Knowledge, Attitude and Practice (KAP) Towards Modern Contraceptives Among Married Women of Reproductive Age in Mpwapwa District, Central Tanzania

Please download to get full document.

View again

of 11
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
Information Report
Category:

Humor

Published:

Views: 0 | Pages: 11

Extension: PDF | Download: 0

Share
Related documents
Description
Current Research Journal of Social Sciences 4(3): , 2012 ISSN: Maxwell Scientific Organization, 2012 Submitted: March 03, 2012 Accepted: March 16, 2012 Published: May 10, 2012 Knowledge,
Transcript
Current Research Journal of Social Sciences 4(3): , 2012 ISSN: Maxwell Scientific Organization, 2012 Submitted: March 03, 2012 Accepted: March 16, 2012 Published: May 10, 2012 Knowledge, Attitude and Practice (KAP) Towards Modern Contraceptives Among Married Women of Reproductive Age in Mpwapwa District, Central Tanzania 1 J. Lwelamira, 1 G. Mnyamagola and 2 M.M. Msaki 1 Department of Population Studies, 2 Department of Rural Development and Regional Planning, Institute of Rural Development Planning, P.O.Box, 138, Dodoma, Tanzania Abstract: This study was undertaken in Mpwapwa District in Central Zone of Tanzania between July to August, 2009 to assess knowledge, attitude and practice towards modern contraceptives among married women of reproductive age (15-49 years). Specific objectives of the study were to ascertain knowledge and attitude towards modern contraceptives, to determine the extent of use of modern contraceptives and identify factors associated with current use of modern contraceptive in the study population. Study design involved a crosssectional survey that involved 160 women randomly selected from eight villages with nearly equal number of respondents per village. Data from respondents were collected using a pre-tested semi-structured questionnaire. Furthermore, eight Focus Groups Discussions (FGDs), with one FGD per village were also carried out to collect qualitative information. Statistical Package for Social Sciences (SPSS) program version 12 was used to analyse quantitative data. Qualitative data were analysed using Content Analysis (CA). Results of this study revealed knowledge of modern contraceptives in a study population to be high. Furthermore, findings of this study indicated substantial proportion of respondents to have positive attitude towards modern contraceptives and hence more room for increasing modern contraceptive use in a study population. For example, half (50%) of respondent that were aware of modern contraceptives thought that benefits of modern contraceptives outweigh negative effects and 42% agreed that they could recommend use of modern contraceptive to a friend. However, despite presence of positive attitude towards modern contraceptives by a good number of women in a study population, negative attitude of husband towards modern contraceptives can be one of the obstacles for the success of campaigns to increase modern contraceptive use in the study area. Two- third (65.8%) of study participants indicated that their husband doesn t approve modern contraceptives. Regarding contraceptive prevalence rate in the target group (i.e., proportion currently use modern contraceptives), although there was some improvement compared to the past national averages, however, the obtained figure (25%) was far (too low) from the desired national target of 60%. Results for Binary Multiple Logistic Regression Analysis indicated that Likelihood (chances) of being current user of modern contraceptives by a woman increased significantly by having secondary education and higher (Odds ratio (OR) = 15.18, p 0.05), having higher number of living children (i.e., 4 and above) (OR = 19.68, p 0.01), spousal communication on modern contraceptives (OR = 1.84, p 0.05), woman participation in decision making regarding fertility in a family (OR = 19.40, p 0.05), husband approval of modern contraceptives (OR = 18.46, p 0.01) and having positive attitudes towards modern contraceptives (OR = 8.50, p 0.05) (i.e., thinking that benefits of modern contraceptives outweighs negative effects) compared to the counterparts. The Odds (chances) of being current user of modern contraceptive by a woman decreased by living more than 5 km from nearest health facility (OR = 0.67, p 0.05) and if had ever encountered side effects (OR = 0.44, p 0.05). Based on these findings recommendations for improving modern contraceptive use in a study population have been indicated. Key words: Contraceptives, family planning, fertility, knowledge INTRODUCTION High fertility rate and hence high population growth rate are among the major economic and social problems facing developing world including Tanzania. High population growth rate has been associated with increased level of poverty (Dabral and Malik, 2004; Adanu et al., 2009; Adiri et al., 2011; Avidime et al., 2010). This rests on inability of governments in these countries to adequately provide social services to the rapidly growing Corresponding Authors: J. Lwelamira, Department of Population Studies, Institute of Rural Development Planning, P.O. Box, 138, Dodoma, Tanzania 235 population and shrinkage of resource base. Furthermore, high fertility rate has been associated with poor child and maternal health as well as increased risk of maternal mortality (UNFPA, 2008; Chipeta et al., 2010; Woldemicael and Beaujot, 2011; Mathe et al., 2011). To control fertility, the government of Tanzania had changed its population policy since early 1990s to allow sexually active persons to access modern family planning services (i.e., modern contraceptives) (URT, 2006). Despite the government efforts, until the mid 2000s fertility rate and contraceptive prevalence were still at unacceptable level. For example Demographic and Health Survey carried in the country between indicated total fertility rate to be 5.6 and modern contraceptive prevalence rate among married women of reproductive age to be 20% and unmet need for contraceptives to be as high as 22%. Among others, factors that limited modern contraceptive uptake included myths, rumours and misinformation about modern contraceptives, low availability and poor access to services (Marchant et al., 2004; URT, 2010). However, in recent years there had been an increased thrust on family planning campaigns in the country by both government and non- governmental organizations, which included among others, intensification family planning services in almost all health facilities including those in rural areas as well as rising awareness to the community on the benefits of family planning (URT, 2010). Since intensification of these campaigns, scanty information is available on current status of modern contraceptive use in most parts of the country specifically in rural areas as well as factors influencing their use. This information is important for more informed decisions on family planning campaigns in the country (Marchant et al., 2004; Oye-Adeniran et al., 2006; Adanu et al., 2009). Therefore, the aim of this study was to assess knowledge, attitude and practice towards modern contraceptives among married women of reproductive age (15-49 years) in Central Zone of Tanzania by taking a case of Mpwapwa district. Specifically, the study intended to ascertain knowledge and attitude among married women of reproductive age towards modern contraceptives in the study area; to determine the extent of use of modern contraceptives by the target group; and to identify factors associated with current use of modern contraception by the target group in the study area. METHODOLOGY Study area: This study was carried out in Mpwapwa district in Dodoma region, Central Tanzania. The district is among the six district of the region. It is located 120 km from Dodoma Region Headquarters. It lies between Latitudes 6º00 and 7º30 South of the Equator and between Longitude 35º45 and 37º00 East of Greenwich. The District covers a total area of 7,379 km 2 (18.1% of total area of Dodoma Region) (URT, 2009). The dominant ethnic group is Gogo accounting for more than 50% of total population. Study design: This study was carried out in the study area between July to August, The study involved a cross- sectional survey in eight 8 randomly selected villages from 4 randomly selected wards (i.e., two villages per ward) of Mpwapwa district covering all three divisions of the district (Mpwapwa, Kibakwe and Rudi). Villages involved in the study included Ilolo, Mwanakianga, Mazae, Kisokwe, Pwaga, Mungui, Chilendu and Mtamba. A total of 160 married women of reproductive age (15-49 years) from 160 randomly chosen households (i.e., one individual per household) were involved in this study. Nearly equal number respondents were chosen from each village. During sampling, in case a household was found to have no married woman of reproductive age, a household was replaced by another nearby household chosen at random. Furthermore, if a household was found to have more than one married woman of reproductive age, only one woman chosen at random was considered for interview. Furthermore, apart from questionnaire survey, 8 Focus Groups Discussions (FGDs), with one FGD per village were also carried out to collect qualitative information for the study and to verify responses from questionnaires. Number of FGD members per group varied between 8-10 married women of reproductive age. During data collection, informed verbal consent was directly asked from respondents before interview. Data analysis: Data collected were verified, coded and then analyzed for descriptive statistics such as percentages using Statistical Package for Social Sciences (SPSS) program version 12. The program was also used for inferential statistical analyses to test if there was significant association between current use of modern contraceptives by a woman (dependent variable) and social- demographic, fertility and attitudinal variables; as well as clinical side effects of modern contraceptives (independent variables). During inferential statistical analyses, bivariate analyses using Chi-square test were carried out to screen significant independent variables, which were then subjected to multivariate analysis using Binary Multiple Logistic Regression using a statistical model below to control for confounding effects (Kebede, 2006; Maria, 2007; Dibaba, 2008): p n 1n X 1 i p i 1 where, by p is a probability of being current user of modern contraceptives, and $ are estimated regression coefficients and X i are various explanatory variables. i 236 Odds Ratio (OR) for determining the effect of various categories of explanatory variables on likelihood of being current user of modern contraceptives were estimated by computing Exp($) for each variable (Hosmer and Lemeshow, 2000). Socio- demographic variables used in association analysis (inferential statistical analyses) included respondent s age, type of marriage, education level, religious affiliation, ethnicity (tribe), household socioeconomic status proxied by annual household income and distance to the nearest health facility; fertility variables included current number of living children and woman participation in household/family decisions regarding fertility; Attitudinal variables included if think benefits of modern contraceptives outweigh their negative effects, husband approval of modern contraceptives and frequent discussion of family planning between spouses (i.e., spousal communication on family planning/modern contraceptives). Reaction (side effects) of modern contraceptives in this study were captured by a question asking if ever experienced side effect for respondents that had ever used modern contraceptives.based on existing literature, in this study it was hypothesized that there was significant association between these variables and current use of modern contraceptives. Association was considered significant when p 0.05. Based on descriptive statistical analysis, since nearly all respondents were aware and had good knowledge on modern contraceptives, association between cognitive variables and current use of modern contraceptive were excluded in association study/analysis. Qualitative information collected in this study were analysed using Content Analysis (CA). RESULTS AND DISCUSSION Socio- demographic characteristics of respondents: Socio- demographic variables are among important factors influencing individual s decisions on contraception and fertility (Dabral and Malik, 2004; Igwegbe et al., 2009; Burke and Ambasa-Shisanya, 2011). Results from Table 1 indicate that although majority of study participants (nearly half) aged between years i.e. younger, however, substantial proportion of respondents (41%) aged more than 30 years. Since marriage/childbearing in rural Africa starts early (Duze and Mohamed, 2006; Atuyambe, 2008), this observation indicates sizeable number of study participants were in age in which they could already have several children and hence could need modern contraceptives for child limiting. Polygamous type of marriage may negatively influence husband-wife communication on family issues including those related to fertility and contraception. Furthermore, studies have shown individuals that are monogamous and have positive attitudes towards contraceptives will be more inclined to use contraceptives Table 1:Distribution of respondents by Socio- demographic characteristics (n = 160) Variable Frequency Percent Age (Years) Type of marriage Monogamy Polygamy Education level None Primary Secondary and above Religious affiliation Catholic Protestant Moslem Tribe/Ethnicity Gogo Others Annual household income 500, ,000 1,000, 1,000, Distance to nearest health facility 5 km and below Above 5 km than those in polygamous marriage. This is more particularly so due to competition to bear children among the co-wives (Duze and Mohamed, 2006). Results in Table 1 indicate type of marriage by 81% of total respondents was monogamy, implying nearly one-fifth (i.e. 20%) of respondents, a noticeable proportion, were in polygamy type of marriage. Results from Table 1 also indicate 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 (Mgabo et al., 2010). About 78% of the sampled individuals had primary education and 20%, that is one in every five married women of reproductive age had at least secondary education. Religious affiliation by most of the respondents was Protestant accounting for nearly threequarters (74.4%) of total respondents, followed by Catholic accounting for 18.1% of total respondents and the rest were Moslem; to some extent reflecting existence variations in religious affiliation/ideology in a study populations and hence possibly differences in beliefs and practices towards modern contraceptives (Dey and Goswami, 2009; Dhingra et al., 2010; Burke and Ambasa- Shisanya, 2011). Similarly, although majority of study participants were Gogo, however a considerable proportion of them (40%) were coming from other tribes and hence possibly existence of cultural differences in a study population, which may in turn influences their beliefs and practices towards modern contraceptives (Singh, 2006; Ndaruhuye et al., 2009; Dey and Goswami, 2009). Socio- economic status (in this study proxied by family income) as well as distance to the nearest health 237 Table 2: Distribution of respondents by information related to fertility (n = 160) Variable Frequency Percent (%) Current number of living children & above If want more children Yes No Desired number children & above Who has final decision on fertility in a household (i.e., when to have next birth and number of children in a family) Husband Wife Both facility may influence woman health seeking behaviour including modern contraception (Amin et al., 2010; Woldemicael and Beaujot, 2011). Results from Table 1 indicate households involved in this study distributed across various categories of social economic status with majority of them (58.8%) having family income of below 500, 000 Tsh. per annum and a quarter having family income per annum of between 500, 000 to 1,000,000 Tsh. Distance to the nearest health facilities by around onethird (36%) of study participant was more than 5 km (i.e. located at distant areas). Information related to fertility : Results from Table 2 indicate current number of living children by most of respondents (62%) were at least three children, with 20% of total respondents having five children and above. Respondents were also asked to indicate if they want more children in the future. In this regard, despite most of respondents had at least three children, still majority (71.9%) wanted more children, with desired number of children in life time (i.e. ideal number of children) by nearly half of respondents (48%) being five and above. These observations reflect preference for higher number of children by a noticeable proportion of families in a study population, a situation which might 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 (Eyayou et al., 2004; Keele et al., 2005; Duze and Mohamed, 2006; Chipeta et al., 2010; Avidime et al., 2010). 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) number of children was also substantial (52%), however, studies have indicated lack or low decision autonomy by women on family matters in a household could be a barrier for achieving a desired number of children Table 3: Distribution of respondents by knowledge on modern contraceptives Variable Frequency Percent (%) Awareness to modern contraceptives (n =160) Aware Not aware Number of modern contraceptives methods known (n = 158) More than Type of modern contraceptives methods known* (n = 158) Pills Injection Male condom Norplant IUD Female sterilization Source of information on modern contraceptives* (n = 158) Hospital Dispensary Health centre Mobile clinic Friends Relative Radio Elders Different people Public announcement Posts Leaflets School *: Data were based on multiple responses in a life time (Matthews et al., 2005; Nwankwo and Ogueri, 2006: Shaikh et al., 2008; Woldemicael and Beaujot, 2011). In this regard, when respondents asked on whom has final decision on fertility in a family (i.e., when to have next birth and number of children in a family), majority of them (71%) indicated the final decision to be done by husband (Table 2), a situation which might negatively influence women s decisions on contraception and their ability to achieve their dreams on wanted number of children in life time in a study population. Knowledge and Attitudes towards Modern Contraceptives: Knowledge on modern contraceptives: Good knowledge and positive attitudes towards an intervention or a new practice by a target group are among the key determinants for adoption (Ndaruhuye et al., 2009; Mathe et al., 2011; Woldemicael and Beaujot, 2011). In this regard, this study was also interested on ascertaining knowledge of married women of reproductive age in study population on modern contraceptives. When respondents were asked if they are aware of modern contraceptives, overwhelming majority (98.8%) indicated to be aware of the methods and over 80% knew at least three methods (Table 3). The most commonly known 238 methods were pills, followed by injection, Norplant and IUD indicated by 94.3, 93.7, 87.3 and 51% of respondents, respectively. This observation support earlier findings in other part of Tanzania and Africa in which it was noted that most women were aware of modern contraceptives despite low adoption rate (URT, 2010; Aryeetey et al., 2010; Opoku and Kwaununu, 2011; Mathe et al., 2011). Less than half (36.1%) of total respondents mentioned male condoms as among of modern contraceptives methods as most of the respondents perceived it as a preventive measure against HIV/AIDS and other sexually transmitted diseases. Similar view among study participants was also noted in a study by Mengistu et al. (2006) in Ethiopia. Main source of information on modern contraceptives were government health facilities such as hospitals and dispensaries (Table 3). The following quote from one participa
Recommended
View more...
We Need Your Support
Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

Thanks to everyone for your continued support.

No, Thanks