The knowledge and determinant factors of contraceptive use among married Sudanese Women

Transcription

1 Applied Science Reports E-ISSN: / P-ISSN: App. Sci. Report. 4 (), 201: PSCI Publications The knowledge and determinant factors of contraceptive use among married Sudanese Women Hanena.O Frini and Wisal Omer. M Nabag² 1. Alziem ALazhari University Faculty of -Medical and technology sciences 2. Alzaeim ALazhari University Faculty of Medicine Corresponding author hanenaselia@gmail.com Key words Knowledge determinant factors contraceptive use married Women A B S T R A C T Introduction: Reproductive health and family planning services and promote it's uptake in city slums is sparse and vary, despite of it's important in reducing poverty and improve quality of life Objective is to assess the knowledge, examine the level of utilization and identify the determinant factors of family planning services utilization among married Sudanese women, Methodology a prospective cross -sectional design, conducted in 2 health centers targeting the population of reproductive age randomly, data was collected from a total of 8 Women using structured questionnaire with interview from women met inclusion criteria during 9 th March-29 th April 201 Results study population were house wives77.8%, parous ladies, their duration of marriage was 1- years, their educational level is primary and secondary school equally( %,) and their main source of knowledge and information were the neighbors. The level of usage and discontinuation of contraception were 25,9%, natural method was preferable in the majorities while contraceptive pills were the predominantly used. Significance level was run in majorities between ( pearson correlation) and was strong between socio-demographic factors and the knowledge Conclusion the main factors affecting contraceptive use in city slums were deficiency of accurate knowledge and information about family planning, poor counseling, number of living children and low socio-economic status 201 PSCI Publisher All rights reserved. Introduction Conception can take place any time during fertile period when pollination occurred naturally free of any impediment (unprotected coitus), and spermatozoon is mature and capacitated (El-MOWFI, 2007), but some time we need protection against unplanned pregnancy which may lead to unpleasant consequences and negative aspect Family planning is choosing the number of children in a family and the length of time between their birth. Currently, only 0. percent of women report receiving pre-pregnancy health counselin. Promotion of family planning which is about to improve quality of life and safe it, has grater contribution in achieving Millennium development goals(mdgs) through improving maternal health, reduction of child mortality, achievement of universal primary education, environmental sustainability, and combating HIV/AIDS, malaria and other diseases as part of (MD Gs) (Khouangvichit, 2002). Reduce population size mean a decreased burden on national expenditure for education,health and other social services as well as less strain on environment and national resource (Timothy et al., 2011) In Sudan, Family planning(fp) and reproductive health services are sparse and vary greatly across different regions and States especially in rural and low developing population, lack of enough accurate information, traditional and religious believes, false rumors, financial considerations and lack of strategic planning, are the major contributing factors preventing uses of contraceptives methods as in eastern Sudan (Abdel Aziem A Ali et al., 2011). Study showed low use of family planning Remarkably low rates of contraceptive usage together with high maternal and infant mortality rates indicate FP services are direly needed. Couples education was the main predictor of this use followed by husband non approval and religious belief. they need to be aware and cleared about their fertility and understand what is contraception (Abdel Aziem A Ali et al., 2011). For developing countries, during the past three decades, contraceptive behavior has changed obviously. The prevalence of contraceptive use has increased sharply, from nearly zero in 190 to around 0 percent in the year 2000 (Bongaarts ) (WHO, 2012). Therefore, the different types of contraception are usually broken down into a few categories: barrier methods (e.g. condoms or a cervical cap), hormonal methods (e.g. the pill), int rauterine devices (IUD) and s terilization.

2 Emergency contraception (morning after pill) is another method. The method chooses depends on woman general health, lifestyle and relationships. Population growth in Khartoum state in Sudan, is one of the highest in Sub-Saharan Africa, despite of decreasing of total population growth rate of the country from 2.84 in 2000 to 1.88 in 2012.Current total fertility rate is 4.5, contraceptive prevalence rate was 7. (200-20) (Isabella, 2009). The main strategies for development include Promotion of health which depends fundamentally upon maternal and child health, to achieve that implementation of family planning is important, as declared by MDGs1,4,5. contraception improve maternal and child health so the objective of the study is to evaluate the knowledge and identify determinant factors of contraceptive use in Sudanese married Women Result of this study will contribute to understand utilization of family planning and then implement in development programs. Profile of study area Ombaddah is the biggest governorate of Omdurman which located in the western region of Khartoum state, the Capital of Sudan.It is about 22.19km ² accommodated by more than 2 million person. include the most city slums of Omdurman (peri -urban area) that characterized by over crowded(large house hold size), high poverty,low level of education, low basic services(electricity,safe water, proper sanitation and,health services) Study design The study is a prospective, descriptive, cross-sectional study, collecting both quantitative and qualitative data. Study population: Target population are all married women of reproductive age(15-44years old) in Ombedda, but the accessible are whom attend to Almanara health center in Section 14 and Alrakha health center in Section 5, from the day 9 th March-29 th April 201, excluded those are menopauses,mentally ill, un married and those who has had hysterectomy. Sampling and sample size Random sampling technique was used to accomplish a descriptive sample size of 8 of respondents. Data collection technique Structured questionnaire with interview was used to obtain data from respondents; the questionnaire was translated to an Arabic language for purpose of understanding and saving the time. Oral consent was taken after introduction, explaining the purpose of the study and contain of the questionnaire. Ethical consideration and legality Permission to carry out this study was obtain from Ministry of health, University of Alziem ALazhari Faculty of postgraduate studies-medical and technology sciences, and local health directorate. In addition, oral consent was obtained from respondents prior to interview. Results The study showed that participant's mean age was 27± (sd=1.4) years and the mean of average duration of marriage was ±(sd=.889).while the average number of living children is 2.1±(sd 1.49), Average mean of monthly income was ±(sd= ), table 1. Majority of women in this study were house wives 77.8%(n= 84) and reported that contraception( FP ) is religiously allowed 5% (n=59) while, only %(n=) were employed at government jobs,.% (n=) of respondents don't know what was the religious perception about contraception. Table (2). showed the result of occupation and religious perception. Question about mode of action was putted in form as ; how dose contraceptives methods prevent the event of pregnancy? This question particularly is the core to explore respondent's believes and other myths and rumors about contraception, as expected, more than fifty percent 4.8%(n=70) said that they didn't know how it prevent pregnancy, 22.2% not answer this question, %(n=) of respondents answered saying : contraceptive methods used lead to increase the spaces between pregnancies. While 2.8%(n=) of respondents answered that : contraceptives are barriers.only one person who employed at one of the center of study area as vaccination personnel, answer this question in term of (barrier + spermicide).table2) Also to examine respondent's knowledge, awareness and updated toward contraception,question about types and numbers of methods that knew by respondents, was asked,which reveal that, the one-third of respondents 2.4%(n=5) was know five methods,followed by 27.8%(n=0) knew four methods,followed by 17.%(n=19) knew three methods, as appear in Table(2). The majority of respondents were received the information about contraception and family planning from their neighbors 40.7%(n=44), while only 12.0%(n=1), %(n=) and (n=) were received the information from doctors, health visitors and mass media respectively. Table (2). Although 50.0%(n=54) of participants have never been using contraceptive methods and 25.9% (n=28) of respondents were discontinued using contraceptives method due to different variety of reasons, only 24%(n=2) are currently use contraception( fig1). 90%(n=98) of the respondents reported that they didn't exposed to physical abuse (fig2) All variables in table () show positive relationship 248

3 at 0.01level, include husband approval(.84), respondent's perception (.8), source of information (.808) and religious perception(.758). Table 1. Distribution of respondent's demographic characteristic according to the mean and standard deviation. Variable Mean SD Age Duration of marriage Number of living children Monthly income Table 2. respondent's social characteristics and knowledge. Variable Frequency(8) Percentage% Occupation Employee House wife Student Worker Religious perception Allow Forbidden Don't know Some of them are allow and others are forbidden Mode of action Barrier Barrier+ spermicide Spacing between pregnancies Don't know Source of information Neighbors Doctors Health visitors Mass media Her sisters Attend courses and reading Number of methods known by respondent Figure 1. percentage of contraceptive use 249

4 Figure 2. Percentage of respondent's physical abuse Table. Association between dependent variable and respondent's knowledge and social characteristics. Contracepti veuse Sourceofinf ormation Husbandap Proval Respondent Perception Religiouspe reception Contracepti veuse 1 Sourceofinf ormation 0.808** 1 Husbandap Proval 0.84** 0.745** 1 Respondent 0.8** 0.99** 0.748** 1 Perception Religiouspe reception 0.758** 0.720** 0.879** 0.707** 1 Discussion The study showed contraceptive prevalence rate of 24% (n=2) which is moderately, low in com pare to the surrounding regions and world wide. It is high in Uganda (0%) according to Birungi Isabella.. There was a wide variation in contraceptive prevalence rate(cpr) world wide, ranging from the lowest 4%, 5%,%,8%, and 9% in South Sudan, Chad, Angola, Eritrea and North Sudan, respectively, in East Central Africa, to the moderate 1% and 29% in Senegal and Cameron, respectively, in North Western Africa.There are selected countries have a moderately good prevalence rate,included Botswana 5%, Congo 44%, Zimbabwe 59% Jordan 59%, Egypt 0%, Algeria 1%. In the developed countries the rate were significantly very high, Norway 88%, Portugal=87%,China=85%, Argentina=78% and Turkey =7%.acording to Sara (UNdata CPR ) Effect of occupation in reducing CPR in this study were strongly significant at (0.01) level which explain by that : majority of respondents were house wives 77.8%(n=84) and received the information about contraception from their neighbors, such information in fact were mixed with myths and rumors. Study in Uganda found that the key determinants for current use of modern contraceptives among the older women (25-4 years) were; a woman's level of education, household wealth and desire for children (Mohamed et al., 2012). Although knowledge and information about contraceptive is wide spread among women, and all of respondents can heard at least about one method of contraception as appear in the result, in addition one-third of respondents (2.4%) knew five methods, 27.%(n=0) knew four methods, this result is inconsistent with the prevalence rate of contraceptive use(2%). To explain this inconsistency, tow predicted variables were used to explore respondent's knowledge about the methods; source of information and how dose the methods prevent pregnancy? respondents have only heard about the name of the methods rather than it's action. side effects, perfect and typical used, which indicate lack of proper counseling. Eisenberq DL et al demonstrated significant knowledge gaps regarding contraceptive effectiveness and over-estimated the effectiveness of pills, the patch, the ring, depo-medroxyprogesterone acetate, and condoms. The level of spontaneous knowledge of at least one method is generally much lower in Sub-Saharan-Africa, but that region also present,market variation among the countries, fewer than 0% of currently married women in Purkina Faso and Nigeria were able to spontaneously name a method, but more than 75% in Malawi and Zambia and 89% Rwanda could do so. The method named spontaneously by the largest percentage of women was the pills in all countries except Rwanda, Senegal and Jordon. In agreement, Martins Chima reported similar findings and stated; Women, even broadly well- educated women in a prosperous part of England, do not knew how effective various forms of contraceptives are, nor are they able to judge the absolute or relative risks of different methods.( Martins, 2012). it have been evident that more than quarter (2%) of respondents were discontinued using contraceptive methods due to variety of reasons, such as, side effects of using the contraceptives (8.%), seeking for having children (20.4%), 250

5 inefficacy of the methods(19.2%),husband disapproval,husband absentees and don't know how to use (7.2%) for each of the last three reasons. Timely and informed method-switching needs to be better recognized by the programmers in order to avoid unintended pregnancies, abortion and unwanted or mistimed births. Improving contraceptive technologies also remains a job unfinished. (Mohamed, 2012). According to the result, it is cleared that women were not fully aware of religious stances of Islam regard contraceptive use, because, more than half of respondent 5%(n=59) believed that FP was HALAL(allow) which is not in proportion with their practice Given that a substantial proportion of women have cited religion as a reason for not using contraceptives, and consider fertility as being controlled by fate, we test the hypothesis whether religious attitudes are significant in reducing the likelihood of contraceptive use.( Mahmood and Ringheim, 199). Very few women reported that the use of contraceptive methods was against religion or cultural beliefs, cited in previous study done in Khartoum state 2007 that agreeing with study findings. (Ibnouf, 2007). Conclusion It will be concluded that: the main factors affecting contraceptive use in city slums were deficiency of accurate knowledge and information about it, poor counseling, number of living children and low socio economic status, References Abdel Aziem A Ali et al Use of family planning methods in Kassala, Eastern Sudan2011. Definition of family planning: El-MOWFI D, Obstetrics simplified. forth edition Health Policy Initiative Ibnouf AH Utilization of family planning services by married Sudanese Women 0f reproductive age.2007' _172_181.pdf Isabella B, Contraceptive utilization and associated factors among HIV positive Women in Mulago ISS clinic UGANDA. Khouangvichit D FACTORS AFFECTING CONTRACEPTIVE USE AMONG MARRIED WOMEN IN REPRODUCTIVE AGE IN LAO PDR. Knowledge of contraceptive effectiveness. Eisenberg DLl. Martins Chima, African Women s' knowledge of contraception and risk they face Mohamed MA et al Causes and consequences of contraceptive discontinuation: evidence from 0 demographic Mohamed MAli, Causes and consequences of contraceptive discontinuation: evidence from 0 demographic 2012 N MAHMOOD and RINGHEIM K. Factors Affecting Contraceptive Use in Pakistan Preconception and interconception health status of women who recently gave birth to a live-born infant pregnancy risk assessment monitoring system (PRAMS), United States, 2 Reporting Areas, opicid=1. THE HENRY J. KAISER FANILY FOUNDATION. Contraceptive prevalence rate Timothy C.Okech et al Contraceptive use among Women of Reprductive Age in Kenya's City Slums Tsui, knowledge of contraception measure. UN Millennium Development Goal in Sudan. Available from : UNdata CPR WHO Media centre - Emergency contraceptives WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt