Publication: Determinants of utilization of reproductive health services among women of reproductive age in South Sudan’s selected public health facilities
Total Views 21
total viewsTotal Downloads 24
total downloadsDate
2024-07
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Mount Kenya University
Cite this Item
Abstract
The utilization of contraceptives among married women in Sub-Saharan Africa is significantly
low, standing at 13 per cent. This low contraceptive use contributes to a high total fertility rate of
5.5 children per woman and an increased adult lifetime risk of maternal death. Notably, Africa
faces the highest maternal death risk at 1 in 26, while developed countries exhibit the lowest risk
at 1 in 7,300. The study's primary goal was to explore the factors influencing the uptake and
utilization of reproductive health services among women of reproductive age in public health
facilities in South Sudan. The study employed a mixed-methods approach, including a longitudinal
ecological study and an analytical cross-sectional study conducted in selected States - Western
Equatoria and Central Equatoria. The target population included women aged 15 to 49 visiting
health facilities during the study period and key informants involved in reproductive health
services and policy implementation. A sample size of 384 respondents, determined through
Fisher's formula, was employed for women of reproductive age. The sampling process utilized a
multi-stage cluster random sampling method, with the initial stage involving the selection of health
facilities and the subsequent stage involving the selection of participants. Data collection methods
encompassed structured questionnaires, in-depth interviews, focus group discussions, and data
abstraction tools. Quantitative data analysis involved descriptive statistics and inferential analyses,
and statistical significance was represented by p-value statistic, where a p-value of less than 0.05
was regarded as statistically significant. Qualitative data underwent content and thematic analysis
to identify common patterns and trends. The study's findings in South Sudan's public health
facilities indicate that family planning and STI prevention are the most used (25.1% each) RHS,
followed by maternal and newborn care (18.1%) and HIV counselling and testing (15.3%). While
overall uptake of reproductive health services increased over the years, there were declines during
the third quarter from 2015 to 2020, coinciding with the rainy season. Study findings demonstrated
that there are seasonal differences in the utilization of RHS during the first and third quarters
throughout the years 2015 to 2022. Importantly, there was a consistent decline in the uptake of
RHS during the third quarter, which coincided with the rainy season of August and September.
Socio-cultural factors played a role, with age (p-value = 0.049), place of residence (p-value =
0.046), and educational (p-value = 0.000) level influencing utilisation. Furthermore, awareness of
nearby clinics, distance from clinics, and the availability of specific contraceptives were related to
service utilisation. Adequate and qualified healthcare staff, education levels, manageable
workloads, and fair compensation were identified as crucial factors in improving reproductive
health service delivery and access in South Sudan's public health facilities. These findings can
guide policymakers and stakeholders in developing interventions and strategies to promote
reproductive health and improve access to services in South Sudan. It highlights the need for
improving service availability, addressing socio-cultural barriers, ensuring accessible facilities,
and adequately supporting the health workforce to enhance RHS utilisation.
Description
Keywords
Contraceptives, Maternal death, Reproductive health services, Socio-cultural barriers, Family planning