1. By - Selam Yilma (MPH) & Wubegzeir Mekonnen ( PhD )
ASSESSMENT OF KNOWLEDGE, ATTITUDE AND INTENTION TO USE LONG ACTING AND PERMANENT CONTRACEPTIVE METHODS AMONG WOMEN IN HIV CHRONIC CARE, ADDIS ABEBA, ETHIOPIA
By - Selam Yilma (MPH) & Wubegzeir Mekonnen ( PhD )

2. Presentation outline Introduction Objective Methodology
Result and Discussion
Strength and Limitation of the Study
Conclusion
Recommendation
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Selam Yilma
Selam Yilma

3. Introduction
Long-acting and Permanent Methods (LAPMs) include the intrauterine device (IUD) and the progestogen implant, as well as male and female sterilization. (K4Health)
LAPMs can provide highly effective protection from unwanted pregnancies and, thus, mother-to-child transmission of HIV.
Unintended pregnancies can be prevented by using LAPMs but it is poorly understood among HIV positive women.(FHI the case of LAPM 2007)
he CPR is highly dependent on short-term family planning methods, nearly 21% for injectables. (RH strategy )
To increase the CPR, the Federal Ministry of Health (FMOH) has considered the important role of LAPMs.
Prevalence of LAPMs is still low (4.2%) and little evidence is available among women in HIV chronic care.
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Selam Yilma

4. Introduction Cont.
The utilization of LAPMs is very low (4.2%) among women of reproductive age group. (EDHS 2011).
There are little evidence showing knowledge, attitude, intention to use LAPMs & barriers for low utilization of this method among women in HIV chronic care.
Ethiopia has made progress in doubling the CPR over the last five years (from 15% in 2005 to 29% in 2011). (EDHS 2005, 2011)
It is very important to conduct research on the area of women’s KAI to use LAPMs women in HIV chronic care in public and private facilities.
This study will contribute to fill the information gap to scale up LAPMs which is given due emphasis by the Federal MOH.
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5. Conceptual framework Intention to use LAPMs Clinical factor
Socio demographic and economic factor
Age
Educational Status and husband’s educational status
Occupational status and husband’s occupational status
Marital Status
Religion
Household monthly income
Clinical factor
WHO Clinical Staging
CD4
Reproductive factor
Age at first marriage
Decide on the No of children
Household size
Total number of children
Intention to have another child
Ever use of family planning methods
Current use of short term family planning methods
Intention to use LAPMs
Knowledge, Attitude & other characteristics to use LAPMs
Knowledge
Attitude
Myths and misconception heard on LAPMs
Availability of trained personnel
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6. OBJECTIVES General Objective
To assess the knowledge, attitude and intention to use long acting and permanent contraceptives methods and its determinants and barriers among women in HIV chronic care in Addis Ababa, Ethiopia.
Specific Objectives
To measure the knowledge, attitude and intention to use LAPMs among women in HIV chronic care in Addis Ababa.
To identify factors associated with the intention to use LAPMs among women in HIV chronic care in Addis Ababa.
To explore barriers on the use of LAPMs among women in HIV chronic care in Addis Ababa.
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7. Methods (1) Study area- conducted in Addis Ababa.
Study period- February-March 2016.
Study design cross-sectional study design with mixed methods
Populations
Source population- all women in HIV /AIDS chronic care in Addis Ababa.
Study Population
Quantitative method - all women of reproductive age group in HIV chronic care selected public and private facilities in Addis Ababa
Qualitative method- MsG on adherence & their service providers
Sample size Method
Quantitative method- Determined by the single population proportion formula using the following assumptionsn= (Zα/2)2 P (1-P) / d2 = (1.96) ( )/ (0.05)2,= 364
Adding a 10 % non-response rate gave the required minimum sample size n = 400
Quantitative method-A total of 5 mother support group &5 ART service providers.
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8. Sampling procedure Method (3)
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9. Method (4) Data quality assurance
Study variables
Dependent Variable- Intention to use LAPMs
Independent variables- Socio-demographic and economic factor, RH factor, Knowledge, Attitude, Myth and misconception.
Study tools (questionnaires, guides )
Quantitative Study- interviewer administered structured questionnaires.
Qualitative Study -An in depth interview guide developed by the PI
Data quality assurance
Quantitative Study - Training, Pre-test, Supervision, rechecking for completeness, entry using soft ware ,designing a data entry template with internal consistency check schemes.
Qualitative Study- Data were audio taped + note was taken to double check its quality, the PI moderated the interview Transcription was also done by the PI.
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10. Data Entry, Cleaning and Analysis
Quantitative Study
Data entered in EPI Info version 7
The data edited, cleaned and analyzed using STATA 12
The summary measures include mean, median value and proportions.
Statistical significance was tested using Chi-square
Bivariate and multivariate logistic regression
Qualitative Study
Audio information Transcribed Translated Imported to open code Coded categorized & merged into thematic areas result was narrated.
Ethical Consideration
The research ethics committee of the SPH, College of Health Sciences in AAU
Written permission-health bureau of the Addis Ababa city government.
Consent obtained from medical directors &Informed verbal consent was also obtained from individual participants.
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11. Result and discussion
A total of 400 women in HIV chronic care were included in this study, which makes the response rate to be 100%.
The mean age of women in HIV chronic was 32 (6.16 SD).
Among women in HIV chronic care 299 (72.75%) women had 0-2 children, while the rest had 3 and more children.
Decision on the number of children were made
women herself 94(48.5%)
jointly with her husband 57 (29.38%)
rest 43(22.16%) of decision made by her husband.
Majority 346(86.5%) of women started ART and the rest of them 54(13.5%) were on pre-ART.
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12. Women’s knowledge on LAPMs
This finding is different with study done in
South Africa-90% know female sterilization (Sarah et al ,2012)
Addis Ababa-86.6% know IUD (Bantamlak ,2014)
Consistent
Zimbabwe (Pester ,2013)
Wolaita zone (Mengistu et al,2014)
EDHS 2011 knowledge on Implant was 67.8%
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13. Attitude of women’s towards use f LAPMS
Women’s intention to use LAPMs
More than half 212(53%) of women had negative attitude to use LAPMs.
This finding is quite similar with study done in
Wolaita zone 52.6%(Mengistu et al,2014)
Mekelle-53.6% (Mussie et al,2014)
Addis Ababa 49.9% (Bantamlak ,2014)
This could be due to the difference myth and misconception in the community, in which women are developing negative attitude on LAPMs.
From a total of 400 women who participated in the study, only 110 (27.5%) had the intention to use LAPMs.
Lower than the study done in
Addis Ababa 38.5% (Bantamlak ,2014)
Mekelle-53% (Hailay et al,2014)
Debremarkos -45.9% (Amanuel,2014)
The FMOH recognizes the important role & contribution of the private sector to Health but little effort is done to increase LAPMs user in private (FMOH FP guidline,2011).
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14. Ever use and Intended LAPMs
Not consistent with the study done in
Pakistan (Sohail ,2010)
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15. Barriers, myths and misconceptions on the LAPMs
58.2% women were thinking there are barriers to use LAPMs, similarly, 55.75% of women heard myths and misconception on LAPMs.
The barrier mentioned by interviewer was husband refusal not to use LAPMs this was explained by member of mother support group as:
“I had experience at one time the husband came before me and said who do you think you are? You inserted this inside my wife, you should remove what you put in my wife…..did you eat unpeeled banana? That you said you have to use condom too…...”
30 years old married mother support group
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16. Myths and misconceptions
This finding is supported by In-depth interview by health provider working in health center explained the situation as:
“They relate the family planning with the result that it makes them fat or thin. If it makes them thin they thought that other persons suspect that they are HIV positive. And if it makes them fat they thought that other persons suspect that they are taking other drugs.um… what if it sucks my blood and finish, cause to me cancer…. I do not want to add other incurable diseases.um…it may leads me to hypertension …. diabetes mellitus? ”
32 years old female BSc nurse from hospital
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17. Table 8: Factors associated with women’s intention to use LAPMs in Addis Ababa, Ethiopia, May, 2016
Characteristics
 Yes
N (%)
 No
 COR
(95% CI)
AOR
(95%CI)
Total number of children
0-2 children
55(18.5%)
236(81.1)
Ref
3-7 Children
55(18.5)
54(49.5)
4.4(2.71,7.04)*
3.28( )**
Decide on the number of children
Husband
11(25.58)
32(74.42)
Myself
14(14.89)
80(85.11)
0.51( )
0.49( )
Me and Husband
46(80.70)
11(19.30)
12( )*
20( )**
Ever use of LAPMs
Yes
40(46.51)
46(53.49) No
70(22.29)
244(77.71)
3( )*
2.85( )**
Knowledge
Low knowledge
25(15.63)
135(84.38)
High Knowledge
85(35.42)
155(64.58)
2.96( )*
10( )**
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18. Factors associated with women’s intention to use LAPMs
Women who never ever use LAPMs were AOR=2.85: 95% CI (1.22, 8.78) times more likely to use LAPMs than women who ever use LAPMs.
Inconsistent with the study done in
Bale zone South east Ethiopia (Abulie et al,2012)
Wolaita (Mengistu et al,2014)- no association
This particular finding could be the fact that those who ever used LAPMs may face side effects and fear to suffer again.
This situation explained by 30 years old widowed MsG as:
“……The previous pain and feeling will remain in their mind. They said at the time am using it I was sick that’s why am removed it so, why should I inserted it again ……”
positive significant association
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19. Factors associated with women’s intention to use LAPMs
Women who had two or more total children were AOR=3.28: 95% CI (1.22, 8.78) times more likely to use LAPMs than those who had less than 2 children.
Consistent
Malawi (Owen,2012)
Addis Ababa (Bantamlak ,2014)
Not consistent
Wolaita(Mengistu et al,2014)
Tigray (Alem et al,2014)
This could be due to increased living cost and better awareness about family planning in urban areas
The situation explained by 38 years old married mother support group as:
“The one who live in urban area more or less have the awareness of family planning because now days living by itself become family planning. The life style is teaching more rather than giving condom and pills to prevent pregnancy because at this time how much will cost milk? It cost six hundred birr….. “
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20. Factors associated with women’s intention to use LAPMs
Women who had decided on the use of family planning together with their husband were highly significant AOR=20: 95%CI ( ) with careful interpretation of the statistical value.
Consistent
Butajira south central Ethiopia(Wubegzier et al ,2011)
Women who had higher knowledge score were AOR=10: 95%CI (3.11, 33.4) times more likely to use LAPMs than women who had low knowledge score.
Consistent
Kenya(Paul et al,2014)
Addis Ababa (Bantamlak ,2014)
Inconsistent
West shoa zone (Eshetu et al ,2015)
Wolaita (Mengistu et al,2014)
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21. Strengths and Limitations of Study
Strength of the Study
The study used mixed design & The Study provides a baseline information.
Limitation of the study
The study does not include men as study participant & Since the study was institutional based, that might undermine generalizing the result to the general population.
Conclusions
The intention to use LAPMs was low in this study area.
women who never ever use LAPMs
women who had two or more total children
women who decided on the use of family planning together with their husband and
women who had higher knowledge have significant association with intention to use LAPMs among women in HIV chronic care.
Fear of drug reaction, fear of drug burden, fear of previous side effect partner disapproval, family and in-laws interference in decision making, perceived service related problems and low awareness on permanent methods were also barriers not to use LAPMs in the study area.
Strengths and Limitations of Study
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22. Recommendations
Addis Ababa health bureau together with FMOH should give due emphasis on awareness creation, Information, education and communication.
ART provider working in ART clinic shall inform and educate PLWHA about prevention of unwanted pregnancy and use of family planning particularly LAPMs.
Further research should be conducted using strong study design at community level.
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23. Acknowledgment
I would like to thank almighty God for His support in all my work.
My advisor Dr. Wubegzier Mekonnen
Addis Ababa University , School of Public Health
Health professionals working in different facilities
Study participant
Data collectors
My family and friends
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24. Thank You
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