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Analysis of Cohort Data (Kenya PNC) Unintended Pregnancy. Weiwei Zhou, Isolde Birdthistle , Susannah Mayhew - on behalf of the Integra Team. Cohort datasets. Cohort: Kenya PNC (n=869) Four rounds: Baseline, 6 months, 16 months, 24 months Study group: Intervention, Comparison

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analysis of cohort data kenya pnc unintended pregnancy

Analysis of Cohort Data (Kenya PNC)Unintended Pregnancy

Weiwei Zhou, IsoldeBirdthistle, Susannah Mayhew - on behalf of the Integra Team

cohort datasets
Cohort datasets
  • Cohort: Kenya PNC (n=869)
  • Four rounds: Baseline, 6 months, 16 months, 24 months
  • Study group: Intervention, Comparison
  • Facility: 6 (Intervention) + 6 (Comparison)
  • UID: Facility code + Interviewers’ code + Client No.
  • Question: Does integration affect the incidence of unintended pregnancy?
  • Method: Time to event (survival) analysis
outcome event unintended pregnancy
Outcome: Event (unintended pregnancy)
  • Since the last time we saw you (x months ago), have you become pregnant?
    • Yes
    • No
    • Missing

+ (AND)

=

Event occurred

Y = 1

  • At the time you became pregnant with the last pregnancy, did you:
    • Want to become pregnant then;
    • Want to wait until later;
    • Not want to have any/more children?
    • Missing
slide4
Outcome: Event (unintended pregnancy)
  • Since the last time we saw you (x months ago), have you become pregnant?
    • Yes
    • No
    • Missing

+ (AND)

Event did not occur

Y = 0

=

  • At the time you became pregnant with the last pregnancy, did you:
    • Want to become pregnant then;
    • Want to wait until later;
    • Not want to have any/more children?
outcome event unintended pregnancy1
Outcome: Event (unintended pregnancy)
  • What did you do when you discovered that you were pregnant with your last pregnancy?
    • Nothing
    • Attempted to stop but not succeed,
    • Attempted to stop and succeed.

If Y = missing,

Y is considered as 1

=

OR

  • How did you feel when you discovered you were pregnant with your last pregnancy?
    • Happy
    • Unhappy/disappointed
    • Felt nothing
    • other
  • Were you using a family planning method when you became pregnant with this last pregnancy?
    • Yes
    • No

AND

slide6
Date of unintended pregnancy

xx months

R(x-1) interview date

R(x) interview date

xx months

OR

How many months pregnant are you?

Miscarried/aborted

R(x) interview date

R(x-1) interview date

=

( b – a )/2

a

b

OR

Given birth

R(x-1) interview date

R(x) interview date

9 months

slide8
Exposure

1) Study Group (Intervention and Comparison)

2) Baseline index (categorical, <1.5, >=1.5)

3) Averaged cumulative index (per day).

slide9
Exposure: cumulative index

Blue circle: Event (size of circle=level of integration)

Red/Green dot: Higher/Lower ACI exposure group

analysis plan
Analysis plan
  • Cox proportional hazards model
  • Univariate analysis
  • Multivariable analysis, Adjusted for:

Demographic: age, education, religion, employment statutes, household income

SES

Fertility preference: number of children, desired additional number of children, want/when to have another child, also husband’s wish.

Other: HIV status, any children died, numbers of pregnancies

  • Test of model assumption
limitations and conclusions
Limitations and Conclusions
  • Index of visits to non-study clinics are not available. Mean index values of study clinics have been used.
  • Event doesn't have an uniform distribution, thus the averaged cumulative index may not represent daily/monthly exposure to clinics.
  • Interaction terms
  • Kenya PNC: No significant effect by using study group, baseline index, or cumulative index as exposure variable.
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