Assessment of KAP of long term reversible contraceptive among womens reproductive age ( 15- 49) of Gelemso town Kebele

01,2013. Research proposal Submitted to department of Nursing for partial fulfillment of BSC Degree in Nursing Principal investigator 1. Abdi dangi- 5117/02 2.Selamawit yitagesu 5750/02 3.Sorome Amsalu 5776/02 4.Tseday Adissu-5811/02
Harar, Ethiopia, 2013

Assessment of KAP of long term reversible contraceptive among womens of reproductive age group ( 15- 49 ) in Gelemso town , kebele 01, 2013. Principal investigators 1. Abdi Dangi -5117/02 2. Selamawit yitagesu - 5750/02 3. Sorome Amsalu 5776/02 4. Tsedey Adissu-5811/02

Research proposal Submitted to department of Nursing for partial fulfillment of BSC Nursing
Advisor: Instructor Hayimanot Mezmur (MSC) Harar , Ethiopia , 2013

Table of Contents
TABLE OF CONTENT ...................................................................................................................................... 4 SUMMARY..................................................................................................................................................... 7 ABBREVIATION /ACRONOMY........................................................................................................................ 8 UNIT ONE ...................................................................................................................................................... 9 1. INTRODUCTION..................................................................................................................................... 9 1.1. 1.2. 1.3. Background ................................................................................................................................... 9 Statement of the Problems......................................................................................................... 10 Significance of the Study............................................................................................................. 11

UNIT TWO ...................................................................................................................................................12 2. LITERATURE REVIEW ...........................................................................................................................12 2.1. Introduction to Long Acting Reversible Contraceptive (LARC) ...................................................12

2.2.1. Knowledge towards LARCs........................................................................................................ 13 2.2.2. Attitude to wads LARC .............................................................................................................. 15 2.2.3. Practice of LARC .......................................................................................................................16 2.2.4. Summary ...............................................................................................................................19

UNIT THREE .................................................................................................................................................20 3. OBJECTIVES ............................................................................................................................................. 20 3.1 General Objective .............................................................................................................................20 3.2. Specific Objectives..........................................................................................................................20 UNIT FOUR ..................................................................................................................................................21 4. METHODOLOGY ...................................................................................................................................... 21 4.1 Study Area......................................................................................................................................... 21 4.2 study Period ...................................................................................................................................... 21 4.3 Study Design...................................................................................................................................... 21 4.4 Populations ....................................................................................................................................... 21 4.4.1 Source of population..................................................................................................................21 4.4.2 Study of population....................................................................................................................21 4.5. Inclusive & Exclusive criteria ...................................................................................................... 21

4.5.1. Inclusive criteria ........................................................................................................................21 4.5.2. Exclusive criteria .................................................................................................................22

4.6. Sampling technique & sample size determination .......................................................................... 22

4.7. Sampling Techniques .......................................................................................................................22 4.8. 4.9. Data Collection Method.............................................................................................................. 23 Description of Variables ............................................................................................................. 23

4.9.1. Independent variable................................................................................................................23 4.10. Operational |Definition .................................................................................................................23 4.11. Data Quality Control ......................................................................................................................24 4.12. Data Processing & Analysis .......................................................................................................... 24 4.12.1. . Data processing.....................................................................................................................24 4.12.2.Data analysis ............................................................................................................................24 4.13. Ethical Consideration ....................................................................................................................24 UNIT FIVE ....................................................................................................................................................25 5. WORK PLAN......................................................................................................................................... 25

UNIT SIX.......................................................................................................................................................26 6. BUDGET JUSTIFICATION ......................................................................................................................26 6.1. 6.2. 6.3. 6.4. 6.5. Personal Cost..............................................................................................................................26 Stationary Cost............................................................................................................................26 Transportation Cost ...................................................................................................................26 Others costs ...............................................................................................................................27 Budget Summary.........................................................................................................................27

UNIT SEVEN.................................................................................................................................................28 7. REFERENCE.......................................................................................................................................... 28

Annex 1. Questionnaire ..............................................................................................................................31

TABLE OF CONTENT
Title Page Acknowledgement .. ..I Table of content I

Summary III Abbreviation / Acronomy ..IV Chapter one 1. Introduction .1 1.1. Back ground .1 1.2. Statement of the problem .4 1.3. Significance of the study 6 Chapter Two 2. Literature Review 7 - Introduction 7 - Body .8 - Summary ............................19 Chapter Three 3. Objective .20 3.1. General Objective .20 3.2. Specific objective . .20 Chapter Four 4. Methodology 21 4.1. Study area ...21 4.2. Study period ..21 4.3. Study design ...21 4.4. Population 22 4.4.1. Source population .22 4.4.2. Study population .22 4.5 . Inclusive & exclusive criteria ..22 4.6 Sample size determination ...22 4.7 Sampling technique ...22 4.8 Sampling procedures .23 4.9 of data collection .23 4.10 Description of variables..23 4.10.1. Dependent variable 23 4.10.2. Independent Variable .23 4.11. Operational definition ...23 4.12. Data quality control ...24

4.13. Plan for data analysis ...25 4.14. Ethical consideration .. 25 Chapter five 5. work plan ...26 Chapter six 6. Budget justification .27 Chapter Seven 7. Reference .28 Annex- questionnaires31 Dummy tables ....37

SUMMARY
Introduction : LTRC method of birth control refers to contraception method that is used by women. It provide effective contraception for an extended period of time with out requirement of users action include implant and IUCD. Because of their long lasting protection, safety, simplicity, effectiveness, low cost long term contraceptive can be used for years. Objective: To assess KAP of LTRC among women of reproductive age (15-49) in gelemso town, kebele 01, june, 2013. Methodology :A. descriptive crossectional quantitative community based study will be conducted to assess KAP of LARC among womens of reproductive age group (15-49) from june 1 to 30,2013. A total of 339 respondents will be inter viewed. multi stage sampling technique will be used. The data will be analyzed by expressing in number, frequency, percent and by using dummy tables. The letter will be written from HU to concerned body. Budget: The total budget will be 2308 birr. Result: result will be presented in text, tables and figures. Conclusion: based on the result of the study conclusion will be given. Reccomendation; based on the result of the study possible recommendation will be recommended for regional health bureau, NGO s who are working for family planning like FGAE & other organization.

ABBREVIATION /ACRONOMY
CPR- contraceptive prevalence rate DC- data collectors CSA-Central statistical agency EDHS- Ethiopian demographic health survey FP- family planning HU- Haramaya University IUCD intra uterine contraceptive device KAP- knowledge attitude practice LACM long acting contraceptive methods LAPMs-long acting permanent methods WHO- world health organization

UNIT ONE 1. INTRODUCTION

1.1. Background

The long-term reversible contraceptive methods of birth control that provide effective contraception for an extended period of time without requirement of users action include implant & IUCD. Implants & IUCD are still the most widely used methods of fertility regulation, in the world because of their safety, simplicity, effectiveness and low cost. Because of their long lasting protection LTRC can be used for years (1). Women and couples who want safe & effective protection against pregnancy would benefit from access to more contraceptive choice, including LARC. Despite of these advantages, LARCMs are given in few areas and sometimes are missing, component of many national reproductive health and family programs. More than 350 million couples worldwide have limited or no access to effective & affordable family planning especially to LARC (1). 13% of the world women use the IUCD as their methods of contraception (2). The global figure of IUCD prevalence masks the variation of IUCD use across the globe. Updates from world contraceptive use in 2009 indicate that 25% of users of any contraceptive used IUD in Asia, followed by 20% in Europe. These proportions are reflected by the predominant of IUD use in china (50% of all users). When excluding china from the global estimates IUDs accounts for 12% of all contraceptive use worldwide. However the IUD represents only 2% of modern method of contraceptive use in sub-Saharan Africa, revealing the under- utilization of this method in the region despite the IUD being such an important choice for women elsewhere (3). Timing & spacing pregnancies is necessary for improving the outcomes of pregnancy & childbirth for both mothers & their children. Better availability of FP service including LARC i.e. IUCD & Norplant, would fulfill the need for healthier timing & spacing pregnancies (4).but

many potential client in sub-Saharan Africa lack information or having misconception about LARCMs. Even in countries were most people know about FP, fewer people have knowledge of IUCD & vasectomy than of other methods. Myths & misconceptions are also wide spread for these methods. (5) LARCMs are convenient for users. Women who use oral contraceptives must remember to take their pills each day. Likewise injectable users must have re-injections every 1-3 months. Depending on the type of injectable, they are using resupply often requires travel to a clinic & the timing of clinic visit is critical for preventing pregnancies LARCM requires almost no attention on the part of users after they are initiated, & their effectiveness is not dependent on daily or monthly action (1). LARCM can be the most cost effective options for users over time. oral contraceptives &injectable may at 1st appears to be lower cost options, but their cumulative cost due to return visits & resupply can be surprisingly high. On the other hand, LARCMs may have a higher onetime start up cost, depending on the type of facility providing them, but are usually less expensive over time (1). LTRC methods such as IUCD & under skin implant are 20 times more effective for preventing pregnancy than short term birth control, plus, patches & rings (6).

1.2.

Statement of the Problems

3.6% of population growth is due to unplanned pregnancies of the 210 million pregnancies occurring each year, nearly 80 million are unintended. Each year modern contraceptives (i.e. IUCD and implant) help women to prevent 215,000 pregnancy related deaths including 66,000 from unsafe abortion), 2.7 million infant deaths & the loss of 60 million years of healthy life. 2.2 million unintended pregnancies occur each year to sub Saharan adolescent females(7). There are two key ways in which the delivery mechanism of FP services may affect use of service access to FP services and the acceptability of such service to the women and men. An estimated 222 million in developing countries would like to delay or stop child bearing but are

not using any methods of contraception. Reason for this includes limited choice of methods.

Limited access to contraception particularly among young people, poorer segments of populations or unmarried people fear or experience of side effects, cultural or religious oppositions & poor quality of available services(8) . An unmet need for FP can have many undesired consequences in the area of health, population growth and development. In developing countries, unintended pregnancy at the time of conception is one of the major consequences of unmet need for contraception(7). According to EDHS 2011, preliminary data show that the contraceptive prevalence rate has increased to 29% use of FP in Ethiopia has traditionally been limited to short acting methods such as injectable & pills due to limited access to long term reversible contraceptive methods. Commodity shortage and lack of skilled health care provider to offer services at the community level. High discontinuation rate are associated with short acting hormonal methods, such as injectable, that are predominantly chosen by contraceptive users in Ethiopia (9)

1.3.

Significance of the Study

The study determines KAP of LARC users & certain factors. In addition to this , the findings generate from this study will make several contribution to women & family planning

users. And also initiate Nurses ( responsible health professionals ) to improve law Utilization , Knowledge & awareness towards LARCMs, By spreading or maximizing out health education for the reproductive age women . To arrange the well distribution of LARCM Give an attention for health professional towards women who have attitude to LARC Finally , the policy makers & Programmers can use it for planning , intervention & to draw effective strategies from maximizing the KAP of LARC to reproductive age ( 15- 49) . In addition to this the study results will provide information for future study & providing recommendation to responsible body . negative

UNIT TWO 2. LITERATURE REVIEW

2.1. Introduction to Long Acting Reversible Contraceptive (LARC)

An estimated 358,000 material death occurred worldwide in 2008 , a 34% decline from the levels of 1990 . Despite this decline developing countries continued to account for 99% ( 355,000) of deaths. Sub-Saharan Africa & south Asia accounted for 87% ( 313,000) of

global maternal death[9] .Fortunately ,the vast majority of maternal and new born deaths can be prevented with proven interventions to insure that every modern contraceptive & every birth is safe ( 10). Women and couples benefit who want safe and more effective protection against pregnancy would pregnancy is wanted using

from access to

contraceptive choices, including long acting permanent

methods . Despite of this advantages, LAPMS are given in few areas & sometimes are missing component of many national reproductive health & FP programs . More than 350 million couples worldwide have limited Or no access to effective & affordable FP , especially to LAPMS ( 20). 13% of the worlds married women use the IUCD as their method of contraception (21). In developing countries ,20 to 30% of women who use oral contraceptives or injectable stop within two years of starting because of side effects or other health concern. Many of these women switching to LAPMs (22). In sub Saharan Africa a quarter of women and couples have Unmet needs for contraception (23). Ethiopia is the 2nd most populous nation in Africa .Its population has increased nearly seven times from 11.8 million at the beginning of the 20 the century to about 80 million today (24) .The total fertility rate of Ethiopia is estimated at 5.4 % children per women , population growth rate is estimated at 2.7%contraception prevalence rate is only 15% & un

unmet need to FP is 34% . Implant & sterilization are the least used methods of modern contraceptive each accounting only for 0. 2% ( 25) Addressing the unmet need of FP in

Ethiopian is expected to avert 12, 800 material deaths & more than 1.1 million child death by the target date of 2015 ( 26) .
2.2.1. Knowledge towards LARCs

Community based survey was conducted on KAP of family planning in Banteay meanchey among 139 married women in rural Cambodia in September 2008. Knowledge of modern contraceptive was found to be universal 99.3% of respondents had heard about contraceptive regardless of educational level and socioeconomic status. All except one women ( more than 99%) had heard about contraceptive and knew at least one modern methods. Though this study reveals high knowledge of contraceptive among respondents, the knowledge varies from one method to another the most popular methods known by respondents are the pill and inject able contraceptive, which accounts for 95% and 83% respectively. The condom is third most popular method cited by respondents, followed by IUD(18). Acrossectional quantitative community based study done on KAP towards modern

contraceptive among

a total of 160 married women of reproduction age group in

Mpwapwa district central Tanzania which is published in may 10,2012. Regarding married women general awareness about modern contraceptive in general out of this 138 (87.3%) & 80 (50.6%) had heard about Norplant and IUD respectively. The information about family planning was obtained from hospital 58(36.7%), dispensary 54( 34.2%) , health center 20 ( 12.7%) , Mobile clinical 18 ( 11. 40%) , friends ( 32) (20.3%) ) , Relative 4( 2.5%), radio 5(3.2%), when respondents were asked of modern contraceptives, over whelming majority ( 98.8%) indicated to be aware of methods and over 80% knew at least three methods. The most known commonly methods were pills followed by injectable, Norplant and IUD indicated by 94.3%, 93.7%, 87.3% & 51% respectively(19). A community based cross-sectional study was conducted from March 9-20, 2011. The study was done in Mekele town, Tigray region in the northern part of Ethiopian among 460 married women. Regarding married women general awareness about LAMPs, 63.9% had heard about LAPMS in general out of this, 80.7%, 55.3% & 39.8% had heard about implant, IUCD & female sterilization respectively. Moreover 124 (44.1%) had awareness about more than one advantage of LAPMS. A focus group discussant said mostly, community members had awareness about

implant . However, I dont think that they may have better awareness about loop & female sterilization. The source of information of LAPMS among women were republic institution 154 (54.8%) , mass media 59 (21%), family 50 (17%) & combination of sources 18 (6.4%). 111 (37.8%) of the women were aware of that IUCD can prevent pregnancies for 10 years & 42.5% were not sure of if IUCD is good for female acquiring STI. In this study 48% & 62.2% of women aware of that IUCD has no influence on sexual intercourse of it result in immediate pregnancy dafter removal , respectively . The majority 69.7% of the married women

aware of that implants results in immediate pregnancy after removal . 126 ( 45%) of the married women were in category of low knowledge, followed by high knowledge 137(31.1%0 towards LAPM where as the remaining ( 23.7%) had moderate knowledge(20) . Result of survey done on KAP of family planning in Amhara , Oromia , SNNPR and Tigray women general awareness about modern regions of Ethiopian September 2004

Regarding married women general awareness about modern methods in urban and rural area of four regions, Tigray ( Urban = 98.1% , Rural = 94.3%), Amhara (urban = 93.2%, Rural = 84.3%), Oromia ( Urban = 91.5% , Rural 84 .3% ) ,SNNNPR ( Urban =

83.8%,Rural = 73.7%) & total awareness of four regions of Urban and Rural was (86.7%) . Of them awareness to LARC such as IUCD in Tigray urban = 61.4% , Rural = 30.9%) ,

amhara ( Urban = 53.0%, rural 25.1% ) Oromia (urban = 53.0%) , SNNPR ( URBAN = 23.7 % , RULAR = 5.8%), total awareness of IUCD in four regions of Urban & rural area was 33.30 and also awareness of Norplant in Tigray (urban 61.7% , Rular = 28.7 ) , Amhara ( urban = 51.4% , Rural= 26.5) ,Oromia ( Urban = 52.8) , Rural = 54.2%) ,SNNPR ( Urban = 24.7%0 Rural = 9.5%) and a total awareness of Norplant in four regions of urban & Rural areas was( 36.05 % ) (21). Acrossectional community based study was conducted among 734 systematically selected married women of reproductive age in goba town , bale zone , south east Ethiopia in

September 2009 One third of respondents 491 ( 66.9%) ever heard about IUCD and . The most ever heard LAPMS contraceptives was Norplant 641 ( 87.3%) . 445(60.8%) of the

respondents have discussed with health professional about LAPMS. 638(86.9%) reported ,they knew where LAPMS of contraceptive were found in the town . 636 (86.6%) of

respondents have information about LAPMS from different source). The major source of information was media 641(87.35) ( radio & TV) (22).
2.2.2. Attitude to wads LARC

According to crossectional community based survey was conducted in mekele town from march 9- 20 2011 more than half of ( 53.6%) of married women have negative attitude towards LAPMs (20). According to crossectional community based survey was conducted from march to 9-20,2011, study was done in Mekele town , Tigray region in the northern part of Ethiopia among 460 married women .With regard to about LAPM, 15.5% & 26.8% married women agreed that implant can result in irregular bleeding & cause severe pain during insertion & remove respectively . Above one over four ( 29.7%) of married women agreed that insertion of IUCD can result in shame while it inserted to cervix by health professional 19.6% agreed that IUCD prevents from doing the normal activities. Asked on their attitude about the side effects of LAPMs they agreed that irregular bleeding due to the use of implant is sever 28.9, insertion & removal of implant is highly painful ( 33.1%), losing privacy during IUCD insertion is shame full ( 61.3%). Concerning level of attitude more than half (53.6%) of married women had negative attitude towards protecting of LAPMs (20). Acrossectional community based study was conducted among 734 systematically selected married womens of reproductive age in Goba town , bale zone , south east Ethiopia in September 2009 .In the past few months, only 251 (34.2%) of respondents discussed about LAPMs. Moreover, 179 (71.30%) have discussed with their husband & 90 ( 35.9%) discussed with their friends or neighbors. 315 (42.9%) of the respondents have never discussed about LAPM of contraceptive with their husband . 496 ( 67.6%) of the

respondents respond that their husband approves using LAPMS . The decision of using LAPMS of contraceptive was mainly made by both partners together for 474 ( 64.6%) of respondents .Asked on their attitude about not practicing LAPM, they agreed that previously used methods inconvenient due to the use of IUD is 2 (57.1%) husband oppose is 1 (14.3%) .In addition to this reason for not practing Norplant due to fear of complication is 12 ( 50%) & due to husband oppose is 6 ( 25%) (22) .

2.2.3. Practice of LARC

According to analysis of 2006- 2010 national survey of family growth , the popularity of LARCM is growing as of 2009 , 8.5% of women ages 15-44 who are using contraceptive use LARCMS ( IUCD & Norplant). In 2002 this proportion was 2.4% . In 2009 only 0.8% of women ages 15-44 reported currently using either hormonal implants. This similar to 2002 when 0.8% of women used one of this methods. Use of LARCMS among young women remains lower than among all women. In 2009, only 4.5% of sexually active females age (15-49) reported using either an IUCD or contraceptive implant at last intercourse. IUCD are more popular in other parts of the world including Europe, Asia & Africa. For example in 2006, 27% of women in Norway used an IUCD, as did 21% in Sweden, & 10% in Germany. Similarly 16% of women in Asia used an IUCD in 2005. As did 14% in the near east & North Africa and 8% in Latin America & Caribbean. Most IUD users 60% are in China(23). According to contraceptive CHOICE project st.lous Missouri. The contraceptive choice project is being conducted by researchers at Washington university in st,lovis in oct,2012, found that satisfaction and continuation rate among LARC users are higher than of women using other methods. Especially at 12moths, 87.5% of women who choose mirena were still using it as were 84.1% of those who choose the copper IUD, and 83.3% who choose the implant. The overall, 86% of women who choose any LARC methods were still using it at users. Womens using LARC reported being more satisfied with their method than those using non LARC methods (23). A cross sectional study was conducted on KAP of family planning among 250 women, in India Haryana 15(6.0%) used IUCD (24). According to community based survey was conducted on KAP of family planning in banteay meanchey among 139 married women in rural Cambodia in September 2008. About 68% of respondents have previously methods & 56% of respondents were using contraception at the time of study among the current users the majority were pills users (44.6%). Implant, IUD and female sterilization all were used by less than 1.5%. Decisions to adopt family planning are influence by the side effect of methods & the desire number of children. Previous study in Cambodia pointed out that many users experienced side effects from different methods .For example an IUCD users mentioned that when I carry something heavy, I feel dull pain in my

womb & pelvis area. I dont dare to work hard in the field, to ride a bicycle (MOH, n.d:21) (18). Across sectional quantitative community based study done on KAP towards contraceptives among a total of 160 married women of reproductive age group in mpwapula district, central Tanzania which is published in May 10, 2012. About 50 (31.6%) of respondents had ever used modern contraceptive methods, 40 (25.3%) of them 11 (22%) were not used nor plant & 2(4%) were used ICUD. The users criteria for choice of methods based on safety 19(38%), approval by husband 5(10%), secrecy 9(18%), convince (easy to use) 15 (30%), effectiveness 1(2%) Advised by health personal 4(8%) (19). According to EDHS 2011 was conducted under the aegis of the MOH and implemented by CSA from September 2010 to June 2011 in Ethiopia with a nationally representative

sample of nearly 18,500 households . 29% of married women are currently married women are using traditional methods .Implant 3% & 2% of married women reported using IUD percentage distribution of married women currently using contraceptive ( LAPM) based age such as users of IUCD between the age of 15- 19 ( 2. 5%) 20- 24 ( 1.9%) , 25- 29 ( 2.2%) ,30-34 (2.7%),35-39( 2.2%),40-44 (2.3%), 45-49(0.3%). And also users of Norplant between the age of , 15- 19 (1.6%) , 20 24 ( 2. 9%) , 25- 29 ( 4.2%) 30-34 ( 3.8%) , 35-39 ( 4.1%) , 40-44 (3.6%) , 45-49(2.0%) . Percentage distribution of married women currently using contraceptive (LAPM) according regions. Users of IUCD in Tigray( 2.1%) ,in Afar (1.3%), in Amhara (1.5%), in oromia (2.2%), in Somalia (0.8%, in Benishangul Gumuz (2.7%), in SNNPR (1.4%), in Gambela (4.4%), in Harari (6.7%), in A.A (10.9%), in D.D (4.7%). In addition to this users of norplant in Tigray (5.6%), in afar (0.2%), in Amhara (4.0%), in oromia (3.4%), in Somalia (0.5%) in Benishanguil Gumuz (1.5%), in SNNPR (2.9%), in Gambela (0.4%), in Harar (3.0%), in A.A (2.8%) & in D.D (8.0%) (25). According to acrossectional community based survey was conducted in mekele town, Tigray region in the Northern part of Ethiopia among 460 married women. The overall prevalence of use of LAPMS was 12.3%. However, there were no users for female & male sterilization. The main reason sited by the majority of married women for not using LAPMS was using another method of contraception 360 (93.3%) mothers who had high knowledge were 8 times more

likely to use LAPMS as compared with those who had low knowledge. (AOR= 7.9), 95% CI of (3.1, 18.3) mothers who had two or more pregnancies were three times more likely to use LAPM as compared with those who had one pregnancy (AOR= 2.7,95%CI of (1.4,5.1) (20). Survey done on KAP of family planning in Amhara, Oromia, SNNPR and Tigray region of Ethiopia September 2004. About 33.5% of respondents had previously used modern contraceptive methods in urban & rural area of four regions. Users of LARC such as IUD in Tigray (urban=3.9% and rural= 0.7%), in Amhara (urban 1.7% and rural =1.2%) , in Oromia (urban =2.9% & Rural= 1.6%), in SNNPR (urban=& 1.3% & rural = 2.5%), a total of four regions of urban & rural areas of IUD users were 1.9%. In addition to this Nor plant users in Tigray (urban= 2.4% & rular = 0.0%), in Amhara (urban= 1.1% & rular =0.3%), in Oromia (urban = 2.1% & a total of four regions of urban & rural areas of nor plant users were (1.4%). About 21.5% respondents had currently used modern contraceptives method in urban & rural areas of four regions. Users of LARC such as IUCD in Tigray (urban=1.4% & rural =0.0%), in Amhara (urban= 0.0% & rural= 0.2%) in Oromia (urban =0.0% & rural =0.3%) in SNNPR (urban=1.3% rural= 0.6%) and a total of four regions of urban & rural areas of IUCD users were 0.35% .And also implant users in Tigray (urban= 1.0% & Rural =0.0%), in Amhara( urban0.3%,rural 0.2% ), in Oromia ( urban=0.9% &rural=0.6%) inSNNPR(urban=0.6%& rural=1.3%)& a total of four regions of urban and rural areas of nor plant users were (0.6%) (21). Acrossectional community based study was conducted among 734 systematically selected married women of reproductive age in Goba town, Bale zone e, south east Ethiopia in sep, 2009. The current utilization rate of LAPMS of contraceptives in the town was 64 (8.72%). Of these 48 (6.5%)were using Nor plan , 11 (1.5%) using IUD & 5 (0.7%) using tuba ligation. 136 (18.5%) of the respondents had ever used LAPMS. The methods ever used were 94 (12.8%) Nor plant, 37 (5.0%) IUD & 5(0.7%) tuba ligation. 219 (29.8%) were pregnant & 195 (26.2%) had five or more pregnancies. The utilization of LAPMS of contraceptive varies change in the age group of respondents. The highest frequency of use was observed in the age group 25-29 years of age .However, there was decreased in use of LAPMs as age of the women increase from 30- 49 years . 239 (32.6%) had no child & 155 (21.1%) had five & more than five children alive. Among 64(8.72%) of current LAPMS users 35 (54.7%) of users were using LAPMS of contraceptives for delaying pregnancy while 36 (40.6%) of users were using LAPMS they didnt

want any more baby. Among 677( 92.2) who were not pregnant & not sour of their pregnancy status in the study period, 351(51.9%) wanted to become pregnant latter and 253 ( 37.4%) dis not want any more . of these 55 (21.4%) want to delay their next baby prefer to use LAPMS. The rest 90(35.6%) want to use LAPMS to limit number of children .For majority of the respondents 532( 79.%) their last pregnancy was intentional , LAPM that have been IUCD ( 3.7%) & Norplant 25(18.7%). Among current short acting

contraceptive users 24 (68.6%) prefer to use Norplant. For half 12 ( 50%) of the non users of Norplant the reason for not using the methods was fear of complication ,for these who want to use LAPMS .But are not Using the methods was fear of complication . For these who want to use LAPMS . But are not using the methods they prefer the reason for non users were previous methods incontinent, health problem, husband opposes & fear of

complication (22).
2.2.4. Summary

A number of factors could contribute to the lack of availability and access of LAPMS. Evidence show from other countries & with in Ethiopia showed that many factors including fertility related reason opposition to use , lack of knowledge , methods related reason could act as barriers to LAPMS use . Higher cost to individuals or MOH : lack of trained providers and wide availability of short acting methods in the rural areas where most people live and distance to clinics and medical barriers inhibits access(26). Health personnel may not pervade LAPMs to clients because of Unnecessary or out doted restrictions , such as age or the number of children a women has . Myths & misconceptions are also wide spread of these methods(27).

UNIT THREE

3. OBJECTIVES
3.1 General Objective
To assess KAP of LARC among women of reproductive age group ( 15- 49) in Gelemso town, kebele 01,2013

3.2. Specific Objectives

To assess knowledge of LARC

To assess attitude of LARC To assess practice of LARC

UNIT FOUR

4. METHODOLOGY
4.1 Study Area
The study will be conducted in Gelemso town .Ethiopia is one of the developing countries in Africa which has regional state . Oromia is one of widest region of Ethiopia & has 17 zones. Gelemso town is located in western Hararge which is 401 km from A.A it is bounded by Guba koricha northern , oda bultu eastern , Boke southern, Darolebu western & Anchar worda to the North west of Gelemso town . The total population of town was estimated to be 23, 415 out of which 12,055 are male & 11545 are female kebele 01 is one of the 2 kebele of Gelemso town . The total population of the kebele was estimated to be 13,159 out of which 6649 are males & 6510 are female the majority of residents of the kebele are Muslim and some are orthodox and protestant .The health Service coverage of Habro Woreda in 2004 is 85% habro Woreda has 1 referral hospital , 7 health center & 32 health post.

4.2 study Period

Study will be conducted from January 01-30 in Gelemso town, kebele 01, 2013.

4.3 Study Design

Descriptive crossectional quantitative community based study design will be used.

4.4 Populations
4.4.1 Source of population

All women of reproductive age group (15-49) in Gelemso town, kebele 01, 2013.
4.4.2 Study of population

All women of reproductive age group (15-49) in Gelemso town, kebele 01, 2013 4.5.

Inclusive & Exclusive criteria

4.5.1. Inclusive criteria

- Women of reproductive age group (15-49)

4.5.2. Exclusive criteria

- Pregnant women - Womens who have psychological problem, & physical problems (who are Unable to give response) - Infertility

4.6. Sampling technique & sample size determination

The sample size is determined by using the following formula n= (Z/2)2 pq d
2

where n= sample size p= estimate prevalence rate p=0.5 q= (1-p)

= (1. 96)2 ( 0.5) ( 0.5) 0.052

Z /2 is the value of standard normal variable at (-2)% confidence = 95% d Margin of error which is 5%

n= n/(1+n/N) n = 384/ (1+384/2,912) = 339 Where n = corrected sample size n =sample size N= total Population From the total reproductive age group in this kebele the sample size will be 339.

4.7. Sampling Techniques

Multi stage sampling. technique will be used to select the study participant 1 st the kebele will be selected by simple random sampling then the house hold will be selected by

systematic random sampling. To get k- value dividing the total household of kebele 01 by the exact sample size Kvalue 2068/ 339 = 6

4.8.

Data Collection Method

Data will be collected by all the necessary format of stated variable , instruments were prepared, data will be collected by 4th year BSC Nursing students through interview the study participant according to the structured questionnaires by telling brief explanation of the aim of the study to obtain information about the stated Variables .

4.9.

Description of Variables
4.9.2 Dependent variable

4.9.1. Independent variable

- Age - Sex - Ethnicity - Educational status - Marital status

- Knowledge of LARC -Attitude of LARC -Practice of LARC

4.10. Operational |Definition

Birth spacing ; bearing child with a given separated period between t he first & the text
or delay having a child

Unintended pregnancy: A pregnancy which occur unconsciously or without willing of the

couples

Unmet need : is need which is not reaches to the optional , adjusted or planned place . Modern contraceptive methods refers to both temporary & permanent contraceptive
women can take

Knowledge : familiarity with any one of contraceptive other than what users were
using at the time of the study gained by information or practice .

CPR: is the total number of women using contraceptive method currently.

Attitude : the way that women think & feel about contraceptive about contraceptive .

Practice: a previous utilization of any of the available contraceptive methods

Contraceptive users: women of 15- 49 years who currently using contraceptives.

Contraceptive; any process or any process or methods that prevent conception or fertilization.
4.11. Data Quality Control
To keep the quality of the study pretest will be under taken before collecting the data. Check the completeness of the questionnaire, the validity of the information that the respondents give.

4.12. Data Processing & Analysis

4.12.1. . Data processing

The data will be processed manually by using pen, pencil paper, scientific calculator , falling of master sheet , festoonery paper & falling .It used to checking completeness &

inconsistency of the data,

4.12.2.Data analysis

The data will be analyzed by expressing in number frequency, percentage & by using dummy tables.

4.13. Ethical Consideration

The official letter will be written from HU college of Health and medical science to

concerned body for the sake of corporation . We will discuss the manager about the benefits of the study. Mothers who are participated in this study can not get any benefit or income so informed consent will be taken from the mothers & mothers will have full right to

terminate & out of the study at any time the confidentiality of the respondents will be kept.

UNIT FIVE

5. WORK PLAN
Tasks to be performed Responsible body Nov Mar Dec Apr Feb Jan

1.

Drafting the proposal and submission to department

PI

2. Clearance from the assigned supervisors 3. Securing permission from department research coordinating office 4. Contact with the funding organization for collecting data 5. Money for material duplication 6. Orientation about the site & having informed consent 7. Conducting protest ( pilot) 8. Data collection 9. Data Processing complication & analysis 10. Finalizing activity 11. Final presentation 12. Submission of report & monitoring Research proposal

PI

PI DC

PI

PI Super Visor PI

PI PI

PI PI,PC supervised PI, RA

UNIT SIX

6. BUDGET JUSTIFICATION
6.1. Personal Cost
Unit Person Person No 4 1 No of days 10 10 Total 40 10

No personnel 1. Data collection 2. Supervisor 6.2.

Stationary Cost
Serial no Unit Rim PCS PCS PCS PCS Roll Pkt Quantity 1 8 16 12 3 3 2 Unit price 150:00 20:00 4: 00 2:00 25:00 70:00 10:00 Total 150:00 160:00 64:00 24:00 75:00 210:00 20 703:00

1. Printing paper 2. Note book 3. Pen 4. Pencil 5. Rewritable CD 6. Flip Chart 7. Marker Sub Total

6.3.

Transportation Cost
Transport Cost Cost /Km No of KM X No Total

1. Bajaj

1:00

2x10x10

200

6.4.

Others costs
No 40 165 10 10 2 Unit cost 5 50 6 25 10 Total 200 825 60 250 20 1355

Expense title 1. Computer writing 2. Duplicating questionnaire 3. Soft drink 4. Using internet ( CDMA) 5. Floppy disk Total

6.5.

Budget Summary
Total Birr 50 703 200 1355 2308

Expense title 1. Personal cost 2. Stationary cost 3. Transportation cost 4. Other cost Total

UNIT SEVEN 7. REFERENCE

1. Acquire project; acquiring knowledge apply lessons learned to strengthen FP /RH services , New York 2008, 2. WWW. Maries topes .org or info @ Maries topes. Org 2011. 3. WHO department of reproductive health & research, Johns Hopkins Bloomberg school of Public Health / center for communication program / INFO project (ccp) , FP ,A global hand book for providers , Baltimore MD & Geneva ; CCP & who , 2007 4. Research triangle park, NC, 277, 09 USA, 2007 by family health international. 5. Healing well. Com LLC, 2012 Health day. 6. addressing Unmet need for FP around the world 2011 7. WHO criteria for contraceptive use 2012. 9. National collaboration center for women & child health Oct.2005 10. Jacob R, bankamjian L,pile M: threatened & still greately needed Fp programs in subSaharan Africa New York : The ACQUIRE project / engender health: 2008 advanced brief No 21 11. USAID: the case for long acting & permanent methods. FHI 2007 12. Acquire project : acquiring knowledge , acquiring knowledge applying lessons learned to strengthen FP /RH services (http;//WWW.acquired project.org/archieve/files/ 3.0 program effectively /3.2 resources /3.2.1 project briefs / acquire knowledge IUD final PDF ) webcite New York 2008 , 14 Accessed on August 24,2011 . 13. Ali M, Cleland J: Determinants of contraceptive discontinuation in six developing counties. J Biosoc sci 1999, 31: 343-60,pub med Abstract 1 publisher full text. 14. Joss JA, winfrey W: contraceptive use, intention to use & unmet need during the extended post partum period international FP perspective 2001, 27: 20-20 publisher full text 15. Planning & programming department, MOH of Ethiopia: health & health related indicators, A.A, 2007.

16. CSA, Ethiopia & ORC macro: EDHS 2005, A.A Ethiopia & calvertion, Maryland, USA & ORC macro, 2006. 17. USAID health policy initiative: the contribution of FP achieving MDGS in Ethiopia 2009. 18.KAP of family planning among married in Banteay mean chey Cambodia , Vang

SREYTOUCH University . ( http: www . bing . com ( accessed on 19/01/13) 19.KAP towards modern contraceptive among married women of reproductive age in

mpwapw district central Tanzania published may 10,2012 J- Lwelamira, G. mny mogola M. M.Msak Department of population , department of rural development and regional planning , institute of rural development planning ( http= /r cube ritsume j. ac jp /bit stream / 10367/109. 20.Factors associated with utilization of long acting and permanent contraceptive method among married women of reproductive age in Mekelle town, Tigray region , North Ethiopia ,by Musse Alemayehu, Tefera Bellachew , & Tizita Tilahun published in 26 Jan , 2012 ( http,// www. Bio medical center .com / 1471- 2393/12/6 # refs.) 21.Oromo , Amhara, Tigiray & SNNPR Ethiopia ,KAP in FP result from sep. 2004 survey of Amhara , Oromia Tigray & SNNPR regions by Berhan research & development

consultancy pathfinder international,Ethiopia development country office. (http. // www 2. Pathfinder .org /site/ Doc server /CPR survey report final June 24.PDF.doc.ID=3961). 22.Demand for long acting & permanent methods of contraceptives & factors for non use among married women of Goba town ,Bale zone, south east Etiopia, by Abula Takele ,Getu Degu & Mezgebu Yitayal .http://WWW.reproductive-health-journal.com content
23.www.advocates for youth org/publication

publication a-z/2083- providing larcs to

young-women written by Martha kember advocates for youth October 2012 24. Ispub.com scientific publication internate journal of health 2011 volume 12 number 1, DOI; 10, 5580, 156e

25.WHO ;Trends in maternal mortality,1990 to 2008 estimates developed by WHO ,UNICEF,UNFPA & the world bank,Geneva;http;/Whqlibdoc.Who.int/publication

/2010/9789241500265 enq.pdf website accessed on Nov 11,2011. 26. USAID; Long acting & permanent methods of contraception; without them, a countries development will be low & slow, the acquired project, 2008. 27. Osei I, birungi H, Addico G, Askew I, Gyapong Jo: what Happened to the IUD in Ghana. Afro J reprods health 2005, 9(2): 76-91. Pub med Abstract publisher full text.

Annex 1. Questionnaire
HARAMAYA UNIVERSITY COLLEGE OF HEALTH AND MEDICAL SCIENCE SCHOOL OF NURSING AND MIDWIFERY

Hello Dear respondent! My name is ------I came from HU. I am among team of people who are carryout this research to assess KAP of LTRC. Among women of reproductive age group in Gelemso, kebele 01. I would like to ask you some question that will take 15-30 minutes. The information that you give us will kept confidentiality. If you are willing to be part of the study we can proceed. Are you willing to be a part of this study? A. Yes B. No

Thank you for being with us. Part I. socio demographic characteristics 1. Age 2. Family size 3. Religion A. orthodox B. Protestant 4. Marital status A.married B. single 5. Ethnicity A. Oromo B. Amhara c. Divorced D. Widowed C. Adere D. Gurage E. Tigre F. Other C. Muslim D. Other

6. Education status A. illiterate B. Read & write D. 5-8 ( 2nd cycle ) F. 11- 12 ( preparatory school )

C. 1- 4 ( primary cycle) E. 9- 10 ( high school ) G. Certificate & above 7. Occupational status A. Government employee E. Student F. Farmer

B. House wife G. Others

C. Merchant

D. Daily laborer

8. How far the health service facilities from your home ? A. > 5km B. < 5km

9. Have you ever been pregnant? A. yes B. No

Part II. Question on knowledge 1. Do you heard about LARC? A. yes 2. B. No

If yes to question no 1, which type of LARC do you know ? A. IUCD B. Norplant

3. If yes to question No 1. Where do you get the information? A. Public health sector A. Print media F. Peer B. Private health sector G. Other C. NGO D. Mass media

4. Why so women use LARC? A. For child spacing B. For prevention of unwanted pregnancy C. Unwilling to have more children D. Other 5. Do you tell me for how long implant be left inside once it is inserted ?

A. 6.

3 years

B. 5 years

C. 7 years

D. Dont know

Do you know side effect of Norplant? A. Yes B. No

7.

If yes which of the following are considered? A. irregular heavy bleeding D. amenorrhea B. Headache C. Effect on fertility F. other

E. Infection at insertion site

8 Do you tell me how Long IUCD be left inside once it is inserted ? A. 10 years 9 B. 12 year C. dont knows

Do you know the side effect of IUCD ? A. Yes B. No

10 If yes, which of the following are considered? A. Irregular heavy bleeding B. Headache C. Infection at the insertion side D. Amenorrhea E. Effect on fertility F. Other 11 For what problems, if any should you come back to the clinic? A. Irregular or bleeding B. Headache C. Infection at the normal insertion site D. When I feel sick E. Other specify Part III. Question on attitude of LARC 1. Would you like to know about LARC? A. Yes B. No C. No response

2. Who is usually in the family that makes decision about family planning? ( For those who are ever married ) A. yes B. No C. no response

3. What is your attitude towards women using LARC? A. Approve 4. B. Disapprove C. No response

What is your husband attitude towards LTRC? A. Supporting B. Against C. Neutral D. No response

5. Do you discuss about LTRC with your husband? A. Yes B. No

6. If the answer of question no 5 is no what is /are the reason A. Husband opposed B. Lack of transparency & fear C. Religious & cultural influence D. Other specify 7. Who should take responsibility to choose LARC? A. Wife B. Husband C. Both D. Noresponse Part IV. Question on practice of LARC 1. Have you ever used LARC in the past A. Yes B. No 2. Which type of LARC methods did you use? A. IUCD B. Norplant

3. If answer to question no 1 is yes, how old were you, when you 1 st start to use IUCD? Age in year ---------

4. If answer to question no 1 is no, why didnt you use IUCD A. fear of side effect B. Medical problem C. fear of infertility

D. cultural taboos & religious influence F. Lack of knowledge I. other

E. desire to have more children H. dont have sexual partner

G. husband disapprove

5. If answer to question no 1 is yes, how old were you, when you 1st start to use Norplant? Age in year -----6. If answer to question no 1 is no, why didnt you use nor plant? A. Fear of side effect B. Medical problem C. Fear of infertility

D. Cultural taboos & religious influence F. Lack of knowledge J. Other 7. Why do you prefer to use LARC? A. Highly effective E. B. Long acting

E. Desire to have more children I. Dont have sexual partner

G. Husband disapproved

C. Reversible

D. Convenient G. Other

Cost effective

F. Nothing to remember but, the remain visit

8. Do you currently used LARC A. yes B. No

9. Which methods of LARC do you use currently? A IUCD B. Norplant 10. Answer to question no 8 is no what is the reason behind ? A. Fear of complication B. Previous method inconvenient C. Health problems D. Husband opposes E. Other specify 11. Do you have intend to use LARC in the future? A. Yes B. No

Annex 2. Dummy Table Table - 1 % distribution of study Gelemso town , kebele 01 - 2013 Variables Age 15-29 30-39 40-49 Total Religion Orthodox Protestant Muslim Others Marital Status Married Single Diuorced Widowed Total Ethnicity Oromo Amhara Adere Gurage Others Total Educational status Illiterate Read & Write 1-4 (Primary ) 5-8 (secondary ) 9-10 (High School) 11-12 (preparatory) Certificate and above Occupational Status Gouernment Employee House Wife Merchant Daily Labourer Student Farmer Other Distance of Health Service facilities from home < 5Km Tally Frequency % population by socio demographic characteristics,

>5Km Table -2 Percentage distribution of awareness towards LARC method on Gelemso Town, Kebele 01,2013 About LARC Norplant IUCD Aware Frequency % Not aware Frequency %

Table-3 percentage distribution of type of source of information about LARC, on Gelemso town. Kebele-01, 2013 Variables Response Information about Yes LARC No Table4. . Source of information Variables Where do you get the info Response Public health sector Private health sector NGOs Mass media Printing media Peer Other Tally Frequency %

Tally

Frequency

Table -5 percentage distribution of knowledge about the side effect of LARC Variables Knowledge about the side effect of LARC Response Yes No Total response Norplant IUCD Norplant IUCD Tally Frequency %

Table 6 percentage distribution of knowledge about how long LARC be left inside once it is inserted Knowledge about how long LARC be left inside once it is inserted Variables Norplant response 3 year 5 Year 7 year Dont know Total 12 year 10 year Dont know Total Tally Frequency %

IUCD

Table 7. Percentage distribution of Knowledge about side effect of LARC Knowledge about side effect of LARC Response Norplant IUCD Response Tally Yes No Yes No Frequency %

Table 7. Percentage distribution of Knowledge about side effect of LARC ( contuied)

Knowledge about the side effect of LARC

Variable Norplant

Response Irregular heavy bleeding Headache Effect on fertility Amenorrhea Infection on insertion site Dont Know Other Total Irregular heavy bleeding Headache Effect on fertility Amenorrhea Infection on insertion site Dont Know Other Total

Tally

Frequency

IUCD

Table -08 percentage distribution of women attitude towards LARC Variable Women attitude towards LTRC Response Aprove Disapprove No response Total Tally Frequency %

Table-09 percentage distribution of husband attitude towards LARC Variable Husband attitude towards LTRC Response Tally Frequency % Supporting Against Neutral Norespnse Total Table -10 percentage distribution of women discuses about LARC with their husband Variable Women discuss about LTRC with their husband Response yes No Total Tally Frequency %

Table -11 percentage distribution of womens reason not discuss about LTRC with their husband Reason of women not discuss about LTRC with their husband Variable Husband oppose Lack of transparency and fear Religious and cultural influence Other Total Tally Frequency %

Table- 12 percentage distribution of responsibility to choose LARC Reaponsible to choose LTRC Response wife Husband Both Noresponse Total Tally Frequency %

Table -13 percentage distributions of women by ever used LARC methods, Gelemso town, kebele-01, 2013 Variable Ever used LARC Response Yes No Total Norplant IUCD Total Tally Frequency %

Table 14. Percentage women using currently LARC methods Variable Currently using LARC Response Tally Frequency % Yes No Total Table 14. Percentage women using currently LARC methods ( continued)

Currently using method of LARC

Norplant IUCD Total

Table -15 percentage distribution of womens by reason for not using L ARC Reason for not using IUCD Fear of side effect Medical problem Fear of side infertility Cultural taboos & Religious influence Lack of knowledge Desire to have more children Husband disapproval Dont have sexual partner Other Total Response Tally Frequency %

Reason for not using nor plant Fear of side effect medical problem Fear of infertility Cultural taboos and religious influence Desire to have more children Husband disapproval Lack of knowledge Dont have sexual partner Other Total Table-16 percentage distribution of women by reason for prefer to use LARC Reason for prefer to use LARC Response Highly effective Long acting Reversible Convinent Cost effective Nothing to remember but the remain visit Other Total Tally Frequency %

Table -17 percentage distribution of women to use LARC in the future Intended to use LARC in the future Variable Yes No Total

Filename: selam (Repaired) Directory: C:\Documents and Settings\Ayele Akuma\My Documents Template: C:\Documents and Settings\Ayele Akuma\Application Data\Microsoft\Templates\Normal.dotm Title: Subject: Author: HP741852 Keywords: Comments: Creation Date: 6/9/2013 8:55:00 PM Change Number: 9 Last Saved On: 6/9/2013 10:37:00 PM Last Saved By: Ayele Total Editing Time: 101 Minutes Last Printed On: 6/9/2013 10:37:00 PM As of Last Complete Printing Number of Pages: 42 Number of Words: 8,682 (approx.) Number of Characters: 49,493 (approx.)