Table 9_Magnitude and associated factors of postpartum family planning uptake among postpartum women in Ethiopia: an umbrella review.docx

BackgroundThe World Health Organization indicates that despite advancements, the rates of maternal and neonatal mortality and morbidity during the postpartum period continue to be alarmingly high. Furthermore, untapped opportunities to enhance maternal health and promote effective newborn care, including family planning services, have not been fully leveraged. Earlier meta-analyses and systematic reviews have addressed this subject; however, a thorough evidence synthesis has not been provided. Therefore, the objective of this study was to compile the existing systematic reviews (SRs) concerning postpartum family planning uptake among postpartum women in Ethiopia.
MethodThis review used an umbrella review method, incorporating numerous systematic reviews. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Meta-analysis of Observational Studies guideline (MOOSE). A comprehensive literature review was conducted across prominent four electronic databases (including MEDLINE/PubMed, Cochrane, Web of Science and Science Direct) from June 15, to July 15, 2024. This review encompassed investigations carried out within the uptake of family planning among post-partum women and its determinants in Ethiopia were the primary outcome. A set of inclusion criteria was established to identify all pertinent systematic reviews, including studies, with no restrictions on data collection and publication year. The quality of the methods was evaluated using the Assessment of Multiple Systematic Reviews tool, (AMSTAR) tool. Statistical analysis was conducted using STATA version 17 software, and the 95% confidence interval was utilized to establish statistical significance. I-squared statistics were employed to evaluate the heterogeneity of the studies by using a random-effects meta-analysis model.
ResultsThe umbrella review includes five studies with a total of 44,276 postpartum women. The pooled prevalence of postpartum family planning utilization was 36.41% (95% CI: 24.78, 48.03). Family planning counseling (AOR: 4.12, 95% CI: 2.89, 4.71), couple discussion (AOR: 3.06, 95% CI: 1.42, 5.60), and postnatal follow-up (AOR: 3.48, 95% CI: 2.60, 4.83) were significantly associated with postpartum family planning uptake.
ConclusionThe result (36.4%) which mentioned in the conclusion part will be removed and the whole text will be replaced by: The study results indicate that the adoption of postpartum family planning in Ethiopia requires focused intervention. This can be achieved by identifying and enhancing community frameworks to involve men in reproductive health initiatives and by providing comprehensive family planning information and services during postnatal care. Addressing the aforementioned factors is crucial to mitigate the risks associated with unintended pregnancies and to manage the swift increase in population.
Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024568435, PROSPERO (CRD42024568435).

研究背景
世界卫生组织（World Health Organization）指出，尽管医学技术持续进步，但产后阶段的孕产妇与新生儿死亡率及发病率仍居高不下，形势令人警醒。此外，改善孕产妇健康、推广优质新生儿护理（含计划生育服务）的潜在机遇尚未得到充分利用。既往元分析与系统综述虽已针对该主题展开研究，但尚未形成全面的证据综合。因此，本研究旨在汇编埃塞俄比亚产后女性产后计划生育采用率相关的现有系统综述（systematic reviews, SRs）。

研究方法
本综述采用伞状综述研究设计，纳入多篇系统综述文献。研究严格遵循《系统综述与元分析优先报告条目》（Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA）指南与《观察性研究元分析指南》（Meta-analysis of Observational Studies guideline, MOOSE）的规范要求。于2024年6月15日至7月15日，在四大主流电子数据库（含MEDLINE/PubMed、Cochrane、Web of Science及Science Direct）中开展系统性文献检索。本综述的主要结局指标为埃塞俄比亚产后女性的计划生育采用情况及其影响因素。研究制定了统一的纳入标准以筛选所有相关系统综述，对数据收集方式与出版年份未设限制。采用多系统综述评价工具（Assessment of Multiple Systematic Reviews, AMSTAR）对纳入研究的方法学质量进行评估。统计分析使用STATA 17统计软件完成，以95%置信区间判定统计学显著性；采用随机效应元分析模型与I平方（I-squared）统计量评估研究间异质性。

研究结果
本伞状综述共纳入5项研究，累计涉及44276名产后女性。产后计划生育服务利用率的合并患病率为36.41%（95%CI：24.78，48.03）。计划生育咨询（调整后比值比[AOR]：4.12，95%CI：2.89，4.71）、夫妻间沟通（AOR：3.06，95%CI：1.42，5.60）及产后随访（AOR：3.48，95%CI：2.60，4.83）与产后计划生育采用率呈显著正相关。

研究结论
本研究结果显示，埃塞俄比亚产后计划生育的推广需实施针对性干预策略。具体可通过构建并完善社区参与框架，推动男性参与生殖健康项目，并在产后护理阶段提供全面的计划生育信息与服务来实现。针对上述影响因素采取干预措施，对于降低非意愿妊娠相关风险、应对人口快速增长态势具有重要意义。

系统综述注册
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024568435，PROSPERO（CRD42024568435）