Prevalence and associated factors of client satisfaction with family planning service among family planning users in Ethiopia: a systematic review and meta-analysis

Studies included in this study were searched using Medline/PubMed, Web of Science, Google Scholar, Scopus, the Ethiopian University Repository online, and the Cochrane Library. In addition, missing data were handled by contacting the corresponding authors. Additionally, missing data were processed by contacting the corresponding authors. Through the standard Population Intervention Comparisons and Outcomes (PICO) questions, a comprehensive search strategy was developed using various Boolean operators. The following search terms were used: "or" and "and". Using Boolean operators, satisfaction and 'family planning or contraception' or client or woman or mother and related factors and Ethiopia and related terms (Amhara, Oromia, Somalia, Southern National Ethnic Region (SNNPR), Tigray, Sidama, Gambella, Afar, Benshangul regions, and Addis Ababa and Dire Dawa city adminstrarion). All studies retrieved from the database were exported to the Endnote library and searched first by title and abstract. The full text of these articles met the selection criteria for title and abstract and was read in full. A systematic review with narrative synthesis was used to estimate the outcome of the articles in Ethiopia. For homogeneous articles, a meta-analysis was considered.

Data extraction was based on parameters such as author name, year of publication, a place where the studies were conducted, the sample size of each study, and the study design. We (TG, EE, and EI) used Microsoft Excel spreadsheets to collect key data from the accepted articles. The authors (TG, NA, and TL) independently extracted data from those included. After consensus and detailed discussion on data extraction was reached and significant analyzes were performed using the Joanna Brings Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MASTER), studies meeting the inclusion criteria were included and tabulated. Articles are checked for quality before selection for final review. Studies with a quality indicator score of 7 or higher on her were classified as low risk. (Table 1).

Data were extracted using a Microsoft Excel spreadsheet and the extracted data were analyzed using STATA version 14. Using a random-effects model meta-analysis, we calculated the overall CS including factors associated with his FP service in Ethiopia. Publication bias was checked by visual assessment using funnel plots. Cochrane Q-Static and I² were used to confirm heterogeneity between studies. Subgroup analyzes were performed to compare the pooled prevalence of CS with FP and related factors across regions. Pooled prevalence was presented in forest pilot format with 95% CI.

From November to December 2022, more than 50 articles were identified in major electronic databases and additional applicable sources were searched. Of these identified items, 15 articles were removed for duplication and 35 articles were reserved for further review. Thirteen studies were excluded because their abstracts and titles did not meet the requirements. Of the remaining 22 articles, 10 studies were excluded because they conflicted with the inclusion criteria set for that study. Finally, 12 studies that met the eligibility criteria were included in this study. (Fig. 1).

A total of 12 articles with 5087 participants were included in this systematic review and meta-analysis. All included studies were cross-sectional studies and sample sizes ranged from [21] to 604 [26]. Regarding the regional distribution of the included studies, four were from the Oromia region [12, 25‐27], two from the Amhara region [16, 28], one from Somalia [15], and five from Southern Nations, Nationalities, and Peoples’ Region (SNNPR) [10, 21‐24] (Table 2).

Among the included studies, the prevalence of client satisfaction with family planning ranged from 42.8 [26] to 75.3 [10]. The pooled estimated prevalence of CS with FP treatment among Ethiopian contraceptive users was 56.78% [95% CI (49.99; 63.56); I² = 96.2%, P ≤ 0.001] (Fig. 2).

In subgroup analyzes performed in each region, the highest prevalence of CS was observed in SNNPR with values ​​of 65.6% (95% CI: 56.9, 75.2) and Amhara with 60.3% (48.07; 71.9), followed by the Somali region 47.1% (46.69, 51.51). The lowest values ​​were observed in the Oromia region, at 46.4 (42.16, 50.63) (Fig. 3).

To minimize and balance study heterogeneity, subgroup analyzes were performed by region. The results of the I² test indicate that there was considerable heterogeneity between studies (I² = 96.2%, p-value of P ≤ 0.001) (Fig. 2). In addition, a random-effects model was used to control for study heterogeneity. Publication bias of the studies was monitored by Egger's test and visual inspection of the funnel plots. Funnel plot results showed that the selected studies had a symmetrical distribution after inspection (Fig. 4a) and Egger's test (P = 0.420) (Fig. 4b). This indicates no publication bias.

In this review, three variables ( privacy maintained, educational level, and waiting time) were significantly associated with FP service, while the side effects explained were not significantly associated with CS (p = 0.774) (Fig. 5).

The review showed a significant association between women's level of education and CS. Women with higher education had 53% higher satisfaction than those with lower education (OR = 0.47, p = 0.001, I² = 87.4%) (Fig. 6). This review demonstrated that there was a significant association between waiting time and CS (OR = 0.2, p = 0.0001, I² = 75.0%) (Fig. 7). In this review, women whose privacy was maintained were 5.46 times more likely to be satisfied with family planning services compared to their contrast group (OR = 5.46, p = 0.000, I² = 95.8%) (Fig. 8).