Individual and community-level determinants of knowledge of ovulatory cycle among women of reproductive age in 29 African countries: a multilevel analysis

BACKGROUND: Knowledge of the ovulatory cycle (KOC) can help reduce the chances of unwanted pregnancies and may improve a woman’s reproductive health. However, little is known about the factors associated with knowledge of the ovulatory cycle across Africa. Therefore, we aimed to investigate the individual/household and community level determinants of KOC among women of childbearing age in 29 African countries. METHODS: We used data from the Demographic and Health Surveys of 29 African countries conducted between 2010 and 2020. Bivariate and multivariate multilevel logistic regressions were used to examine the association between women’s correct knowledge of the ovulatory cycle and individual/household and community-level factors. The results were reported using adjusted odds ratios (AOR) with a 95% confidence interval (CI). RESULTS: The pooled results showed that correct KOC among women was 15.5% (95% CI 14.2–17.0%), varying from 11.5% in Liberia to 57.1% in the Democratic Republic of Congo. Regarding regional distribution, the highest prevalence of KOC was observed in West Africa (38.8%) followed by East Africa (21.3%) and was lowest in Southern Africa (15.6%) and Central Africa (15.5%). After adjusting for potential confounders, at the individual level, we found the odds of KOC to be higher among older women (40–44 years-aOR 3.57, 95% CI 1.90–6.67, 45–49 years-aOR 2.49, 95% CI 1.29–4.82), and women with higher educational level (aOR 2.58, 95% CI 1.40–4.75); at the community level, higher KOC was among women exposed to media (aOR 2.24, 95% CI 1.32–3.81). CONCLUSIONS: Knowledge of ovulatory cycle among women of reproductive age was found to be low in the region and varied by country. Women’s age and educational level were the individual-level factors associated with increased knowledge of ovulatory cycle while community-level media exposure was found to be associated with increased knowledge of ovulatory cycle in this study. This finding highlights the need for appropriate strategies (possibly use of mass media) to increase knowledge of ovulatory cycle among women of reproductive age, especially among adolescents in Africa.