CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATIONS
5.1 Discussion
This chapter presents the analyzed results, conclusions derived from the study in relation to the specific objectives, conclusion and recommendations. The aim of this study was to understand the factors associated with the recommendation of lactation amenorrhea by nurses in Mulago National Referral Hospital. A sample of 59 nurses was involved in the study.
5.1.1 Socio-economic factors associated with the recommendation of lactation amenorrhea by nurses in Mulago nursing school.
According to the study findings, most of the nurses new the meaning of Lactation amenorrhea since most of them described it as the temporary postnatal infertility that occurs when a woman is amenorrheic and fully breastfeeding. This finding is in line with Brogen, (2016), who stated that lactation amenorrhea is a temporary contraceptive method that relies on exclusive breast feeding. It can be used from birth up to six months afterwards. Producing milk is called lactating and not having a period is called amenorrhea, hence this method of birth control is called Lactation amenorrhea
The results revealed majority (54.2%) of respondents disagreed that they don’t consider mothers education level while recommending for LAM while minority (45.8%) suggested that they consider the mothers education. This implied that most nurses didn’t pay attention to the mother’s education when recommending LAM. This is contrary to Hight-Laukaran, (2014) who stated that level of maternal education should be considered when recommending LAM since it. This was because the mothers who have attained the highest level of education mostly do not to use this method of family planning and therefore it is hard for the nurses to recommend this method to them.
Most nurses (91.5%) said that mother’s religion does not influence their decision to recommend LAM while minority 8.5% said it does. This implies that nurses did not consider the mothers religion in order to recommend LAM. This finding contrary (IHO, 2016) which revealed that nurses recommend the use of the Lactation amenorrhea basing on the religion of the mothers. Mothers who are born again do not accept and recognize the use of most of the other family planning methods, they consider them to be unreligious and also they consider them to be against the God’s plan. Therefore nurses normally recommend the Lactation amenorrhea method of family planning to more religious mothers compared to the non-religious mothers. Similarly the World Health Organization Report on the use of Lactation amenorrhea for 2014, it revealed that countries like Egypt use this method of family planning because they are more religious and they consider this method to be of no sin when it is used. In another study by the,
Furthermore, It was revealed from the study that majority of respondents 94.9% suggested that they had attended training regarding the use of LAM while minority 5.1% suggested that they had never been trained in the application of LAM as a family planning measure. This implies that most nurses were well trained and had the necessary knowledge and skills to recommend the use of LAM by many mothers.
5.1.2 Demographic factors associated with the recommendation of Lactation amenorrhea by Nurses in referral hospitals.
The study revealed that majority of respondents (89.8%) suggested that they don’t consider the mothers age while recommending them for LAM while minority 10.2% said that they do consider the mothers age. This implied that the mothers’ age does not matter when nurses are recommending LAM to mothers. This further shows the poor practices nurses had towards recommending LAM as a family planning method to mothers.
This is contradicts with (Kennedy, 2015) who stated that age of the mothers has been a major factor in determining the recommendation of Lactation amenorrhea by Nurses in referral hospitals. Most teenagers do not recognize the use of this family planning method because they say that breast feeding the child for many months can affect their body shape and their breast shape. Mothers between the ages of 18-37 were not encouraged by the public health nurses to exclusively breast feed since they don’t breast feed their children for too long (WHO, 2015). In another study, most teenager’s breast feed for only one month and others less than one month and this makes the nurses not to decide to recommend a method that involves exclusive breastfeeding(Huffman, 2015).To the contrary, the RHU (2015) Report conducted in Wakiso district on breastfeeding among the teenage mothers, it revealed that teenagers between the age of 18 to 30 years have been able to breast feed their children to the age of four years and this has enabled nurses to easily recommend exclusive breast feeding.
It was also revealed by the study that, majority (93.2%) of respondents suggested that they don’t consider the mothers marital status while recommending them for LAM while minority 6.8% suggested that they do consider marital status. This implies that most nurses were not considering mothers marital status when recommending LAM. This finding contradicts with (Huffman, 2015) who stated that marital status of the mother affects the nurses’ decision to advise exclusive breast feeding. In most cases single mothers have more execution of getting married to other men and therefore they do not want to breast fed their children for so long. Similarly, World health report on breastfeeding among the mothers in the sub Saharan Africa, it revealed that nurses recommend the Lactation amenorrhea method to married mothers because marrieds tend to breastfeed for so long due to the influence of their husbands to ensure that the child is breast fed to a maximum of two years. However Zziwa, 2016 agrees in his study done in Buikwe district, 50% of women do not breast feed and rather having their husbands compete with children for their breasts therefore making it hard for the public health specialists in this region to campaign for Lactation amenorrhea.
According to the study findings, majority of respondents 83.1% don’t consider the mothers parity when recommending LAM while minority 16.9% said they consider parity. His implied that nurses don’t take mothers parity into consideration while recommending LAM to mother. This result is contrary to World Health Organization Report (2016) who stated that mothers Parity have been a big factor in the recommendation of Lactation amenorrhea by the nurses. In most cases nurses look at the number of time the mother has been pregnant or the number of children the mother has before recommending this method of family planning. The on the use of Lactation amenorrhea in Africa revealed that nurses base on the number of children the mother have because mothers who have many children can breastfeed for so long compared to mother who have one child. The report concluded that nurses have to be kin in considering this parity factor while recommending the use of Lactation amenorrhea method of family planning to the mothers because is not a must that mothers with fewer children do not easy feed compared to mother with many children.
5.1.3 The intermediate factors associated with the recommendation of Lactation amenorrhea by Nurses in referral hospitals.
The results of the study showed that majority 91.5% of respondents do not consider mothers’ culture when recommending the use of LAM while minority 8.5% suggested that they don’t consider the culture. This implies that most nurses did not pay attention to mothers’ culture when recommending LAM to mothers. This finding is contrary to (WHO 2016) which stated that Cultural beliefs have influenced the recommendation of Lactation amenorrhea by the nurses. Some cultures not breast feed the child for so long that is to say they do not breast feed the child beyond one year of age and other culture breast feed the child up to four years. This therefore makes the nurses to consider the cultural norms of the mother before recommending this method of family planning.
The study further revealed that majority of respondents 59.3% agreed that mothers have reported side effects associated with LAM whereas minority 40.7% disagreed that mothers had never reported to them any side effects as result of using LAM as a family planning method. This implied that most mother who use LAM get side effects. This finding is in line with WHO 2016 which stated that side effect of the Lactation amenorrhea has affected its recommendation by the nurses to the mothers. Basing on different reports like the World health report on Lactation amenorrhea of 2015 which was conducted in Afghanistan and other Arabic countries, it revealed that Lactation amenorrhea is effective 98% and it does not have any side effect on the mother and it is okay for the nurse to recommend this method to the mothers. However according to the WHO report of 2016 which was conducted in USA on the effectiveness of Lactation amenorrhea among the mothers, it revealed that this method has 16% negative effect on the mother if used frequently and this puts its recommendation by the nurses to the mothers on standstill. Therefore the recommendation of the Lactation amenorrhea is affected by its effect on the mothers and nurses have to look at the positive and negative effects before it is being recommended.
5.2 Conclusion.
The study concludes that almost all nurses have been trained on the use and how to recommend LAM mothers. However due to other factors like negligence, unsuccessful LAM execution by mother, side effects and the availability of other family planning methods, the practice of recommending the use of LAM to mothers has been poorly done. This is true because most nurses don’t attend regular training, ignore mothers Education Level, religion, marital status, parity, culture, occupation, age and sometimes they don’t put their training into practice. This has resulted in the ineffectiveness to the recommendations they give to mothers about LAM.
5.3 Recommendations.
- The Ministry of Health should promote nurses knowledge, attitude and most of all to promote the recommendation of LAM and other family planning methods to mothers who visit Mulago National Referral Hospital.
- Training family planning to nurses should be taken seriously right from nursing training schools putting emphasis on Natural planning methods like LAM.
- Continuous medical education session on family planning should made mandatory for every practicing nurse and even student nurses to make sure that they embrace the recommendation of these methods especially LAM to visiting mothers.
- Mulago Referral hospital should put in place a strict supervisory mechanism which will ensures practice what they are trained.
INSTRUCTIONS
- Please tick the appropriate responses.
- Fill in the blank spaces where necessary
SECTION A: Biodata
1 Gender of the respondent
(i) Male (ii) Female
- Age bracket of the respondent………..
- Marital status
(i) Married (ii) single (iii) divorced (iv) widowed
- Religious affliction
(1) Catholic (ii) Anglican s (iii) Moslem (iv)others specify
- Carder attained by the respondent so far……………………..
- Years of service ……………………………..
SECTION B: The socio-economic factors associated with the recommendation of lactation amenorrhea by nurses.
- What do you understand by term Lactation ammenhoea?
………………………………………………………………………………………………………………………………………………………………………………………………………………
- Does the mother’s education level influence your recommendation of lactation ammenhoea method of family planning?
(i) Yes (ii) No
If yes/no why?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
3.Does the mothers religion influence your recommendation of LAM method of family
planning?
(i) Yes (ii) No
If yes/no why?
………………………………………………………………………………………………………
……………………………………………………………………………………………………
- Have you attended any trainings on lactation ammenhoea. Method?
(i) Yes (ii) No
a)If yes. How often?
(i) once in 4 months
(ii) twice in 4 months
(iii) three times and more in 4 months
b).How beneficial have you found the trainings as far as recommendation of lactation amenorrhea is concerned/?
………………………………………………………………………………………………………………………………………………………………………………………………………………
c). Have you recommended LAM basing on the training acquired?
(i) Yes (ii) No
SECTION C: The demographic factors associated with the recommendation of lactation amenorrhea by nurses
- Are you influenced by the mother’s age in recommending lactation ammenhoea method?
(i) Yes (ii) No
If yes, How?
………………………………………………………………………………………………………………………………………………………………………………………………………………
- Does marital status of the mother influence your recommendation of lactation ammenhoea?
(i) Yes (ii) No
If yes, how?
………………………………………………………………………………………………………………………………………………………………………………………………………………
- Does the mother’s parity level influence your recommendation of lactation ammenhoea?
(i) Yes (ii) No
If yes, how?
……………………………………………………………………………………………………………………………………………………………………………………………………………
SECTION D: The intermediate factors associated with the recommendation of lactation amenorrhea by nurses
- Can the mother’s culture influence your recommendation of lactation amenorrhea?
- i) Yes (ii) No
If yes how?
……………………………………………………………………………………………………..
………………………………………………………………………………………………………
- Do mothers report any side effects associated with Lactation amenorrhea?
(i) Yes (ii) No
If yes, how do these side effects affect your recommendation of the method?
(i) Loss off shape (ii) painful breasts (iii) Un hygienic appearance
(iv) Other, specify ………………………………………………………………………………………………………………………………………………………………………………………………………………
- Does the nature of job of the mother influence your recommendation of lactation ammenhoea?
(i) Yes (ii) No
If yes how?
……………………………………………………………………………………………………………………………………………………………………………………………………………..
- Do you remember recommending this method to a mother in the past three month?
(i) Yes (ii) No
- Is there any factor that we have not mentioned that influences your recommendation of lactation amenorrhea? If any specify…………………………………………………………………………….
Thanks for your cooperation.
