Makupe Davis James, Kumwenda Save, Kazembe Lawrence
1University of Malawi, The Polytechnic, P/Bag 303, Chichiri, Blantyre 3, Malawi.
2University of Malawi, Chancellor College, P.O.Box 280, Zomba, Malawi.
Contracept Reprod Med. 2019 Jun 27;4:12. doi: 10.1186/s40834-019-0088-y. eCollection 2019.
In Malawi, the current approach to family planning using contraceptive methods is individualised, yet studies have shown that variability in contraceptive-use still remains after accounting for it at individual and household levels. Therefore, this study assessed variability at higher levels such as enumeration areas, districts and regions. Biasness of the estimates was addressed by the use of Bayesian approach. The study used 2015-16 Malawi Demographic Health Survey women data. After ascertaining the significance of association of all explanatory variables with contraceptive use, the top-down (backward) stepwise model selection method was followed in the Bayesian framework using Markov Chain Monte Carlo and defuse priors. Models were compared on the basis of Deviance Information Criteria and significance of parameter estimates was checked via credible intervals while that of cross-cluster variances was checked by examining their diagnostic plots. All the selected socio-demographic factors were strongly associated with contraceptive-use (-value 0.001). These factors include; region, place-of-residence, age, parity, education, occupation, marital-status and religion. It was also found that about 15 and 2.3% of the variation in contraceptive-use was attributed to enumeration area and district clustering, respectively. The single-level model underestimated the parameter estimates by at least 4% for both models. And parity-enumeration area, age-enumeration area and age-district random effects were significant in their respective models. It was also noted that most young women aged between 15 and 24 years were not using any contraceptive methods. The study indicated that there exist significant enumeration area and district heterogeneity on contraceptive use in Malawian women and that random-effect models are the most appropriate models other than single-level models. Thus family planning programs focusing on contraceptive-use should switch to inclusive approach and statistical analyses should consider including enumeration area and district heterogeneity while controlling for the above significant factors. Stakeholders may also consider encouraging young women to use contraceptive methods, if Malawi is to minimize problems due to overpopulation.
在马拉维，目前使用避孕方法的计划生育方式是个体化的，但研究表明，在考虑了个体和家庭层面的因素后，避孕措施使用情况的变异性仍然存在。因此，本研究评估了诸如普查区、地区和区域等更高层面的变异性。采用贝叶斯方法解决了估计的偏差问题。该研究使用了2015 - 2016年马拉维人口与健康调查的女性数据。在确定所有解释变量与避孕措施使用之间关联的显著性之后，在贝叶斯框架下采用自上而下（向后）的逐步模型选择方法，使用马尔可夫链蒙特卡罗方法和弥散先验。基于偏差信息准则对模型进行比较，并通过可信区间检查参数估计的显著性，同时通过检查诊断图来检查跨聚类方差的显著性。所有选定的社会人口因素都与避孕措施的使用密切相关（P值 < 0.001）。这些因素包括：地区、居住地点、年龄、胎次、教育程度、职业、婚姻状况和宗教信仰。研究还发现，避孕措施使用情况约15%和2.3%的变异分别归因于普查区和地区聚类。对于两个模型，单水平模型至少低估了4%的参数估计值。并且胎次 - 普查区、年龄 - 普查区和年龄 - 地区随机效应在各自模型中具有显著性。还注意到，大多数年龄在15至24岁之间的年轻女性未使用任何避孕方法。该研究表明，马拉维女性在避孕措施使用方面存在显著的普查区和地区异质性，除单水平模型外，随机效应模型是最合适的模型。因此，专注于避孕措施使用的计划生育项目应转向包容性方法，统计分析应考虑纳入普查区和地区异质性，同时控制上述显著因素。如果马拉维要尽量减少因人口过剩带来的问题，利益相关者也可考虑鼓励年轻女性使用避孕方法。
