Evaluation of the knowledge, attitude and practice among women attending family planning at Bwera g

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Mbambu

INOSRExperimentalSciences11(1):1-16,2023.

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Evaluation of the knowledge, attitude and practice among women attending family planning at Bwera general Hospital.

Mbambu, M. Jannet SchoolofNursingKampalaInternationalUniversity-WesternCampus

ABSTRACT

Family planning is the practice of controlling the number of children and the intervals between births by use of contraceptives or voluntary sterilization. There are two types of family planning which include natural and artificial. Natural family planning services include the calendar method, abstinence; withdraw method, breastfeeding, moon bead method, artificial family planning methods include the use of hormones, counseling and education, preconception care screening, laboratory tests, and intrauterine devices. The objective of the study is to assess the knowledge of women and establish practices of women attending family planning clinic at Bwera general Hospital. Data entry, coding and analysiswereperformedusingmicrosoftExcelsversionssoftwarepackage.Toexplainthe study population in relation to relevant variables, frequency, percentages and summary statistics will be used. Associations between dependent and independent variables were assessed and presented using tables, graphs and pie charts Majority of the respondents were in the age bracket of 36-45(57%) and 27-35 (11%) were the least age bracket. Classification according to level of education, most of the respondents stopped at secondarylevel20(45%)andleastattendedlevelofeducation wastertiaryinstitution0(0%). For occupation, majority of the respondents were civil servants 20(45%) and the least respondents 4(9%) were those who belonged to other professions. The results show that most of the respondents were Bakonzo 28(64%) and the least respondents by tribe 3(7%) were those who belonged to others 3(7%) who included the bakiga, Basongora and Banyabindi. Then according to marital status, majority of the respondents were married 35(80%)andtheleastrespondents were those who were widowed.Mostof the respondents were from protestant religion 25(57%) and least were from catholic religion 1 (2%). When interviewed, majority of the respondents used injectables 20(45%) and least used family planning method by respondents was tub ligation 0(0%). In conclusion, knowledge of modern contraceptive is high in a study population. Substantial proportion of women had positive attitude towards modern contraceptives and hence more room for increasing moderncontraceptiveuseinpopulation.

Keywords:Familyplanning,contraceptives,injectables,hormones.

INTRODUCTION

Globally, family planning is the practice of controlling the number of children and the intervals between births by use of contraceptives or voluntary sterilization. There are two types of family planning which include natural and artificial. Natural family planning services include the calendar method, abstinence, withdraw method, breastfeeding, moon bead method, artificial family planning methods include the use of hormones, counseling and education, preconception care screening, laboratory tests, and intrauterinedevices[1,2,3,4,5]

In Canada studies done by [2,6,7,8,9,10] who was an industrialist and philanthropistbasedinKitchener,Ontario and early pioneer of the birth control movement in Canada, founded parent’s information Bureau in 1935 to distribute birth control information and sent nurses directlytohomestoprovidefamilieswith Condoms and contraceptive jellies. Contraceptive usage has been rising gradually in India. For instance, in 1970, 13% of Married women used modern contraceptive methods which rose to 35%

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by 1997 and 48% by 2009 [11,12,13,14,15,16,17].

In Africa (1982), family planning program was integrated into MCH Services within the context of primary health care of the ministry of health. The government launched a Population policy in 1989. Today a full range of family planning services are available throughout the country[3].

However, in Easter Africa family planning services are facing complicated process entangled in political, social, moral cultural network [4]. For example, Tanzania is among East African countries with the highestfertilityrate at 5.4births perwoman[5].

InUganda,itisgenerallybelievedthatthe government of Uganda introduced family planningmethodsinorderto mitigatethe problem of over population, to reduce unwanted pregnancies, maternal and mortality rates, abortion and to ensure women have spaced children in order to reduce birth complications and therefore improve the health of child bearing women.However,familyplanninghasnot improved the women`s health in the country. Women who use family planning methods usually complain of cancer, heavy bleeding during periods, unreliable periods, constant headache, dizziness andproducingdisabledchildren

Problem statement

InUganda,overthelastyears,thefertility rate in Uganda has remained persistently high with an average of 6.2births per woman. According to the [6] 41% of the women in Uganda would like to delay or stop having children but afraid of the risks associated with the use of family planning and their husbands’ refusal to adopt any of the family planning methods. The Ministry of Health with funding from (USAID) United States Agency of International Development and the Health Communication Partnership (HCP)haslaunchedacampaigntoaddress underlying barriers to family planning use.

InKasesedistrict,BweraHospitalasstudy area, much as studies were conducted on knowledge, attitude, and practices on family planning methods. However, in

Bwera hospital family planning clinic in particular no research has previously been done as lack of proper documentation and no document exists on Knowledge, attitude, and practice among women attending family planning at their hospital. Despite the fact that government has put more efforts on employing confined health workers to provide routine healthy education on family planning methods. This problem will continue causing maternal morbidity and mortality if not addressed hence motivating the researcher to undertake this study in order to provide some key recommendations for stake holders to intervene.

Aim of the study

The purpose of the study is to assess the knowledge, attitude and practice that women have towards family planning methods.

Objectives of the study

1. To assess the knowledge of women attending Bwera family planning clinics aboutfamilyplanningmethods.

2. To find out the attitude of women attending Bwera family planning clinic towardsfamilyplanningmethods.

3. To establish the practice of women attending Bwera family planning clinic towardsfamilyplanningmethods.

Hypothesis/Research questions

1. What knowledge do women attending Bwera family planning clinic have on familyplanningmethods?

2. What are the attitudes towards women attending Bwera family planning clinic haveonfamilyplanningmethods?

3 What are the practices of women attending Bwera family planning clinic haveonfamilyplanningmethods?

Justification of the study

The information from the study will be used by the nurses of Bwera family planning clinic about other knowledge, attitudeandpractices

The research will also equip the student with more information about other problems that are affecting women attendingBwerafamilyplanningclinic The findings will help the researcher to meet her academic requirement in researching on KAP among women

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attending Bwera hospital family planning clinic.After completion of the study, the researcher will have fulfilled the partial

Study Design and rationale.

requirement for an award of diploma in nursingsciences.

METHODOLOGY

The researcher used a descriptive design which was both qualitative and quantitative. It was qualitative because it involved interviews and it was quantitative because it involved explanations, descriptions and presentationofdata.

Study setting and rationale

The study was carried out in Bwera Hospital which iss located in mpondwe Lhubriiha Town council in Bukonzo County, Kasese District and Western Uganda. It is bordered by Nyakiyumbu subcounty in the North and kisaka parish inthe west.Thereisa populationof 7000 house households including males and females according to reports from the planningdepartment[2016]

Population of the study; The study targeted women of reproductive age [18-35] attending Bwera HospitalFamilyPlanningClinic

Sample size determination

The sample size was determined using the formula for simple random sampling usingsingleproportiongivenby;[7] Equation1;KishandleslieFormula;

n=(��2���� ��2 )

Where;

N=Samplesize

Z=Volume corresponding to 95 % level of significance=1.96

P=expected proportional of mothers attendingfamilyplanning50%=0.5

Q = (1-p) = (1-0.5) = 0.5, d = absolute precision5%=0.05

N=Total number of mothers in Bwera hospitalfamily planningclinicatthetime ofsurvey=45

D=Thedegreeofaccuracydesired0.05or 5%

Therefore,fromtheaboveformula

N=(1962∗05∗05 0052 )

N=384.16

Since my sample population N was less than10000

Equation2: Target population of less than 10000;

N=( �� 1+ �� �� )

N=(384 1+384⁄45 ⁄ )N=44.23respondents

WherenoissamplesizeforN,population lessthan10,000

The sample size was therefore be 44 respondents

Sampling procedure

The researcher used non-probability sampling specifically convenience sampling and purposive sampling. The researcher used convenience sampling to chooserespondentsthatareeasytoreach because it saves time and reduces bias. Purposive Sampling was used to the respondents that are key informants like midwives, VHTs and nurses because they are the ones that give and implement familyplanningservicestowomen.

Inclusion and exclusion

The study included women of reproductiveage(15-45)atBwerahospital family planning clinic who consented to participate

Exclusion

Womenbelow15yearsandthoseabove45 years were not considered from this study, as they were not in the targeted populationbyUganda ministryofHealthy forfamilyplanningmethods

Definition of variables

Assessment of knowledge, attitude and practices among women attending Bwera family planning clinic. It’s composed of independent and dependent factors or variables

Dependent variables

Women of reproductive age between 1545years

Independent variables

Knowledge, attitude, practices and other social, cultural, economic, and demographic factors like Age, education, marital status, occupation, religion and others

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Research instruments

The researcher used a number of data collection instruments namely questionnaires and interview guide. Questionnaire was used to collect data because it saves time. The questionnaires possessed both open and closed ended questions where they were answered at the respondents own free time. This method helped respondents to reveal theirattitudestowardsthestudy. The interview guide obtained necessary information for the respondents. The interview guide was used as a guide during the face-to-face interview session. Also, it helped the researcher to obtain first-handinformation.

Pretesting of the Research instruments

Questionnaire was pretested at Bwera hospital one week before data collection for validity and reliability. Any observed inconsistency of the questions was corrected to meet the intended objectives beforetimeofdatacollection

Data collection methods/procedure

Theresearcherusedanumberofmethods in the collection of data such as questionnaire and interview guide. The questionnaire contained both closed ended and open-ended questions. The questionnaires will be sent to the respondents and later on collected by the researcher; this will help the respondents tofillinduringtheirconvenienttime.The interview guide will contain pre determined questions and this will help the researcher to get first hand information.

Data management and quality control

One daytraining will be given to research assistants the objectives and procedures ofdatacollectionbytheinvestigators. Data completeness and consistency was checked by the researcher and his

research assistants. Data cleaning and editing took place; missed values were statistically handled at the time of data collection to help address concerns caused by incomplete data. Data obtained was keptin safe custodyand treated with respect and confidentiality. Coding and sorting at the end of data collection process was done to ensure adequacy, completeness and correctness of informationcollected.

Data analysis

Data entry, coding and analysis were performedusingmicrosoftExcelsversion s software package To explain the study population in relation to relevant variables, frequency, percentages and summary statistics will be used. Associations between dependent and independent variables will be assessed and presented using tables, graphs and piecharts.

Ethical consideration

Informed consent and confidentiality

Authorities of Bwera general hospital where the study will be conducted will be presented with recommendation letter fromtheKampalaInternationalUniversity School of Nursing seeking approval to undertakethestudy.Therespondentswill also be asked to consent before being interviewed. Interviews will be conducted in a manner that enable every respondent respondsfreelyandopenlyintheabsence of any other tension raising persons for confidentiality.

Names of the respondents will not be included in the data to ensure confidentiality.

The researcher will face the problem of climatic change. However, this problem will be solved by buying an umbrella.

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RESULTS

From the study conducted, the following resultswereobtainedfromasampleof44

respondents who attended Bwera family planningclinic

Table 1: Majority of the respondents were in the age bracket of 36-45(57%) and 5(11%) were the least age bracket

Classification according to level of education, most of the respondents stopped at secondary level 20(45%) and least attended level of education was tertiaryinstitution0(0%).

Occupation, majority of the respondents were civil servants 20(45%) and the least

respondents were those who belonged to otherprofessions(occupation)4(9%)

The results in the table above show that most of the respondents were Bakonzo 28(64%) and the least respondents by tribe were those who belonged to others 3(7%) who included the bakiga, Basongora andBanyabindi.

Thenaccordingtomaritalstatus,majority of the respondents were married 35(80%)

Table 1: Socio and Demographic Characteristics of Respondents, where n=44 AGE(YEAR)

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andtheleastrespondentswerethosewho werewidowed.

Most of the respondents were from protestantreligion 25(57%) andleast were from catholic religion 1 (2%).

Table 2: Majority of the respondents had 3-4 children 27(61%) and least being 0-2 children 7(16%), and 27(61%) wanted more children and 17(39%) said no meaning they didn’t want more children.

Fig.1;Pie chart: desired number of children

desired number of children

According to the pie chart above, the respondents who were interviewed, majority 26(59%) desired 3-4 children and lastly2(5%)desired0-2children.

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Fig.

Who has a final decision in a home about fertility

final decision in home about fertility

Majority of the respondents their husbands had a final decision in their homes on fertility 23(52%) and lastly

7(16%) respondents, final decision was madebyboth.

2; Pie chart

3: Distribution of respondents on knowledge about contraceptives

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Fig 3: Number of modern contraceptive methods known

Number of modern contraceptives known

Majority of the respondents knew more 3 contraceptive methods 20(45%) and lastly 4(9%) knewonlyonecontraceptive

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Fig. 4; Column graph : Type of modern contraceptives methods known. n=44

Majority of the respondents knew oral pills 15(34%) and least known methods were 4(9%) diaphragmandfemalesterilization4(9%)respectively

Source of information on modern contraceptives

Majority of the respondents, source of informationwasbyhealthfacility22(50%) and 6(14%) respondents got their

information from radios which was the leastsourceofinformation.

Fig. 5; Column graph: SOURCE OF INFORMATION

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Fig. 6;Pie charts: Distribution of respondents by information related to attitude towards modern contraceptives

Discussed family planning with husband

Majority of the respondents never discussed family planning methods with their husbands 32(72%), 6(14%) discussed

with their husbands once or twice and 6(14%) discussed family planning methodswiththeirhusbandsmoreoften

Practice towards modern contraceptives among women attending Bwera family planning clinic. n=44

Fig. 7; Column graph: Family planning methods in use

When interviewed, majority of the respondents used injectable 20(45%) and

least used family planning method by respondentswastubligation0(0%).

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Fig.8; Bar graph: Reasons for contraceptive use

Majority of the respondents used family planning methods for birth spacing 32(73), and 0(0%) respondents used

family planning methods because they completedtheirfamilies.

DISCUSSION

The study included 44 respondents of which all of them were women of reproductive age attending family planning clinic at Bwera general hospital in kasese district. Majority of the respondents that participated were in the age group of 36-45 , 25(57%), classification according to the level of education 20,(45%) attended secondary school,morethanhalf oftherespondents who participated 25,(57%) were from Anglican religion or protestant and marital status , three quarters of the respondents who participated 35(80%) weremarriedandmostoftheparticipants , three quarters were from the Bakonzo tribe 28(64%) and this is more than ½ of the participants, and according to occupation , majority of the participants werecivilservants20(45%).

Socio demographic variables

Socio demographic variables are among factors influencing the individuals decision on contraception and fertility

This is in line with studies done by [8,9, 10] and majority of the participants aged between 36-45 ,25 (57%). Since marriage and child bearing in rural Africa starts

early.Thissimilarstudywasdoneby[11]. This observation indicates sizeable number of participants was in the age in which they could have already several number of children and could need them tohavecontraceptivesforchildlimiting. Results in table1: also indicate that good literacy level for the study population and hence more likely possessing good ability to understand message in health promotion materials (i.e , posters , brochures), including those involving family planning .This is in line with studies done by [12]. About 34% of the sampled population had primary education and 45% of women of reproductive age had secondary education.

Religious affliation; To some extent reflecting existence variations in religious affiliations/ideology in a study population and hence possibly differences in beliefs and practices towardsmoderncontraceptives. Thisisin linewithstudiesdoneby[13,14,15].

Simillarly although majority of the study participants were Bakonzo, however a considerable proportion of them (40%)

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were coming from other tribes and hence possibly existence of culutural differences in a study population which may in turn influence their beliefs and practices towards modern contraceptives and this is in line with studies done by [16,17,13,14,15,16,17]

Information related to fertility

These observation reflect preferences for higher number of children by noticeable proportion of families in a study population, a situation which may hinder uptake of modern contraceptives and hence lowered pace for reducing fertility in the area. Preference for higher number of children by African rural families was also reported in other parts of Africa [18; 19,20,21,22,23,24,25,26,27]

Although a considerable proportion of respondents preferred higher numbers of children (5 and more), proportion of respondents that preferred low (0-2) to medium(3-4)numberofchildrenwasalso substantial. However studies have indicated that lack or low decision autonomyby women on family matters in a house hold could be a barrier for achieving a desirednumberof children in alifetime.

This is similar to the studies done by [23,24,25,26,27,28,29,30,31,32,33,34]. In this regard , when respondents asked on whom has final decision on fertility in family (i.e when to have next birth and number ofchildreninafamily), majority of them indicated that final decision to be done by husbands, a situation which might negatively influence womens’ decision on contraception and their dreams on wanted number of children inlifetimeinastudypopulation.

Knowledge of women towards contraceptives methods

Good knowledge and positive attitude towards an intervention or anew practice by a target groups are among the key determinants for adoption

[27,28,29,35,36,37]. In this study, there wasaninterestonascertainingknowledge of women of reproductive age in study population on modern contraceptives. When asked if theyare aware of modern contraceptives, overwhelming majority indicatedto be aware of the methods 95%

and over 45% knew at least three methods. The most commonly known methods were pills, followedbyinjection, Norplant and IUD. This observation supports earlier findings in otherparts of Uganda and Africa in which it was noted that most women were aware of modern contraceptives despite low adoption rate [30,31,32,33,38,39,40,41,42,43,44,45,46,4 7,48,49,50].

Similar views among study participants was also noted in a study by [34] in Ethiopia. Main source of information on modern contraceptives were Health facilities such as hospitals and health centres

Attitude of women toward family planning methods

According to the table of results above, participants had positive attitude towards modern contraceptives. However despite positive attitude of modern contraceptives by a considerable proportion of women in a study population, its use can be limited by negative attitude of husbands towards modern contraceptives as it has been observedinotherstudiesinotherpartsof Africa[35,36,37,38,40,41,42,43,44,45,46,4 7,48,49,50]. Results from the table indicate that 66% of the participants shows that their husbands disapproves modern contraceptives and this is almost 2/3 of the total participants and 72% never discuss modern family planning with their husbands. A situation which may hinder uptake of modern contraceptives by women in a study population

Practice of women towards family planning methods

In practice women show to use the modern contraceptive methods and according to the results in column graph 1resultsin thea study,most participants haveoptedtheuseofinjectablesfollowed by oral pills and most participants in this study showed up to have used Barrier methods at first coitus especially male condoms followed by oral pills and this showspreferenceofthesemethodsdueto the side effects of other family planning methods. However according to table 11, most participant reasons for not using

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family planning methods is partner opposition and a situation which may limit or hinder uptake of family planning by women in the study population, [39] andaccordingtothestudythepercentage

ofuseaveragely25%inthestudywhichis less far away from the national target of 60% [30], indicating more effortis needed to increase contraceptive use in the study population.

CONCLUSION

Knowledge of modern contraceptive is high in a study population. Substantial proportion of women had positive attitude towards modern contraceptives and hence more room for increasing modern contraceptive use in population, though negative attitude of husbands towardsmoderncontraceptiveandlackof spousal communication on family planning could be a limitation. Likely hood of being current users of modern contraceptives by a woman increased increased with increase in the level of education , having higher number of living children , spousal communication on modern contraceptives i.e frequently talking/discussing family planning methods among spouse), women participation in decision making regarding fertility in a family , husbands approval of family planning methods especially the modern contraceptives and having positive attitude towards modern contraceptives or family planning methods. For example thinking of benefits of family planning methods out weighingnegativeeffects.

Recommendations

Based on findings of this study, to en hence contraceptive use by women of

reproductive age in a study population, it is recommended that education to the community on importance of having smallerfamiliesshouldbeintensified. Furthermore, campaigns to empower women such as emphasis on their education,encouraginggender balanceby changing community attitude towards position status of women in a house hold and in a society as a whole should be strengthened. This would improve their participation in house hold decisions including those related to fertility and contraceptiveuse.

Campaigns to raise awareness on importance of modern contraceptives or family planning methods among males (husbands) should be emphasized and should go along with those involving women. This could be through involvement of males in family planning programmes. More education/counseling services to women on how to handle/deal with side effects associated with various moderncontraceptives.

Campaigns against myths and beliefs that negatively affect use of modern contraceptives in the study should be initiated.

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