Intention to use vasectomy and its associated factors among married men in Debre Tabor Town, North West Ethiopia, 2019

Alemu Degu Ayele; Fentahun Yenealem Beyene; Kihinetu Gelaye Wudineh; Bekalu Getnet Kassa; Yitayal Ayalew Goshu; Gedefaye Nibret Mihretie

doi:10.1371/journal.pone.0238293

. 2020 Sep 3;15(9):e0238293. doi: 10.1371/journal.pone.0238293

Intention to use vasectomy and its associated factors among married men in Debre Tabor Town, North West Ethiopia, 2019

Alemu Degu Ayele ¹, Fentahun Yenealem Beyene ^2,^*, Kihinetu Gelaye Wudineh ², Bekalu Getnet Kassa ¹, Yitayal Ayalew Goshu ¹, Gedefaye Nibret Mihretie ¹

Editor: Wen-Jun Tu³

PMCID: PMC7470275 PMID: 32881873

Abstract

Background

Vasectomy is one of the most effective and permanent male contraceptive methods, and involves cutting and ligating the vas deferens to make the semen free of sperm during ejaculation. Although it is effective, simple, and safe, it is not well known and practiced in the majority of our community. This study assessed the intention to use vasectomy and its associated factors among married men in Debre Tabor Town, North West Ethiopia, 2019.

Methods

A community- based cross-sectional study was conducted among 402 married men from March 05 to April 15, 2019. A simple random sampling technique was employed to select the study participants. Data was collected by face to face interview using a structured and pre-tested questionnaire. Questions concerned socio-demographic and reproductive variables and views on vasectomy. The association between variables was analyzed using a bivariable and multivariable logistic regression model.

Result

A total of 402 participants were included with a response rate of 98.75%. The mean participant age was 37.12(SD ± 6.553) years with the age range of 20–56 years. The prevalence of intention to use vasectomy was 19.6% with 95%CI (15.6%-23.4%). Multivariable logistic regression showed that age from 30–39 years (AOR = 3.2(95% CI: 1.19–8.86)), having more than three living children (AOR = 2.5(95% CI: 1.41–4.68)), good knowledge (AOR = 3.4(95%CI: 1.88–6.40)) and positive attitude (AOR = 4.8(95% CI: 2.61–8.80)) of married men were significantly associated with intention to use vasectomy.

Conclusion and recommendation

Intention to use vasectomy was comparable with findings in four regions of Ethiopia (Amhara, Oromia, SNNP, and Tigray). Age, the number of living children, knowledge, and attitude were significantly associated with the intention to use vasectomy. Improving the level of knowledge and attitude towards vasectomy is an essential strategy to scale up the intention of men to use vasectomy.

Background

In mid-2016, the estimated population of Ethiopia was 101.7 million which is the second fast population growth in Africa next to Nigeria [1]. It is also affected by high maternal morbidity and mortality related to unintended and unwanted pregnancies [1, 2]. The goal of family planning all over the world has attracted attention due to its importance in decision making about population growth and development issues [3]. Worldwide, using contraceptives potentially reduced maternal mortality by 44% [4].

Even though the 1994 International Conference on Population and Development (ICPD) in Cairo emphasized that men’s involvement in sexual and reproductive health issues is very important for a better outcome and set clear directions to increase men’s participation in family planning, male involvement in family planning is still very low in Africa [5–7].

Vasectomy is a male method of contraceptive which is known and acceptable only in some developed countries of the world. Although it is safe and easy to perform, only 45 million couples worldwide rely on it [8, 9].

International health organizations in recent years have suggested that the involvement of men on the utilization and promotion of contraceptive methods is very crucial to provide couples with more male-oriented contraceptive choices, such as vasectomy. Even though its procedure is simple and easy with a high success rate (>99%) and minimal complications, it is underutilized around the world, especially in developing countries including Ethiopia [10–12]

Couples who complete their family or no want more children, vasectomy is the option than tubal ligation, due to it poses fewer surgical risks. Although it’s a higher effective, simple process and fewer complications, currently vasectomy users in the United States only 8% [13].

Ethiopia has a target plan to increase the contraceptive prevalence to 55% by the year 2020 [14]. To achieve this goal, the government in collaboration with other stack holders focuses on different FP methods by increasing demand and access to long-acting and permanent methods [15]. Due to this effort, the Contraceptive Prevalence Rate (CPR) with currently married women were reached 36%, with 35% using modern methods and 1% using traditional methods. Of 35%, injectable (23%), implant (8%), IUD(2%), pills(2%), male condom and tubal ligation <1% Ethiopia Demographic Health Survey (EDHS 2016) [16].

Different reviewed literature reports showed that the intention to use vasectomy was associated with different variables [11, 15, 17, 18]. Age, educational status, occupation, religion, Cultural beliefs, societal norms, lack of knowledge about the procedure for a vasectomy, and misconceptions were found to be predictors of intention to use vasectomy. In addition, the duration of married time, number of living children, complete family size, the future desire of more children, accessibility of service, level of knowledge, and attitude of men towards vasectomy have an influence on intention to use vasectomy [18–22].

According to EDHS 2016, the national demand for family planning is 58%. However, vasectomy utilization is almost negligible [16]. There are very few studies on the intention of married men to use vasectomy in Ethiopia. Therefore, this study was designed to determine the intention of men to use vasectomy and identify factors associated with the intention to use vasectomy among married men in Debre Tabor Town, Northwest Ethiopia.

Methods

Study design and setting

A community- based cross-sectional study design was conducted in Debre Tabor Town from March 05 to April 15, 2019. The Town is found in the Amhara region, and it is a capital city of South Gondar Zone, North West Ethiopia. It is located 665 kilometers from the capital city of Ethiopia and 103 kilometers North West of Bahir Dar Town. The Town was divided into six small administrative units called kebeles with a total population of 92, 530 based on the 2018 report of Town administration [23]. The Town had one general hospital, three health centers, and four health posts that provide family planning and other health services in the study area. All married men whose wives were in the reproductive age group living in all six kebeles of Debre Tabor Town were the study population. All married men whose wives were in the reproductive age group in the town within the study period were included. Whereas married men whose wife were in the reproductive age group who were critically ill (bed reddened), had already done vasectomy, had infertile wife, and had a wife with a hysterectomy and married men women who live less than 6 months during data collection period in Debre Tabor town were excluded.

Sample size calculation and sampling procedures

Epi-Info version 7 statistical software was used to calculate the sample size assuming that 39% of men had the intention to use vasectomy [21], 95% confidence interval with a 5% margin of error. By adding a 10% non-response rate the final sample size was 402. A simple random sampling technique was applied to select 402 married men. A total of 14,088 households and 14,614 married men were living in the town [23]. A household was sampling unit in each kebeles and samples were allocated proportionally to each kebeles based on their total household number. Household numbers with married men in each kebeles were found from the kebeles registration book. Study households were selected from each kebeles through a simple random sampling technique by using a table of random numbers starting from kebele one from a random start point. The first household was selected in each kebele by using the lottery method. One married man per household was interviewed. When two or more eligible men were found in one household, only one was interviewed by lottery method and if no eligible men were identified in the selected household, the next eligible household located in the clockwise direction was visited and included until we got the desired sample size (Fig 1).

Measurement and data collection procedure

Data were collected via face to face interview techniques using a structured, validated, and pre-tested questionnaire. The tool was first prepared in English then translated to Amharic and back to English by language experts to maintain the consistency of the instrument. Three diploma holder male midwives conducted the face to face interview and one BSc degree midwife supervised the data collection process. The information was collected on participants socio-demographic characteristics (age, religion, educational status, wife education, occupation and wife occupation), Reproductive characteristics (duration of married life, number of living children, the desire of more children, discussion with a partner, support from a partner), knowledge- related, and attitude- related questions (S1 File). Intention to use vasectomy means the planning of respondents to use vasectomy as a contraceptive method for a future time [24]. In this study knowledge about vasectomy was determined by using nine knowledge’s related questions. A value of one and zero was given for each correct and incorrect answer respectively and labeled as good knowledge; those individuals who answered at least five knowledge related questions and poor knowledge; those answered less than five knowledge’s related questions. In this study attitude about vasectomy was determined by using nine attitudes related questions and labeled as a positive attitude; those participants who scored greater than or equals to the mean score and negative attitude; those individuals who scored less than the mean score [25, 26].

Data quality assurance

The data collection tool was prepared after an intensive review of relevant literature. Pretest of the questionnaire was done on 20 married men in Wereta Town and adjustments were made accordingly. Any error, ambiguity or incompleteness identified was corrected immediately. Data collectors and supervisors were trained for one day about the contents of the questionnaire, the aim of the study, method of data collection, confidentiality, responders’ right, and informed consent. The completeness of the data was checked by data collectors during data collection and also immediately after data collection by the supervisor and principal investigator.

Data processing, analysis, and interpretation

Data were cleaned, coded, and entered by using Epi-Data version 3.1 and then exported to SPSS version 23 for analysis. Descriptive statistics like frequencies and percentages were used to present the categorical independent variables and mean/standard deviation was used to describe a continuous variable. Frequency tables and graphs were used to present descriptive results. Bivariable logistic regression analysis was executed by computing odds ratio (OR) with a 95% confidence interval to see the association between each independent and dependent variable. Finally, all independent variables associated with dependent variables with p<0.2 were entered into multivariable logistic regression for further analysis by controlling confounding factors and significant association was identified based on p<0.05 and adjusted odds ratio (AOR) with 95% CI. Model adequacy was checked using the Hosmer and Lemeshow goodness of fit test (p-value = 0.41).

Ethics approval and consent to participate

Ethical clearance was obtained from the institutional review board of Bahir Dar University. A support letter was written to the Debre Tabor town administration and consent was obtained. Participants of the study were informed about the purpose, objectives, and their right to participate or not participate in the study. Privacy and confidentiality of the study participant were ensured by keeping all information anonymous. Written informed consent was obtained from each participant.

Result

Socio-demographic characteristics of participants

A total of 402 married men participated in this study with a response rate of 98.75%. Half of the respondents 200(50.3%) were belonged to the age group of 30–39 years with the mean age and standard deviation of 37.12 (±6.553) years and with the age range of 20–56 years. The majority of the participants, 387(96.7%) were Amhara by ethnicity and orthodox Christian followers, 355(89.4%). More than half of the participants, 252(63.4%) were their educational status was college and above and one hundred eight two (45.8%) participants wives have attained college and above in their educational status. One hundred seventy-three (43.6%) participants and one hundred thirteen was a civil servant by occupation (Table 1).

Table 1. Percentage distribution of the study population by socio-demographic characteristics; Debre Tabor Town, North West Ethiopia, March 05-April 15, 2019 (N = 397).

Variables	Frequency	Percent
Age 20-29years	57	14.4
30–39 years	200	50.3
40–49 years	119	30.0
≥50 years	21	5.3
Mean age ± SD		37.12±6.553
Ethnicity Amhara	384	96.7
Oromo	7	1.8
Others^*	6	1.5
Religion Orthodox	355	89.4
Muslim	33	8.3
Others^**	9	2.3
Educational status No formal education	36	9.1
Primary	36	9.1
Secondary	73	18.4
College and above	252	63.4
Wife education No formal education	56	14.1
Primary	65	16.4
Secondary	94	23.7
College and above	182	45.8
Occupation Civil servant	173	43.6
Private business	164	41.3
Employed at private	45	11.3
Daily laborer	15	3.8
Wife occupation House wife	157	39.5
Civil servant	113	28.5
Private business	92	23.2
Employed at private	21	5.3
Student	14	3.5

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*Tigray, Gurage

** protestant, catholic

Reproductive characteristics of participants

Among the respondents, 157(39.5%) were living with their wives from 6–10 years with the average duration of marriage 9.85 years. Two hundred forty-three (61.2%) of participants had three living children. The majority of the study participants, 355(89.4%) were discussed about FP with their partner. One hundred two (25.7%) participants got emotional support from their partner to use vasectomy. Two hundred eighty-one (70.8%) participants were completed their family size. Among 116(29.2%) participants who had not completed their family size, 83(72%) participants were their number of children desire was three and less than three for their future life (Table 2).

Table 2. Percentage distribution of the study population by reproductive characteristics; Debre Tabor Town, North West Ethiopia, March 05 -April 15, 2019(N = 397).

Variables	Frequency	Percent
Duration of married year ≤ 5 years	95	23.9
6–10 years	157	39.5
11–15 years	77	19.5
≥16 years	68	17.1
mean ± (SD)		9.85±4.82
Number of living children ≤3 children	243	61.2
>3 children	154	38.8
mean ±(SD)		3.01±1.56
Discuss FP with a partner no	355	89.4
yes	42	10.6
Get emotional support from partner no	102	25.7
Yes	295	74.3
Complete family size no	116	29.2
yes	281	70.8
Future desire no of children(N = 116)
≤ 3 children	83	72
>3 children	33	28
mean±(SD)		2.73±1.42

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Knowledge of participants towards vasectomy

Two third of the study participants 247(62.2) had poor knowledge about vasectomywhile150 (37.8%) of them had good knowledge (Table 3).

Table 3. Percentage distribution of the study population by knowledge related questions; Debretabor Town, North West Ethiopia, March 05-April 15, 2019 (N = 397).

Knowledge related questions	Response	Frequency (%)
Heard about vasectomy Do you know that vasectomy is a contraceptive method by cutting and ligating Vass deference?	Yes	185(46.6)
	No	212(53.4)
Vasectomy is permanent and irreversible?	Yes	146(36.8)
Vasectomy is permanent and irreversible?	No	251(63.2)
Does vasectomy require a minor surgical procedures?	Yes	145(36.5)
Does vasectomy require a minor surgical procedures?	No	252(63.5)
Seminal fluid during ejaculation are present after vasectomy	Yes	88(22.2)
	No	209(77.8)
Do you know how a vasectomy works?	Yes	62(15.6)
Do you know how a vasectomy works?	No	335(84.4)
Vasectomy is done in Ethiopia without any charge	Yes	28(19.6)
Vasectomy is done in Ethiopia without any charge	No	319(80.4)
Do you know where vasectomy service is available	Yes	122(30.7)
Do you know where vasectomy service is available	No	275(69.3)
Have you heard that who can use vasectomy as a family planning?	Yes	150(37.8)
	No	247(62.2)
If yes who are they(N = 150)	All married men	26(17.4)
If yes who are they(N = 150)	Married men who complete the family size	124(82.6)

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The attitude of participants towards vasectomy

The majority of participants 245(61.7%) had a negative attitude while 152(38.3%) had a positive attitude towards vasectomy (Table 4).

Table 4. Percentage distribution of the study population by attitude related questions; Debre Tabor Town, North West Ethiopia, March 05-April 15, 2019 (N = 397).

Attitude related questions	Agree	Neutral	Disagree
FP is the responsibility of women	15(3.8)	2(0.5)	380(95.7)
Do you believe that vasectomy negatively affects sexual performance/desire	95(23.9)	222(55.9)	80(20.2)
Do you believe that vasectomy has series side effects	133(33.5)	203(51.1)	61(15.4)
Vasectomy is not acceptable in my religion	280(70.5)	52(13.1)	65(16.4)
Vasectomy is culturally unacceptable	259(65.2)	63(15.9)	75(18.9)
I am uncertain for the future pregnancy may happen after vasectomy	82(20.7%	204(51.3)	111(28)
Vasectomy is similar to castration	132(33.2)	203(51.1)	62(15.7)
Vasectomy can cause physical weakness, cannot do hard work	38(9.6)	247(62.2)	112(28.2)
Vasectomy can ashamed the individual in the community	82(20.6)	127(32%)	188(47.4)

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Intention to use vasectomy and reason not to use vasectomy among study participants

This study identified that 19.6% with 95% CI (15.6–23.4) participants had the intention to use vasectomy as a contraceptive method for their future life.

In this study, 80.4% of the participants had no intention to use vasectomy as a contraceptive method for their future life due to many reasons. Among this, lack of awareness (74%) was the major reason followed by religious prohibition (70.5%) (Fig 2).

Factors affecting intention to use vasectomy among study participants

In binary logistic regression; age, participant wife occupation, duration of the married year, number of living children, and level of knowledge and attitude of participants had an association with intention to use vasectomy. In multivariable binary logistic regression analysis, after adjusting other co-variables by using backward likelihood stepwise method; age, number of living children, level of knowledge, and attitude had a significant association with intention of married men to use vasectomy.

Participants whose age group between 30–39 years were 3.2 times more likely to have the intention to use vasectomy [AOR = 3.2, (95% CI: 1.19–8.86)] as compared to Participants whose age lies below 30 years. Married men who had more than 3 alive children were 2.5 times higher the odds of intention to use vasectomy [AOR = 2.5(95% CI: 1.41–4.68)] as compared to men who had less than or equals to three alive children.

Moreover, study participants who had good knowledge about vasectomy were 3.4 times the odds of intention to use vasectomy [AOR = 3.4(95% CI: 1.88–6.40)] as compared with study participants who had poor knowledge about vasectomy. Participants who had a positive attitude towards vasectomy were 4.8 times more likely to use vasectomy as compared with their counterparts [AOR = 4.8(95%CI: 2.61–8.80)] (Table 5)

Table 5. Bivariable and multivariable analysis of factors affecting intention to use vasectomy; Debre Tabor town, North West Ethiopia, March 05-April 15, 2019(N = 397).

Variables	Intention to use vasectomy
Variables	Yes No		COR (95%CI)	AOR (95%CI)	P-value
Age 20–29 years	6(10.5)	51(89.5)	1	1
30–39 years	55(27.5)	145(72.5)	3.224(1.309–7.938)	3.251(1.192–8.863)	0.021*
40–49 years	12(10.1)	107(89.9)	0.953(0.339–2.684)	0.861(0.274–2.702)	0.797
≥50 years	5(23.8)	16(76.2)	2.656(0.715–9.874)	3.216(0.73714.028)	0.120
Educational status
No formal education	5(13.9)	31(86.1)	1	1
Primary	6(16.7)	30(83.3)	1.24(0.342–4.498)	0.99(0.237–4.13)	0.989
Secondary	5(6.8)	68(93.2)	0.456(0.123–1.690)	0.35(0.084–1.449)	0.148
College and above	62(24.6)	190(75.4)	2.023(0.754–5.429)	1.142(0.373–3.492)	0.816
Wife education
No formal education	9(16.1)	47(83.9)	1	1
Primary	7(10.8)	58(89.2)	0.63(0.218–1.819)	0.54(0.141–2.063)	0.368
Secondary	16(17.0)	78(83.0)	1.071(0.438–2.617)	0.996(0.279–3.553)	0.995
College and above	46(25.3)	136(74.7)	1.766(0.804–3.883)	1.149(0.299–4.412)	0.84
Occupation
Civil servant	33(19.1)	140(80.9)	0.354(0.118–1.063)	0.218(0.042–1.128)	0.069
Private business	31(18.9)	133(81.1)	0.350(0.116–1.055)	0.257(0.049–1.337)	0.106
Employed in the private sector	8(17.8)	37(82.2)	0.324(0.090–1.172)	0.293(0.049–1.768)	0.181
Daily laborer	6(40.0)	9(60.0)	1	1
Wife occupation
House wife	27(17.2)	130(82.8)	1	1
Civil servant	28(24.8)	85(75.2)	1.586(0.875–2.876)	1.067(0.488–2.332)	0.870
Private business	12(13.0)	80(87.0)	0.722(0.346–1.506)	0.499(0.208–1.199)	0.120
Employed at private	5(23.8)	16(76.2)	1.505(0.508–4.459)	1.643(0.425–6.349)	0.472
Student	6(42.9)	8(57.1)	3.611(1.159–11.25)	0.858(0.180–4.082)	0.847
Duration of married
≤ 5 yrs	12(12.6)	83(87.4)	1	1
6–10 yrs	31(19.7)	126(80.3)	1.702(0.827–3.502)	1.007(0.422–2.405)	0.987
11–15 yrs	19(24.7)	58(75.3)	2.266(1.021–5.026)	1.161(0.371–3.635)	0.798
≥ 16 yrs	16(23.5)	52(76.5)	2.128(0.933–4.856)	2.124(0.614–7.342)	0.234
No of living children ≤ 3	36(14.8)	207(85.2)	1	1
>3	42(27.3)	112(72.7)	2.156(1.306–3.559)	2.575(1.416–4.684)	0.002^*
Discus with partner on FP
No	5(11.9)	1	1	1
Yes	73(20.6)	282(79.4)	1.916(0.727–5.047)	1.77(0.573–5.469)	0.321
knowledge poor	25(10.1)	222(89.9)	1	1
good	53(35.3)	97(64.7)	4.852(2.850–8.260)	3.473(1.884–6.404)	0.001^*
Attitude Negative	24(9.8)	221(90.2)	1	1
Positive	54(35.5)	98(64.5)	5.074(2.967–8.676)	4.801(2.617–8.807)	0.001^*

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* P-value < 0.05 considered as statistically significant

Discussion

Within the sphere of family planning, vasectomy is very often ignored, despite being one of the safest, simplest, and highly effective and least expensive contraceptive methods [5]. The descriptive report of this study revealed that around 37.8% and 38.3% of participants had good knowledge and positive attitude towards vasectomy respectively. This implied that there was poor knowledge and attitude towards vasectomy in the study area; to improve this; the country should design and implement the following strategies in its program;—Provision of Information and Services for Men in clinic setup, Outreach Male Motivators, and Peer Educators; Community Engagement; design community communication program; comprehensive Sexuality Education should be design and design community campaign. When compared to studies done in Malaysian private medical college which is (60.9%and 76%) of the respondents had a positive attitude and showed good acceptance towards vasectomy [27] which is significantly higher than from our studies. This might be due to the difference in study participants since the previous study was conducted on the medical students they might be hade a better view and attitude towards vasectomy than the general population.

Another surprising descriptive report of this study was participants educational level, college and above (63.4%) and participants occupation, civil servant (43.6%). This implies that as participants more educated and becoming civil servants; they might have easy access to information regarding to their fertility desire and might have more awareness and easily decide to use it. When compare to the finding in EDHS 2016 report which was (5%) and not more than 5% of respondents attained secondary school and above and their occupation is civil servant [16] respectively. This might be due to difference in study population, study area and time. The previous study was conducted at large country level which included both urban and remote rural areas that might be results lower educational level and civil servants whereas the current study was conducted at single town the educational characteristics might be more educated and also as they more educated the more being civil servant also since they are nearby information and access to education. And the other hypothesis might be the previous study participants marital status were both married and un married respondents were considered whereas current study only on married respondents considered; this also might be reason of the difference.

This study showed that 19.6% of participants had the intention to use vasectomy for their future life. This finding was in lined with the studies done in India showed that 21.4% and 21% of the participants had the intention to use vasectomy [28, 29] respectively.

The intention of married men to use vasectomy in this study was also in agreement with study conducted in Bangalore rural population (17%) [30], Indonesia (16.6%) [20] and four regions of Ethiopia (Oromia, Amhara, SNNP and Tigray) (18.1%) [15].

But the finding of this study was lower than studies conducted in Kenya and Rwanda (27.5%, 26.6%) [18, 19] respectively. The discrepancy may be due to differences in the number of children the participants had since only 38.8% of participants in this study had more than three children but in the comparable studies (76.6% and 63.3%) of the participant had more than three children respectively. In addition, only 38.3% of the participant in this study had a positive attitude but in Rwanda, 60% of the participant had a positive attitude towards vasectomy which had a direct relationship with their intention.

According to our study, the intention to use vasectomy as a FP method was also lower than study conducted in the East Wollega zone of the Oromia region (30%) [22]. The discrepancy may be due to difference in study setting and participants. The current study was community- based but the previous study was done in a health institution and the participants were men who were visiting health institutions together with their partner for FP service, maternity and child health unit, which has a positive impact on their intention by increasing their awareness about the method.

The finding of our study was higher than the study conducted in India (11%) and Turkey(11.4%) [17] and [10] respectively. The variation may be due to difference in the marital status of study participants, in the current study only married men participated but in the previous study, the participants were both married and unmarried men who had a significant difference in their intention since thinking about vasectomy without being married is not ideal and visible. And also the difference is might be difference in socio-demographic characteristics, study area, and participants.

The result of this study revealed that being in the age category of 30–39 years had an increased intention to use vasectomy as a contraceptive method as compared to the age category of 20–29 years. This finding is supported by studies conducted in India and Nepal [17, 31]. Another study conducted in Indonesia also showed that the age of the respondent which was found between 30–39 had a significant relationship with intention to vasectomy [32].

The possible explanation for this finding might be participants in this age category (30–39) might have easy access to information and educated from the younger once, as the educational status increase, the knowledge might also scale up in the same fashion which had a positive impact on intention. The other reason might be men in the age category of 30–39 may have steady jobs, a greater number of living children, and stable family life from younger once. Another explanation those mens, whose aged 40 and above years might be thought that their wives near to menopause and no more have children at more.

According to our study finding, having more than three living children was the other predictor variable as it stated that having more than three children increase the intention of participants to use vasectomy. Similar studies conducted in Indonesia stated that as the number of alive children increases the intention to use vasectomy was also increased [20, 32]. Likewise, research conducted in India also concluded that the number of living children was a significant predictor for intention to use vasectomy [33]. The finding of this result was also supported by studies performed in Kenya and Rwanda [18, 19]. The possible reason may be men who had a smaller number of children might have a high future fertility desire and their intention to use the contraceptive methods might be low. In other words, since vasectomy is permanent and irreversible, it is a choice of contraceptive method for those men who had more children and for those who want to limit their family.

The result of this study also showed that there was a positive relationship between knowledge of vasectomy and its acceptance by married men; it revealed that participants who had good knowledge about vasectomy had a higher intention to use it. The finding was also in line with a study conducted in Nigeria and the Kingdom of Eswatini [34] and [11] respectively. This might imply that knowledge plays an important role in the intention of vasectomy by increasing the awareness of individuals, having good knowledge about vasectomy used to helps men to know the importance of it from other methods avoids different misconceptions, changes the behavior and positively affects the attitude of men towards vasectomy.

Men who had a positive attitude towards vasectomy had increased intention to use it from that of men who had a negative attitude. The finding of this study was in agreement with the study finding from Nepal and Indonesia [21] and [20].

This might be attitude is a key factor that influence the intention, men with positive attitude towards vasectomy are better able to use it and share responsibilities in FP practice with their partner. The other reason may be individual who had positive attitude, they can break myths and misconception that was negatively affects intention to use vasectomy.

Generally, even though the health policy of Ethiopia puts or states different strategies to decrease maternal mortality like optimum utilization of family planning, but no practical change in attitudinal, behavioral, cultural and reliogional change is showed in men’s family planning utilization like vasectomy; therefore, the countries policy should work for practical change rather theoretical report. In addition, for researcher community based, qualitative studies should run, that can find out more explorative factors.

Conclusion

In conclusion, the prevalence of intention of married men to use vasectomy for future life was inlined with a study done in four regions of Ethiopia (Amhara, Oromia, SNNP and Tigray). Age (30–39) years, having more than three living children, having good knowledge, and a positive attitude towards vasectomy were significantly associated with the intention to use vasectomy for future life as a contraceptive method. As per finding, improving level of knowledge and attitude towards vasectomy is an essential strategy to scale up the intention of men to use vasectomy. We also recommend further researchers to come up with additional and detailed findings especially on qualitative aspect.

Supporting information

S1 File. English version questionnaires.

(DOCX)

Click here for additional data file.^{(20.1KB, docx)}

Acknowledgments

The authors would like to acknowledge College of Medicine and Health Sciences, Bahir Dar University, for sponsoring this research project. We would also like to extend our heart full gratitude to Debre Tabor town Administration for permitting to conduct the study and providing the necessary preliminary information. The last but not the list we would like to extend our appreciation to the study participants, supervisor and data collectors.

Data Availability

All relevant data are within the manuscript and its Supporting Information files.

Funding Statement

Yes, Bahirdar University.

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PLoS One. doi: 10.1371/journal.pone.0238293.r001

Decision Letter 0

Sphiwe Madiba

4 Feb 2020

PONE-D-19-27356

Intention to use vasectomy and its associated factors among married men in Debretabor Town, North West Ethiopia, 2019.

PLOS ONE

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Additional Editor Comments

Please revise the introduction to provide a generalized background vasectomy and its utilization, benefits, family planning, involving men in reproductive health, factors associated with low uptake of vasectomy and opinions and attitudes of men about vasectomy. There is adequate and recent data on the topic in sub Saharan Africa
I am recommending the following articles;

Please read Shattuck et al, A review of 10 years of vasectomy programming and research in low-resource settings. Glob. Health: Sci. Pract. 2016, 4, 647–660 for the global statistics on vasectomy,

Also read Shongwe et al, Assessing the Acceptability of Vasectomy as a Family

Planning Option: A Qualitative Study with Men in the Kingdom of Eswatini, nt. J. Environ. Res. Public Health2019, 16, 5158. Please tell us about the factors associated with the low uptake of vasectomy

Barriers to O_ering Vasectomy at Publicly Funded Family Planning Organizations in Texas. Am. J. Men Health 2017,

Please read, Kısa et al. Opinions and attitudes about vasectomy of married couples living in Turkey. Am. J. Men Health 2017, 11, 531–541

Mar, S.O.; Ali, O.; Sandheep, S.; Husayni, Z.; Zuhri, M. Attitudes towards vasectomy and its acceptance as a method of contraception among clinical-year medical students in a Malaysian private medical college

Methods

Please follow the journal’s standard subheadings for the methodology.
Integrate the operational definitions with the measures and data analysis, write as a narrative, and remove the bolding from the words.

Data collection

Provide details on the tool and type of questions that were asked. Was the tool validated, how was intention measured-the type of question, what does future intention mean- is there a time factor on the future?

Results

Please follow the standardized categories for age and reanalyse the data accordingly, correct for all the tables and narratives in the document.

Discussion

The discussion need a revision in line with the introduction
Please tell us about those who intended to use vasectomy-what were their demographics before you do the comparisons with other studies, first in Ethiopia and other countries
You spend too much effort of why your study findings are different from those of others and not on the implications of your findings.

Conclusion

Improving level of knowledge and attitude towards vasectomy is an essential strategy-details on how this will be done
The document should be copy edited for language and grammar by a professional language editor before submitting your revised manuscript.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

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Reviewer #1: Partly

Reviewer #2: No

**********

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Reviewer #1: I Don't Know

Reviewer #2: No

**********

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Reviewer #1: No

Reviewer #2: Yes

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Reviewer #2: No

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Reviewer #1: This paper addresses an important topic – vasectomy and whether men would be willing to use the method and the characteristics of men expressing such willingness. The title of the manuscript is misleading = it says “intention” but the variable in the paper is “willingness” – those are not the same thing. The authors should be clear what the men were asked out (intention or willingness – and say in the paper the question/questions asked about willingness or intention to use.

Knowledge of vasectomy: The authors say that knowledge of vasectomy was measured through 9 questions – but do not say what those questions are. The questions should be included in the paper.

What does “emotional support” from their partners to use vasectomy mean? How was this question asked? Were the men asked about current contraceptive use by themselves or their wives/partners?

Willingness (or intention?) to use: The authors should explain whey they did not ask the men if they knew where they could get a vasectomy and what would prompt them to actually have a vasectomy in the future.

Furthermore, the findings of willingness or intention need to be put in the context of the availability of vasectomy in the country. Without available services, men will not be able to act on their willingness or intentions.

The current comparison of the findings with findings from studies in other countries is interesting, but ultimately without expanded services, knowledge and willingness (or intention) is not sufficient. The authors could use the findings that are fairly consistent across studies to say that their seems to be latent interest in vasectomy that is not being satisfied with programming.

The authors should note that the sample in this study are highly educated (63% have a college education or above, and half the wives also have a college education or above) – what is the percent of the population in Ethiopia with a college education? The authors should explain why the town of Debre Tabor was selected for the study.

With that said, the men in this study could be vanguard users of vasectomy, so the findings are useful for advocating for expansion of vasectomy services in Ethiopia. It would be useful for the authors to refer to Ethiopia’s FP Costed Implementation Plan 2016-2020 to see if vasectomy is covered in it (http://www.healthpolicyplus.com/ns/pubs/2021-2030_EthiopiaCIPNov.pdf). FHI360 has prepared a brief on promoting vasectomy in Ethiopia that also might be helpful (https://www.fhi360.org/sites/default/files/media/documents/resource-vasectomy-evidence-ethiopia-final.pdf).

References should be listed by Last Name, First name (currently first names and last initial are included in the references).

This paper would benefit from a more thorough literature review on vasectomy and programming for men. Some other references to consider:

Vasectomy: A Long, Slow Haul to Successful Takeoff, James D Shelton and Roy Jacobstein, Global Health: Science and Practice December 2016, 4(4):514-517; https://doi.org/10.9745/GHSP-D-16-00355 Glob Health Sci Pract. 2016 Dec 23; 4(4): 647–660.

A Review of 10 Years of Vasectomy Programming and Research in Low-Resource Settings, Dominick Shattuck, Brian Perry, Catherine Packer, and Dawn Chin Quee , Global Health: Science and Practice, Published online 2016 Dec 23. doi: 10.9745/GHSP-D-16-00235

Hardee, K, M Croce-Galis, and J Gay. 2017. “Are Men Well Served by Family Planning Programs?” Reproductive Health. 14(14). DOI: 10.1186/s12978-017-0278-5.

Ross, J, and K Hardee. 2016. “Use of Male Methods of Contraception Worldwide.” 2016. Journal of Biosocial Science. Published online.

Reviewer #2: Even though the topic is of public health importance as we strive to promote the use of male methods in the family planning method mix, the manuscript as it is now is very poorly written. It is extremely difficult to understand the content because of the poor quality of English. Additionally, the sampling procedure is inadequately explained - for example how was the first household selected in each kebele and how was the sample size for each kebele arrived at? It is also unclear how 'the next eligible household located in the clockwise direction was visited..' Another issue is that the authors did not provide an operational for 'intention to use vasectomy' and the Table titles are inappropriate.

The manuscript as it stands now will require major revisions, and should be seen by an English proof-reader before re-submission

**********

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Reviewer #1: Yes: Karen Hardee

Reviewer #2: Yes: Easmon Otupiri

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PLoS One. 2020 Sep 3;15(9):e0238293. doi: 10.1371/journal.pone.0238293.r002

Author response to Decision Letter 0

11 Mar 2020

To Plose One Academic Editor (Sphiwe Madiba, DrPH).

PONE-D-19-27356

From Alemu Degu

First of all I would like to say thank you very much for your timely response and for your interesting comments. And my heart full gratitude to all reviewers those giving essential comments and questions by devoting their golden time.

Point by point response to editors

I. General comments

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be foundathttp://www.journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdfandhttp://www.journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

Response 1: I accept the comment and I have fully follows the journals quid line (style requirements).

Response 2: I accept the comment and I have incorporated the questionnaire as additional information.

II specific comments

A. On introduction

1. Please revise the introduction to provide a generalized background vasectomy and its utilization, benefits, family planning, involving men in reproductive health, factors associated with low uptake of vasectomy and opinions and attitudes of men about vasectomy. There is adequate and recent data on the topic in sub Saharan Africa

Response: I accept the comment and I have incorporated and rewrite the introduction and discussion part of the main document.

B. Methods

1. Please follow the journal’s standard subheadings for the methodology.

2. Integrate the operational definitions with the measures and data analysis, write as a narrative, and remove the bolding from the words.

Response: I accept the comment and I have followed the journals guideline in all aspects.

C. Data collection

1. Provide details on the tool and type of questions that were asked. Was the tool validated, how was intention measured-the type of question, what does future intention mean- is there a time factor on the future?

Response: I accept the comment and I have included in detail of the tool and type of questions. The tool was validated by those individuals who have experienced in related subject matter and future intention means view, thinking or expectation to use /yes there is time factor. See on the manuscript result part.

D. Results

1. Please follow the standardized categories for age and reanalyse the data accordingly, correct for all the tables and narratives in the document.

Response: I accept the comment, but I have consider the previous related research age categories for comparison and discussion purpose and no participant age <20 years at the time of data collection, since the number of respondents are small those are aged in between 50 -59, 60-69, 70-79...merged as age >=50 years.

D. Discussion

1. The discussion need a revision in line with the introduction

2. Please tell us about those who intended to use vasectomy-what were their demographics before you do the comparisons with other studies, first in Ethiopia and other countries

3. You spend too much effort of why your study findings are different from those of others and not on the implications of your findings.

Response: I accept the comment and incorporated to the main document (manuscript) based on your comments.

E. Conclusion

1. Improving level of knowledge and attitude towards vasectomy is an essential strategy-detail on how this will be done

2. The document should be copy edited for language and grammar by a professional language editor before submitting your revised manuscript.

Response: I accept the comment and the question; we can improve the level of knowledge and attitude by giving detail awareness on the methods and benefit of it and by avoiding false remorse that talking about vasectomy. We have seen the language we ourselves the author +online grammar checker +by professional language editor.

II. Point by point response to Reviewers

For Reviewer#1

#1: This paper addresses an important topic – vasectomy and whether men would be willing to use the method and the characteristics of men expressing such willingness. The title of the manuscript is misleading = it says “intention” but the variable in the paper is “willingness” – those are not the same thing. The authors should be clear what the men were asked out (intention or willingness – and say in the paper the question/questions asked about willingness or intention to use.

Response#1: I accept the comment and the question widely. Yes all write, Intention and willingness is not the same thing. Where taking to Intention it is mostly explains futures expectation, thinking but the possibility may or may not. Whereas willingness is being willing to do that thing on the time or future. Generally Intention is some body’s view, thinking, expectation to the future and it is somewhat light /superficial whereas willingness is some bodies willing to act/ do or to perform and it is somewhat hard.

#2: Knowledge of vasectomy: The authors say that knowledge of vasectomy was measured through 9 questions – but do not say what those questions are. The questions should be included in the paper.

Attitudes about vasectomy: It is not clear how knowledge scores can translate into positive or negative attitudes towards vasectomy. One could have good knowledge and still have a negative attitude about the method. What does “emotional support” from their partners to use vasectomy mean? How was this question asked? Were the men asked about current contraceptive use by themselves or their wives/partners?

Response#2: I accept the comment and the question and we have included questions that we used to measure Knowledge of vasectomy in the edited manuscript. Yes write that those having good Knowledge of vasectomy may have a negative attitude about the method. And there are attitude measurement questions and knowledge measurement questions separately. ‘Emotional support’ to mean that; have you got a support or volunteer from wives, I think we use emotional inappropriate word selection and make the confusion. And we are going to asking like this “Do you get support from your partner to use FP?” Currently we accept the comment and corrected like this. Do you get support from your partner to use FP?”

#3. Willingness (or intention?) to use: The authors should explain whey they did not ask the men if they knew where they could get a vasectomy and what would prompt them to actually have a vasectomy in the future.

Response #3: I accept the comment and the question, but the question is not clear ; in my understanding to mean that place of vasectomy ; And we are asking the availability of the service like this “Do you know where vasectomy/male sterilization service is available? So place of vasectomy is answered by this question.

#4: Furthermore, the findings of willingness or intention need to be put in the context of the availability of vasectomy in the country. Without available services, men will not be able to act on their willingness or intentions.

Response #4: I accept the comment and the availability of the service is largely there. In any district hospital, general hospital can be performed. And the service also given in the study area.

#5; The current comparison of the findings with findings from studies in other countries is interesting, but ultimately without expanded services, knowledge and willingness (or intention) is not sufficient. The authors could use the findings that are fairly consistent across studies to say that their seems to be latent interest in vasectomy that is not being satisfied with programming.

Response #4: I accept the comment and the service is at large present in our country. But insufficient number of users is there?

#5. The authors should note that the sample in this study are highly educated (63% have a college education or above, and half the wives also have a college education or above) – what is the percent of the population in Ethiopia with a college education? The authors should explain why the town of Debre Tabor was selected for the study.

Response #5: I accept the comment and questions ; the sample in our study is highly educated which is 63% ; the reason is that the study conducted is in the town and small place and may easily accessible to education whereas the general population educational level in Ethiopia is less than this is due to the above explanation . The reason I select the study area is ; since am working there , I am not still see the procedure of vasectomy even the service is available . Due to this fact I intended to assess the intention and its factors in this area.

#6; With that said, the men in this study could be vanguard users of vasectomy, so the findings are useful for advocating for expansion of vasectomy services in Ethiopia. It would be useful for the authors to refer to Ethiopia’s FP Costed Implementation Plan 2016-2020 to see if vasectomy is covered in it (http://www.healthpolicyplus.com/ns/pubs/2021-2030_EthiopiaCIPNov.pdf). FHI360 has prepared a brief on promoting vasectomy in Ethiopia that also might be helpful (https://www.fhi360.org/sites/default/files/media/documents/resource-vasectomy-evidence-ethiopia-final.pdf).

References should be listed by Last Name, First name (currently first names and last initial are included in the references).

This paper would benefit from a more thorough literature review on vasectomy and programming for men. Some other references to consider:

Hardee, K, M Croce-Galis, and J Gay. 2017. “Are Men Well Served by Family Planning Programs?” Reproductive Health. 14(14). DOI: 10.1186/s12978-017-0278-5.

Ross, J, and K Hardee. 2016. “Use of Male Methods of Contraception Worldwide.” 2016. Journal of Biosocial Science. Published online.

Response #5: I accept the comment and I have revised the literature based on your comment and suggestions.

Thank you !!!.

Alemu Degu

For Reviewer#2

Even though the topic is of public health importance as we strive to promote the use of male methods in the family planning method mix, the manuscript as it is now is very poorly written. It is extremely difficult to understand the content because of the poor quality of English. Additionally, the sampling procedure is inadequately explained - for example how the first household was selected in each kebele and how was the sample size for each kebele arrived at? It is also unclear how 'the next eligible household located in the clockwise direction was visited..' Another issue is that the authors did not provide an operational for 'intention to use vasectomy' and the Table titles are inappropriate.

The manuscript as it stands now will require major revisions, and should be seen by an English proof-reader before re-submission

Response: I accept the comment and questions; I have taken the comment as a comment and corrected the manuscript based on your comment. Largely the issue is on grammar and language; I accept it edited at much as possible with online grammar and language checkers and with my friend fluent English speaker in my university. The first house hold is selected rondomely by lottery method for each kebele, after the number of households with married men in each kebele were found from the kebele registration book. Then the study households were selected from each kebele through simple random sampling technique by using computer generating table starting from kebele one from a random start point. One married man per household was interviewed. See it again I have operationalized it . The table title “ I have corrected based on the journal guideline. Thank you!!!.

Alemu Degu

Attachment

Submitted filename: point by point response (Response to Reviewers)..docx

Click here for additional data file.^{(26.3KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0238293.r003

Decision Letter 1

Wen-Jun Tu

27 Apr 2020

PONE-D-19-27356R1

Intention to use vasectomy and its associated factors among married men in Debretabor Town, North West Ethiopia, 2019.

PLOS ONE

Dear Mr. Ayele,

We would appreciate receiving your revised manuscript by Jun 11 2020 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled 'Manuscript'.

We look forward to receiving your revised manuscript.

Kind regards,

Wen-Jun Tu

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: No

**********

6. Review Comments to the Author

Reviewer #1: The authors have addressed the reviewers’ comments on the original manuscript for the most part. A few issues are still outstanding. The authors describe intention to use vasectomy as “willingness of respondent to use vasectomy as a contraceptive method for future time.” This mixed intention and willingness, which are not the same things. Intention is stronger than willingness and implies that the man is planning to use vasectomy. Willingness implies that he might be interested in using it at some time in the future. The authors need to be clear what was asked – otherwise this seems like a vague outcome that might be more due to respondent courtesy bias than actual interest in using the method.

Is there a reason the men were not asked if they (their wives) were currently using a contraceptive method? Most of the men said they had completed their family size, so it would be important to know if they / their wives were currently doing something to avoid pregnancy.

Figure 2 is labeled “reason not to use vasectomy for future life” – is that how the question on intention to use was asked? This is likely a translation issue – what does it mean to use a method for future life?

Figure 2 shows that 74% said the reason not to use vasectomy was lack of awareness – yet 46.6% said they had heard of vasectomy according to Table 3. If nearly half of the men said they had heard of vasectomy, how could three-quarters say unfamiliarity with the method was a reason not to use it?

The discussion would be strengthened if it focused less on how the findings of the study match other studies and more on the programmatic implications for Ethiopia – how can the findings from this study improve access to and use of vasectomy in Ethiopia.

The manuscript still needs English language editing.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

PLoS One. 2020 Sep 3;15(9):e0238293. doi: 10.1371/journal.pone.0238293.r004

Author response to Decision Letter 1

21 May 2020

To Plose One Academic Editor

PONE-D-19-27356R1

From Alemu Degu

First of all I would like to say thank you very much for your timely response and your actively involvement on the comments and coordination without hesitating by the current issue (COVID 19). And my heart full gratitude again reaches to all reviewers those giving a measurable, fruitful and observable comments and questions by devoting their golden time and with the challenge of COVID19. I am happy to see you the next time and year. God bless to you and us!!!

I. Point by point response to Reviewers

For Reviewer#1

1. The authors describe intention to use vasectomy as “willingness of respondent to use vasectomy as a contraceptive method for future time.” This mixed intention and willingness, which are not the same things. Intention is stronger than willingness and implies that the man is planning to use vasectomy. Willingness implies that he might be interested in using it at some time in the future. The authors need to be clear what was asked – otherwise this seems like a vague outcome that might be more due to respondent courtesy bias than actual interest in using the method

Response#1: We accept the comment and the question. Yes all write, Intention and willingness is not the same thing, even though some scholars give they are synonym at some point of time. As we have searched and reading different articles and different scholars point of view “Intension to use something” is the view of futurity, planning to use in the future, their future motivation to use and their effort to use in the future whereas “willingness to use something” is being willing to do that thing on the time, readiness to use and openness to perform or act. Therefore based on these and our consensus we have tried to assess their intension to use vasectomy as a contraceptive method for future time rather their willingness. We have tried to ask the respondents on part VI question number 501and 502”Do you have intention to use vasectomy for future? If yes when? “; on these we want to assess their future planning or view rather willingness. We can directly interpret the above question like this one “Do you have plan to use vasectomy for future? If yes when? “

And also we have assessed published articles related to this topic and the variables were adapted from previously published articles.

2. Is there a reason the men were not asked if they (their wives) were currently using a contraceptive method? Most of the men said they had completed their family size, so it would be important to know if they / their wives were currently doing something to avoid pregnancy.

Response#2: We accept the comment and the question. This is a very easy but serious issue. We are making some systematic error that makes the authors confused. Around 281 respondents had completed their family size and 116 respondents have not completed. We have tried to ask 116 respondents on future desire no of children but wrongly we report 281 respondents, we make a mistake on copy paste to the table. Those 281 respondents no need of asking about their future desire no of children, since they side already completed family size. Generally those men who have (their wives) were currently using a contraceptive method were asked about future intention to use vasectomy as contraceptive method unless their wives used permanent methods like bilateral tubal ligation.. or both those complete their family size and not complete were asked about future intention to use vasectomy as contraceptive method. We have corrected on the manuscript.

3. Figure 2 is labeled “reason not to use vasectomy for future life” – is that how the question on intention to use was asked? This is likely a translation issue – what does it mean to use a method for future life?

Response#3: We accept the comment and the question. Yes it makes some confusion on word utilization. And we have corrected as “Percentage distribution of study participants by reason not have intention to use vasectomy for future life ; Debre Tabor Town, North West Ethiopia, March 05-April 15 2019”.

4. Figure 2 shows that 74% said the reason not to use vasectomy was lack of awareness – yet 46.6% said they had heard of vasectomy according to Table 3. If nearly half of the men said they had heard of vasectomy, how could three-quarters say unfamiliarity with the method was a reason not to use it?

Response#4: We accept the comment and the question. To avoid these confusion better to describe difference between awareness and simply heard about vasectomy. Having awareness about vasectomy is that having detail knowledge of vasectomy about its purpose, procedure, side effect and advantage whereas heard about vasectomy is simply hear the presence of vasectomy not have detail knowledge. Therefore those having heard about vasectomy might or might not have awareness but those have awareness were heard about vasectomy. Therefore even though 46.6 % of respondents heard about vasectomy, they may or may not have awareness. Mostly hearing information is easy but when we asking how, for home, when…Is not answered by the respondents.

5. The discussion would be strengthened if it focused less on how the findings of the study match other studies and more on the programmatic implications for Ethiopia – how the findings from this study can improve access to and use of vasectomy in Ethiopia.

Response#4: We accept the comment and the question. And we have tried to edit based on the comment.

6. The manuscript still needs English language editing.

Response#4: We accept the comment and the question. And we have tried to edit as much as possible with online grammar and language checkers and with my friend fluent English speaker in my university.

Thank you!!!

Alemu Degu

Attachment

Submitted filename: point by point response to reviewer.docx

Click here for additional data file.^{(20.7KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0238293.r005

Decision Letter 2

Wen-Jun Tu

27 May 2020

PONE-D-19-27356R2

Intention to use vasectomy and its associated factors among married men in Debretabor Town, North West Ethiopia, 2019.

PLOS ONE

Dear Dr. Ayele,

Please submit your revised manuscript by Jul 11 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Wen-Jun Tu

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: No

**********

6. Review Comments to the Author

Reviewer #1: This version of the manuscript has not addressed completely the comments I made on the second revision and I’ve noticed some additional issues.

Table 3 shows that 53.4% of the men had NOT heard about vasectomy. I should have caught this the first time I reviewed the paper. These men should have been skipped out of responding to other questions about vasectomy – if they haven’t heard of the method, how can they respond to specific questions about the method? The rest of the analysis should only be done on the 46.6% of the men who had heard of vasectomy. The conclusion that lack of knowledge about the method is an impediment to expanding use of vasectomy is still important. And then knowing what men with knowledge of the method think about it and their intention of using it will be programmatically useful.

Also, something I noticed rereading the paper – what does it mean in Table 2 that 74% said they got emotional support from their partners to use vasectomy? Again, how could they get support from their partners that they haven’t heard of?

The discussion section is still weak – it still focuses too much on comparison of findings from Ethiopia and other countries and not enough on how the findings are useful for Ethiopia’s program. I am recopying my previous comments:

I had previously suggested that the authors put the findings in the context that the sample is highly educated - 63% have a college education or above, and half the wives also have a college education or above – which is higher than Ethiopia’s average educational attainment. The men in this study could be vanguard users of vasectomy, so the findings are useful for advocating for expansion of vasectomy services in Ethiopia. It would be useful for the authors to refer to Ethiopia’s FP Costed Implementation Plan 2016-2020 to see if vasectomy is covered in it (http://www.healthpolicyplus.com/ns/pubs/2021-2030_EthiopiaCIPNov.pdf). FHI360 has prepared a brief on promoting vasectomy in Ethiopia that also might be helpful (https://www.fhi360.org/sites/default/files/media/documents/resource-vasectomy-evidence-ethiopia-final.pdf).

In my first review, I had suggested looking at additional references on vasectomy, which I note the authors have not included in the references, so it appears they did not review them. My comment still stands that this paper would benefit from a more thorough literature review on vasectomy and programming for men. For example,

Hardee, K, M Croce-Galis, and J Gay. 2017. “Are Men Well Served by Family Planning Programs?” Reproductive Health. 14(14). DOI: 10.1186/s12978-017-0278-5.

Ross, J, and K Hardee. 2016. “Use of Male Methods of Contraception Worldwide.” 2016. Journal of Biosocial Science. Published online.

Also, while the English is better, the manuscript still needs editing for English language usage.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PLoS One. 2020 Sep 3;15(9):e0238293. doi: 10.1371/journal.pone.0238293.r006

Author response to Decision Letter 2

15 Jun 2020

To Plose One Academic Editor

PONE-D-19-27356R2

From Fentahun Yenealem

I. Point by point response to Reviewers

For Reviewer#1

Q1. Table 3 shows that 53.4% of the men had NOT heard about vasectomy. I should have caught this the first time I reviewed the paper. These men should have been skipped out of responding to other questions about vasectomy – if they haven’t heard of the method, how can they respond to specific questions about the method? The rest of the analysis should only be done on the 46.6% of the men who had heard of vasectomy. The conclusion that lack of knowledge about the method is an impediment to expanding use of vasectomy is still important. And then knowing what men with knowledge of the method think about it and their intention of using it will be programmatically useful.

Response#1: We accept the comment and the question. Yes alright, we have made a great mistake on using language /taking or writing the manuscript rather data collection; we using Heard about vasectomy to mean or replaces that Do you know that vasectomy is a contraceptive method by cutting and ligating Vass deference? So this is assessing the knowledge of men’s about its procedure. Yes you are right in previous situation completely it is skip question; but wrongly usage of language. If you have time it is possible to see and check its consistency in additional file 1. We have made correction based on the comment both track change and clear manuscript.

Q2. Also, something I noticed rereading the paper – what does it mean in Table 2 that 74% said they got emotional support from their partners to use vasectomy? Again, how could they get support from their partners that they haven’t heard of?

Response#2: We accept the comment and the question. Yes alright, the question might be answered in the above response since heard of vasectomy is corrected accordingly.

Q#3: The discussion would be strengthened if it focused less on how the findings of the study match other studies and more on the programmatic implications for Ethiopia – how the findings from this study can improve access to and use of vasectomy in Ethiopia.

Response#4: We accept the comment and the question. And we have tried to edit based on the comment and based on your recommendation.

Q#4.The manuscript still needs English language editing.

Response#4: We accept the comment and the question. And we have tried to edit as much as possible with online grammar and language checkers and with my friend fluent English speaker in my university.

Thank you!!!

Fentahun Yenealem

Attachment

Submitted filename: point by point response to reviewer.docx

Click here for additional data file.^{(19.2KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0238293.r007

Decision Letter 3

Wen-Jun Tu

19 Jun 2020

PONE-D-19-27356R3

Intention to use vasectomy and its associated factors among married men in Debretabor Town, North West Ethiopia, 2019.

PLOS ONE

Dear Dr. Beyene,

Please submit your revised manuscript by Aug 03 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

We look forward to receiving your revised manuscript.

Kind regards,

Wen-Jun Tu

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #3: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #3: No

**********

6. Review Comments to the Author

Reviewer #3: This is a valuable empirical contribution to an understanding of men's potential use of vasectomy, in Ethiopia but in international scope too. I did not review earlier version(s) of the manuscript. My overall sense is that the research design is satisfactory, that the findings follow from the design, and that the key findings stand out clearly.

My major concern is that the writing quality is inadequate for the journal, and that a more professional editorial process is necessary before a final version can be accepted. To illustrate some examples of spelling or grammatical concerns that are of scientific merit in how the findings are reported, Vass difference should be vas deferens; alive children would be better phrased living children; and I atttempt my own version of the Abstract and Key Words (cut and pasted below) that I think illustrates what would be a more polished version than the current one. In a related vein, the formatting of the Tables and Figure needs to be improved (e.g., columns don't align), and any acronymy (e.g., EDHS) should be written out the first time introduced.

I also suggest several additions to the Introduction and Discussion as follows. a) Please discuss in the Discussion the high educational attainment and prevalent civil servant occupations of this sample: how do these compare with national Ethiopian data (perhaps compare with EDHS data, if available), and how generalizable or not are the current data? b) Perhaps also note what percent of men have 0, 1, 2 and 3 children just to share empirical data within the category of men having 3 or fewer children. c) In the Introduction when presenting data on Ethiopian family planning patterns, please also share some information about the prevalence of specific types of family planning such as condoms, tubal ligation, etc. d) In a related vein, in the Discussion, might another factor relevant to why men 40+ have lower vasectomy intent than men 30-39 be age- and fertility-related patterning of their wives' family planning (e.g., do older men's wives more often use tubal ligation, and does that mean that men's vasectomy decisions are somewhat contingent upon those of their wives). e) Please state the age range of male participants, in the Abstract and Results. I am guessing that these are men aged 20 years and older, but whether men in their teens were excluded was not noted in the Methods, nor is the upper limit of male ages specified.; f) in the Methods section, please craft a clearer sentence that specifies what the cutoffs are for differentiating good and poor knowledge. g) Does the item "Get emotional support from partner" refer to emotional support generally, or specifically to family planning support?

Background: Vasectomy is one of the most effective and permanent male contraceptive methods, and involves cutting and ligating the vas deferens to make the semen free of sperm during ejaculation. Although it is effective, simple and safe, it is not well known and practiced in the majority of our community. This study assessed intention to use vasectomy and its associated factors among married men in Debre Tabor Town, North West Ethiopia, 2019.

Methods: A community based cross-sectional study was conducted among 402 married men from March 05 to April 15, 2019. Simple random sampling technique was employed to select the study participants. Data were collected by face-to-face interview using a structured and pre-tested questionnaire. Questions concerned sociodemographic and reproductive variables and views on vasectomy. The association between variables was analyzed using bivariable and multivariable logistic regression model.

Results: A total of 402 participants were included with response rate of 98.75%. The mean participant age was 37.12 (SD ± 6.55) years. The prevalence of intention to use vasectomy was 19.6% with 95%CI (15.6%-23.4%). Multivariable logistic regression showed that age from 30-39 years (AOR=3.2 (95% CI: 1.19-8.86)), having more than three living children (AOR=2.5 (95% CI: 1.41-4.68)), good knowledge of vasectomy (AOR=3.4 (95%CI: 1.88-6.40)) and positive attitude toward vasectomy (AOR=4.8 (95% CI: 2.61-8.80)) were significantly associated with intention to use vasectomy.

Conclusion and recommendation: Intention to use vasectomy was comparable with findings in four regions of Ethiopia (Amhara, Oromia, SNNP and Tigray). Age, number of living children, knowledge and attitude were significantly associated with the intention to use vasectomy. Improving level of knowledge and attitude towards vasectomy is an essential strategy to scale up intention of men to use vasectomy.

Key words : Vasectomy, male contraception, family planning, fertility, Ethiopia

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #3: No

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PLoS One. 2020 Sep 3;15(9):e0238293. doi: 10.1371/journal.pone.0238293.r008

Author response to Decision Letter 3

22 Jul 2020

To Plose One Academic Editor

PONE-D-19-27356R3

From Fentahun Yenealem

First of all I would like to say thank you very much for your timely response and your actively involvement on the comments and coordination without hesitating by the current issue (COVID 19). And my heart full gratitude again reaches to reviewer#3 that was giving a measurable, fruitful and observable comments and questions by devoting their golden time and with the challenge of COVID19.

I. Point by point response to Reviewer

For Reviewer#3

General comments and recommendation: We have completely accepted the general comments and recommendations especially on the abstract section. Thank you very much for your recommendation!. Following this; We have tried to give response for each comments and questions raised by the reviewer.

Q #1 Please discusses in the Discussion the high educational attainment and prevalent civil servant occupations of this sample: how do these compare with national Ethiopian data (perhaps compare with EDHS data, if available), and how generalizable or not are the current data?

Response#1: We accept the comment and the question. We have made correction based on the comment both in track change and clear manuscript. We have tried to discussing with EDHS 2016 finding the educational attainment and civil servant occupations.

Q #2. Perhaps also note what percent of men have 0, 1, 2 and 3 children just to share empirical data within the category of men having 3 or fewer children.

Response#2: We accept the comment and the question. Yes alright, the question might be answered in the above response since heard of vasectomy is corrected accordingly. The total numbers of participants those having <= 3 children is 243. The empirical data without categorized to <=3 child. 1. Those have no child 25, having one child 67, having two children 113 and having three children 38. But on the manuscript we have write by category<=3 and> 3 child.

Q #3. In the Introduction when presenting data on Ethiopian family planning patterns, please also share some information about the prevalence of specific types of family planning such as condoms, , etc.

Response#3: We accept the comment and the question. And we have tried to edit based on the comment and based on your recommendation. See in the clear manuscript and track changes.

Q#4. In a related vein, in the Discussion, might another factor relevant to why men 40+ have lower vasectomy intent than men 30-39 be age- and fertility-related patterning of their wives' family planning (e.g., do older men's wives more often use tubal ligation, and does that mean that men's vasectomy decisions are somewhat contingent upon those of their wives).

Response#4: We accept the comment and the question. And we have tried corporate based on your recommendation and question.

Q#5. Please state the age range of male participants, in the Abstract and Results. I am guessing that these are men aged 20 years and older, but whether men in their teens were excluded was not noted in the Methods, nor is the upper limit of male ages specified.

Response#5: We accept the comment and the question. And we have tried to edit based on the comment and based on your recommendation. We are not excluded those teenager participants. But on interview no participants <20 and >56 years old. That is why we are not describing in the method section. And we have made correction based on your comment on the age range in between 20-56 years. See in the clear manuscript and track changes.

Q#6. in the Methods section, please craft a clearer sentence that specifies what the cutoffs are for differentiating good and poor knowledge.

Response#6: We accept the comment, recommendation and the question. But we have been describing it in the method section specifically in the sub heading of Measurement and data collection procedure (line 11-13).

Q#7: Does the item "Get emotional support from partner" refer to emotional support generally, or specifically to family planning support?

Response#7: We accept the comment, recommendation and the question. In this situation get emotional support from partner" refer to emotional support specifically to family planning support.

8# My major concern is that the writing quality is inadequate for the journal, and that a more professional editorial process is necessary before a final version can be accepted.

Response#8. We accept the comment and the question. And we have tried to edit as much as possible with online grammar and language checkers and with my friend fluent English speaker in my university.

Thank you!!!

Fentahun Yenealem

Attachment

Submitted filename: point by point response to reviewer.docx

Click here for additional data file.^{(21.1KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0238293.r009

Decision Letter 4

Wen-Jun Tu

24 Jul 2020

PONE-D-19-27356R4

Intention to use vasectomy and its associated factors among married men in Debretabor Town, North West Ethiopia, 2019.

PLOS ONE

Dear Dr. Beyene,

Please submit your revised manuscript by Sep 07 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

We look forward to receiving your revised manuscript.

Kind regards,

Wen-Jun Tu

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #3: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #3: Yes

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6. Review Comments to the Author

Reviewer #3: The authors have addressed adequately the few substantive questions/comments I raised in the last round of review. I do not request any additional substantive edits. However, I still feel that the manuscript needs copyediting before it could be published. I do not know if PLoS ONE provides that service. If not, then it is worth noting that some formatting issues and grammatically awkward phrases remain in this revision. I don't believe this is the task of a reviewer to undertake all of these, as I illustrated previously with edits to the Abstract. I thus would ask that some formal copyediting process beyond what the authors have done be undertaken to ensure a final polished version of the manuscript.

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Reviewer #3: No

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PLoS One. 2020 Sep 3;15(9):e0238293. doi: 10.1371/journal.pone.0238293.r010

Author response to Decision Letter 4

13 Aug 2020

To Plose One Academic Editor

PONE-D-19-27356R4

From Fentahun Yenealem

First of all I would like to say thank you very much for your timely response and your actively involvement on the comments and coordination without hesitating by the current issue (COVID 19). And my heart full gratitude again reaches to reviewer#3 that was giving a measurable, fruitful and observable comments and questions by devoting their golden time and with the challenge of COVID19.

I. Point by point response to Editor and Reviewer

Q# 1. Reviewer #3: The authors have addressed adequately the few substantive questions/comments I raised in the last round of review. I do not request any additional substantive edits. However, I still feel that the manuscript needs copyediting before it could be published. I do not know if PLoS ONE provides that service. If not, then it is worth noting that some formatting issues and grammatically awkward phrases remain in this revision. I don't believe this is the task of a reviewer to undertake all of these, as I illustrated previously with edits to the Abstract. I thus would ask that some formal copyediting process beyond what the authors have done be undertaken to ensure a final polished version of the manuscript.

Response 1: We accept the comment and the question. And we have tried to copy edit as much as possible with online grammar and language checkers and with my friend fluent English speaker in my university.

Thank you!!!

Fentahun Yenealem

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PLoS One. doi: 10.1371/journal.pone.0238293.r011

Decision Letter 5

Wen-Jun Tu

14 Aug 2020

Intention to use vasectomy and its associated factors among married men in Debretabor Town, North West Ethiopia, 2019.

PONE-D-19-27356R5

Dear Dr. Beyene,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Wen-Jun Tu

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

PLoS One. doi: 10.1371/journal.pone.0238293.r012

Acceptance letter

Wen-Jun Tu

24 Aug 2020

PONE-D-19-27356R5

Intention to use vasectomy and its associated factors among married men in Debretabor Town, North West Ethiopia, 2019.

Dear Dr. Beyene:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Wen-Jun Tu

Academic Editor

PLOS ONE

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

S1 File. English version questionnaires.

(DOCX)

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Data Availability Statement

All relevant data are within the manuscript and its Supporting Information files.

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PERMALINK

Intention to use vasectomy and its associated factors among married men in Debre Tabor Town, North West Ethiopia, 2019

Alemu Degu Ayele

Fentahun Yenealem Beyene

Kihinetu Gelaye Wudineh

Bekalu Getnet Kassa

Yitayal Ayalew Goshu

Gedefaye Nibret Mihretie

Roles

Abstract

Background

Methods

Result

Conclusion and recommendation

Background

Methods

Study design and setting

Sample size calculation and sampling procedures

Fig 1. Schematic presentation of the sampling procedure for a study conducted on an intention to use vasectomy and its associated factors among married men in Debre Tabor Town North West Ethiopia 2019.

Measurement and data collection procedure

Data quality assurance

Data processing, analysis, and interpretation

Ethics approval and consent to participate

Result

Socio-demographic characteristics of participants

Table 1. Percentage distribution of the study population by socio-demographic characteristics; Debre Tabor Town, North West Ethiopia, March 05-April 15, 2019 (N = 397).

Reproductive characteristics of participants

Table 2. Percentage distribution of the study population by reproductive characteristics; Debre Tabor Town, North West Ethiopia, March 05 -April 15, 2019(N = 397).

Knowledge of participants towards vasectomy

Table 3. Percentage distribution of the study population by knowledge related questions; Debretabor Town, North West Ethiopia, March 05-April 15, 2019 (N = 397).

The attitude of participants towards vasectomy

Table 4. Percentage distribution of the study population by attitude related questions; Debre Tabor Town, North West Ethiopia, March 05-April 15, 2019 (N = 397).

Intention to use vasectomy and reason not to use vasectomy among study participants

Fig 2. Percentage distribution of study participants by reason didn’t have the intention to use vasectomy for future life; Debre Tabor Town, North West Ethiopia, March 05-April 15 2019, (N = 319).

Factors affecting intention to use vasectomy among study participants

Table 5. Bivariable and multivariable analysis of factors affecting intention to use vasectomy; Debre Tabor town, North West Ethiopia, March 05-April 15, 2019(N = 397).

Discussion

Conclusion

Supporting information

Acknowledgments

Data Availability

Funding Statement

References

Decision Letter 0

Sphiwe Madiba

Roles

Author response to Decision Letter 0

Decision Letter 1

Wen-Jun Tu

Roles

Author response to Decision Letter 1

Decision Letter 2

Wen-Jun Tu

Roles

Author response to Decision Letter 2

Decision Letter 3

Wen-Jun Tu

Roles

Author response to Decision Letter 3

Decision Letter 4

Wen-Jun Tu

Roles

Author response to Decision Letter 4

Decision Letter 5

Wen-Jun Tu

Roles

Acceptance letter

Wen-Jun Tu

Roles

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

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