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Assessment of the Knowledge, Attitudes and Practices of Female Secondary School Learners on Emergency Contraception in Ongwediva, Oshana Region

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Assessment of the Knowledge, Attitudes and Practices of Female Secondary School Learners on Emergency Contraception in Ongwediva, Oshana Region i ASSESSMENT OF THE KNOWLEDGE, ATTITUDES AND PRACTICES OF FEMALE SECONDARY SCHOOL LEARNERS ON EMERGENCY CONTRACEPTION IN ONGWEDIVA, OSHANA REGION THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE DEGREE OF MASTER OF PUBLIC HEALTH OF THE UNIVERSTY OF NAMIBIA BY Emmanuel Magesa Student Number : 201119102 March 2014 Main Supervisor: Dr. Lischen Haoses-Gorases Co-supervisor: Dr. Timothy Rennie Dr. Solomon Yigeremu (I-Tech, Washington University) ii DECLARATION I, Emmanuel Magesa, hereby declare that this study is a true reflection of my own research, and that this work, or part thereof has not been submitted for a degree in any other institution of higher education. No part of this thesis/dissertation may be reproduced, stored in any retrieval system, or transmitted in any form, or by means (e.g. Electronic, mechanical, photocopying, recording or otherwise) without the prior permission of the author, or The University of Namibia in that behalf. I, Emmanuel Magesa, grant The University of Namibia the right to reproduce this thesis in whole or in part, in any manner or format, which The University of Namibia may deem fit, for any person or institution requiring it for study and research; providing that The University of Namibia shall waive this right if the whole thesis has been or is being published in a manner satisfactory to the University. ....................................... ....................... Emmanuel Magesa Date iii DEDICATION I dedicated this work in the memory of all female school learners who lost their lives and [those] dropped out of schools because of unwanted pregnancies. I believe they could have changed this world or make a substantial difference amongst their societies. iv ACKNOWLEDGEMENTS I would like to express my gratitude to the following people and institutions who contributed to the positive outcome of my studies First, I thank God for giving me strength during my study. Dr.Lischen Haoses–Gorases, Dr. Timothy Rennie, and Dr. Solomon Yigeremu, my supervisors from the University of Namibia for their professional guidance and tireless efforts to assist me during the course of my study without their support this study could have been impossible. Ministry of Education and University of Namibia for granting me permission to carry out research at Mweshipandeka and Gabriel Taapopi secondary schools. The Principal and staff of Mweshipandeka and Gabriel Taapopi secondary schools and respondents of the study, where I carried the research and data collectors of the study for facilitating the data collection processes, without whom the research couldn‘t have succeeded. Agatha Thomas Mkonyi (my wife) and my children, Daniel Emmanuel Magesa, Abigael Emmanuel Magesa and Gideon Emmanuel Magesa for their love, support and encouragement during my study. Rochelle Van Wyk (course coordinator) and all MPH students and lecturers of the school of Nursing and Public Health, University of Namibia. You have been my inspiration. The Almighty God bless you all. v TABLE OF CONTENTS DECLARATION…………………………………………………………… ii DEDICATION……………………………………………………………… .iii ACKNOWLEDGEMENTS………………………………………………… iv LIST OF TABLES…………………………………………………………… …..ix LIST OF FIGURES…………………………………………………………... …..x LIST OF ABREVIATIONS AND ACRONYMS…………………………. xii ABSTRACT………………………………………………………………… xiv CHAPTER 1: INTRODUCTION 1.1 INTRODUCTION/BACKGROUND.....................................................................1 1.2 PROBLEM STATEMENT.......................................................................................5 1.3 AIM OF THE STUDY.............................................................................................7 1.4 SPECIFIC OBJECTIVES .......................................................................................7 1.5 DEFINITION OF TERMINOLOGY……………………………………………..7 1.6 SIGNIFICANCE OF THE STUDY………………………………………………9 1.7 SUMMARY………………………………………………………………………..9 CHAPTER 2: LITERATURE REVIEW 2.1 INTRODUCTION....................................................................................................11 2.2 CONCEPTUAL FRAMEWORK………………………………………………….11 2.3 OVERVIEW OF EMERGENCY CONTRACEPTION…………………………..14 2.4 HISTORICAL BACKGROUND OF EMERGENCY CONTRACEPTION……..15 2.5 EFFICACY STUDIES FOR EMERGENCY CONTRACEPTION………………17 2.6INTERNATIONAL CONFERENCES/AGENCIES WHICH PROMOTE EC…..20 2.6.1 Cairo international conference on population…………………………....20 2.6.2 Bellagio conferences……………………………………………………..21 2.6.3The International Consortium for Emergency Contraception's (ICEC)…..21 2.6.4. The European Consortium for Emergency contraception (ECEC)……...22 2.7 EMERGENCY CONTRACEPTION METHODS USED WORLDWIDE……..23 2.7.1Yuzpe method……………………………………………………………23 2.7.2 Levonorgestrel…………………………………………………………..26 2.7.3 Mifepristone……………………………………………………………..27 2.7.4 High dose estrogen………………………………………………………28 2.7.5 Danazol………………………………………………………………….28 2.7.6 Copper IUD……………………………………………………………..29 2.8 EMERGENCY CONTRACEPTION METHODS USED IN NAMIBIA………30 vi 2.8.1 Levonorgestrel only regimen……………………………………………..30 2.8.2 Combined estrogen-progestin (Yuzpe) regimen…………………………31 2.8.3 Copper IUD…………………………………………………………….. .31 2.9 LAWS WHICH HAVE IMPACT ON EMERGENCY CONTRACEPTIVE……31 2.9.1 Abortion law around the world…………………………………………..31 2.9.2 Abortion law and sterilization act in Namibia……………………………32 2.8.2.1. Unsafe abortion among school learners in Namibia…………..33 2.10 UNPLANNED PREGNANCY AMONG LEARNERS ………………………..35 2.10.1 School drop-out due to pregnancy in Namibia………………………….36 2.11 EMERGENCY CONTRACEPTION……………………………………………38 2.11.1 Mechanism of action of EC……………………………………………..38 2.11.2 Effectiveness of emergency contraception……………………………..39 2.11.3 Side effects and contradiction of EC…………………………………..39 2.11.4 Importance of EC for school learners…………………………………..40 2.11.5 Correcting myth and misunderstanding on emergency contraception…41 2.11.6 Recommendation on the EC dosage regimen in Namibia………………42 2.11.7 Barrier to emergency contraception and use……………………………43 2.11.8 Need for emergency contraception in Namibia…………………………44 2.11.9 Knowledge and practice of school learners on EC…………………….45 2.11.10 Knowledge of emergency contraception………………………………45 2.11.11 Factors that affect knowledge, attitudes and practices of school learners………………………………………………………………………………....52 2.12 SUMMARY………………………………………………………………………53 CHAPTER 3: RESEARCH METHODOLOGY 3.1 RESEARCH DESIGN.............................................................................................54 3.1.1 Study area...................................................................................................54 3.1.2 Target and study population……………………………………………...............57 3.1.2.1 Inclusion criteria………………………………………………..57 3.1.2.2 Exclusion criteria……………………………………………….58 3.1.2.3 Sample and Sampling process………………………………………….58 3.1.2.4 Sample size……………………………………………………………..58 3.1.2.5 Sampling procedure…………………………………………………….60 3.1.3 Research instrument...................................................................................62 3.1.4 Data collection and quality control………………………………………62 3.1.5 Data analysis……………………………………………………………..63 3.1.6 Validity and reliability……………………………………………………64 3.1.6.1 Reliability…………………………………………………… ….64 3.1.6.2 Validity…………………………………………………… ………….65 3.1.7 Pilot study..................................................................................................65 vii 3.1.8 Research ethics..........................................................................................66 3.1.9 Dissemination of the results……………………………………………...68 3.2 SUMMARY............................................................................................................. 68 CHAPTER 4: RESULTS 4.1 INTRODUCTION…………………………………………………………………69 4.2 DEMOGRAPHIC CHARACTERISTICS OF THE RESPONDENTS……………69 4.2.1 Social, economical characteristics of respondents‘ household head…… .72 4.3 KNOWLEDGE OF RESPONDENTS ON EMERGENCY CONTRACEPTION..75 4.3.1 Awareness on methods available for emergency contraception………….75 4.3.2 Perception of factors responsible for unprotected sex among young people…………………………………………………………………………………..75 4.3.3 Knowledge and awareness on emergency contraception………………...76 4.3.4 Source of information on emergency contraception……………………..78 4.3.5 Knowledge of timing of emergency contraception use………………… 79 4.3.6 Knowledge on accessibility of emergency contraception on potential users…………………………………………………………………………………….81 4.3.7 Knowledge on how emergency contraception works……………………82 4.4 ATTITUDES AND PRACTICES TOWARDS EMERGENCY CONTRACEPTION…………………………………………………………………..83 4.4.1 Practices………………………………………………………………………….83 4.4.2 Attitudes…………………………………………………………………………86 4.4.2.1 Attitudes after previous experience with EC………………………………….74 4.4.2.2 Attitudes towards future use of emergency contraception…………………….87 4.4.3 Attitudes of respondents towards selected sexual practices among young people.............................................................................................................................88 4.5 SUMMARY……………………………………………………………………….90 CHAPTER 5: DISCUSSION, RECOMMENDATIONS AND CONCLUSION 5.1 INTRODUCTION………………………………………………………………….91 5.2 DISCUSSION………………………………………………………………………92 5.2.1 Knowledge of female learners towards emergency contraception……….92 5.2.2 Limitation of the study…………………………………………………..99 5.2.2.1 The strengths of the study…………………………………......99 viii 5.2.2.2 Weakness of the study………………………………………….99 5.3 RECOMMENDATIONs………………………………………………………….101 5.3.1 Improve female learners‘
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