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Abstract：
BACKGROUND: The United Nations established the Sustainable Development Goals (SDGs) in 2015 to enhance global development. In this study, we examine an SDG indicator: the percentage of women aged 15-49 whose family planning needs are met by modern contraception (mDFPS). We evaluate both the factors influencing its coverage and its progress since 2015.
METHODS: We used nationally representative surveys data (Demographic and Health Surveys (DHS) and Performance Monitoring for Action (PMA)) from Ethiopia, Kenya, and Nigeria. We assessed predictors of mDFPS. We also computed mDFPS coverage across countries and subnational areas, assessing coverage changes from the SDGs onset to the most recent period, using a Bayesian model-based geostatistical approach. We assessed whether the subnational areas exceeded the minimum recommended WHO mDFPS coverage of 75%.
RESULTS: Varied individual and community-level determinants emerged, highlighting the countries\' uniqueness. Factors such as being part of a female-headed household, and low household wealth, lowered the odds of mDFPS, while rural-residence had low odds only in Ethiopia and Nigeria. The results indicate mDFPS stagnation in most administrative areas across the three countries. Geographic disparities persisted over time, favouring affluent regions. The predicted posterior proportion of mDFPS and exceedance probability (EP) for WHO target for Ethiopia was 39.85% (95% CI: [4.51, 83.01], EP = 0.08) in 2016 and 46.28% (95% CI: [7.15, 85.99], EP = 0.13) in 2019. In Kenya, the adjusted predicted proportion for 2014 was 30.19% (95% CI: [2.59, 80.24], EP = 0.06) and 44.16% (95%CI: [9.35, 80.24], EP = 0.13) in 2022. In Nigeria, the predicted posterior proportion of mDFPS was 17.91% (95% CI: [1.24, 61.29], EP = 0.00) in 2013, and it was 23.08% (95% CI: [1.80, 56.24], EP = 0.00) in 2018. None of the sub-national areas in Ethiopia and Nigeria exceeded the WHO target. While 9 out of 47 counties in Kenya in 2022 exceeded the WHO mDFPS target.
CONCLUSIONS: The study unveils demographic, geographic, and socioeconomic mDFPS disparities, signalling progress and stagnation across administrative areas. The findings offer policymakers and governments insights into targeting interventions for enhanced mDFPS coverage. Context-specific strategies can address local needs, aiding SDG attainment.
METHODS: We used nationally representative surveys data (Demographic and Health Surveys (DHS) and Performance Monitoring for Action (PMA)) from Ethiopia, Kenya, and Nigeria. We assessed predictors of mDFPS. We also computed mDFPS coverage across countries and subnational areas, assessing coverage changes from the SDGs onset to the most recent period, using a Bayesian model-based geostatistical approach. We assessed whether the subnational areas exceeded the minimum recommended WHO mDFPS coverage of 75%.
RESULTS: Varied individual and community-level determinants emerged, highlighting the countries\' uniqueness. Factors such as being part of a female-headed household, and low household wealth, lowered the odds of mDFPS, while rural-residence had low odds only in Ethiopia and Nigeria. The results indicate mDFPS stagnation in most administrative areas across the three countries. Geographic disparities persisted over time, favouring affluent regions. The predicted posterior proportion of mDFPS and exceedance probability (EP) for WHO target for Ethiopia was 39.85% (95% CI: [4.51, 83.01], EP = 0.08) in 2016 and 46.28% (95% CI: [7.15, 85.99], EP = 0.13) in 2019. In Kenya, the adjusted predicted proportion for 2014 was 30.19% (95% CI: [2.59, 80.24], EP = 0.06) and 44.16% (95%CI: [9.35, 80.24], EP = 0.13) in 2022. In Nigeria, the predicted posterior proportion of mDFPS was 17.91% (95% CI: [1.24, 61.29], EP = 0.00) in 2013, and it was 23.08% (95% CI: [1.80, 56.24], EP = 0.00) in 2018. None of the sub-national areas in Ethiopia and Nigeria exceeded the WHO target. While 9 out of 47 counties in Kenya in 2022 exceeded the WHO mDFPS target.
CONCLUSIONS: The study unveils demographic, geographic, and socioeconomic mDFPS disparities, signalling progress and stagnation across administrative areas. The findings offer policymakers and governments insights into targeting interventions for enhanced mDFPS coverage. Context-specific strategies can address local needs, aiding SDG attainment.
摘要：
背景：联合国于2015年制定了可持续发展目标（SDGs），以促进全球发展。在这项研究中,我们研究了一个可持续发展目标指标:通过现代避孕(mDFPS)满足计划生育需求的15-49岁女性百分比.我们评估了影响其覆盖率的因素及其自2015年以来的进展。
方法：我们使用埃塞俄比亚的全国代表性调查数据（人口与健康调查（DHS）和绩效监测行动（PMA）），肯尼亚,和尼日利亚。我们评估了mDFPS的预测因子。我们还计算了各国和国家以下地区的mDFPS覆盖率，评估从可持续发展目标开始到最近一段时间的覆盖范围变化，使用基于贝叶斯模型的地统计学方法。我们评估了国家以下地区是否超过了WHO推荐的75%的mDFPS最低覆盖率。
结果：出现了不同的个人和社区水平的决定因素，突出国家的独特性。作为女性户主家庭的一部分，和低家庭财富，降低了mDFPS的几率，而仅在埃塞俄比亚和尼日利亚，农村居民的几率很低。结果表明，这三个国家的大多数行政区域的mDFPS停滞。地理差异随着时间的推移而持续存在，有利于富裕地区。埃塞俄比亚WHO目标的mDFPS和超标概率（EP）的预测后验比例为39.85％（95％CI：[4.51，83.01]，2016年EP=0.08）和46.28%（95%CI：[7.15，85.99]，2019年EP=0.13）。在肯尼亚,2014年调整后的预测比例为30.19%(95%CI：[2.59，80.24]，EP=0.06）和44.16%（95CI：[9.35，80.24]，2022年EP=0.13）。在尼日利亚,mDFPS的预测后验比例为17.91%(95%CI：[1.24，61.29]，EP=0.00），2013年为23.08%（95%CI：[1.80，56.24]，EP=0.00），2018年。埃塞俄比亚和尼日利亚的国家以下地区都没有超过世卫组织的目标。2022年，肯尼亚47个县中有9个超过了世卫组织mDFPS的目标。
结论：这项研究揭示了人口统计，地理,和社会经济mDFPS差异，标志着行政领域的进步和停滞。这些发现为政策制定者和政府提供了针对干预措施以增强mDFPS覆盖率的见解。针对具体情况的策略可以满足当地需求，帮助实现SDG。
方法：我们使用埃塞俄比亚的全国代表性调查数据（人口与健康调查（DHS）和绩效监测行动（PMA）），肯尼亚,和尼日利亚。我们评估了mDFPS的预测因子。我们还计算了各国和国家以下地区的mDFPS覆盖率，评估从可持续发展目标开始到最近一段时间的覆盖范围变化，使用基于贝叶斯模型的地统计学方法。我们评估了国家以下地区是否超过了WHO推荐的75%的mDFPS最低覆盖率。
结果：出现了不同的个人和社区水平的决定因素，突出国家的独特性。作为女性户主家庭的一部分，和低家庭财富，降低了mDFPS的几率，而仅在埃塞俄比亚和尼日利亚，农村居民的几率很低。结果表明，这三个国家的大多数行政区域的mDFPS停滞。地理差异随着时间的推移而持续存在，有利于富裕地区。埃塞俄比亚WHO目标的mDFPS和超标概率（EP）的预测后验比例为39.85％（95％CI：[4.51，83.01]，2016年EP=0.08）和46.28%（95%CI：[7.15，85.99]，2019年EP=0.13）。在肯尼亚,2014年调整后的预测比例为30.19%(95%CI：[2.59，80.24]，EP=0.06）和44.16%（95CI：[9.35，80.24]，2022年EP=0.13）。在尼日利亚,mDFPS的预测后验比例为17.91%(95%CI：[1.24，61.29]，EP=0.00），2013年为23.08%（95%CI：[1.80，56.24]，EP=0.00），2018年。埃塞俄比亚和尼日利亚的国家以下地区都没有超过世卫组织的目标。2022年，肯尼亚47个县中有9个超过了世卫组织mDFPS的目标。
结论：这项研究揭示了人口统计，地理,和社会经济mDFPS差异，标志着行政领域的进步和停滞。这些发现为政策制定者和政府提供了针对干预措施以增强mDFPS覆盖率的见解。针对具体情况的策略可以满足当地需求，帮助实现SDG。
