A total of 3616 records were screened, of which 3510 were excluded. From 106 full-text articles assessed for eligibility, 50 were included for qualitative synthesis and 21 included in the meta-analysis. From the studies, a total of 12 356 participants were included in the analysis. From the meta-analysis, the overall proportion of HCWs with training in family planning was 62% (95% CI: 48%, 76%) while 60% (95% CI: 41%, 80%) reported providing family planning counselling to their clients. Forty-one percent (95% CI: 20%, 61%) of HCWs had received IUCD insertion training with 63% (95% CI: 44%, 81%) expressing a desire for additional training. Only 27% of HCWs (95% CI: 18%, 36%) deemed IUCD appropriate for HIV-infected women. Moreover, restrictions for IUCD and injectables based on a minimum age were imposed by 56% (95% CI: 33%, 78%) and 60% (95% 41 CI: 36%, 84%) of HCWs, respectively. Lastly, minimum parity restrictions were also observed among 29% (95% CI: 9%, 50%) of HCWs for IUCDs and 36% (95% CI: 16%, 43 56%) for injectable contraceptives. Conclusion: The study revealed that there is a gap in knowledge of HCWs regarding family planning counselling and LARC provision. In addition to this, the results indicate that unnecessary provider-imposed restrictions may hinder the uptake of LARC methods by women in sub-Saharan Africa. With the deadline for the Family Planning 2020 initiative and the 2030 SDGs quickly approaching, there is a need to address these issues.