FACTORS ASSOCIATED WITH THE RECOMMENDATION OF LACTATION AMENORRHEA: A CASE STUDY OF NURSES IN MULAGO REFERRAL HOSPITAL
Table of Contents
1.1 Background of the Study. 8
1.2 Statement of the Problem.. 9
1.4 Objectives of the Study. 10
1.7 Justification of the study. 11
1.8 Significance of the Study. 11
2.1. Lactational Ammenhoea. 14
3.2. Area of the study and Population of the study. 20
3.3 Sample size and sample selection procedures. 20
3.4 Data collection methods. 21
3.4.2 Key informant interviews. 21
3.5 Data analysis and presentation. 21
3.7 Procedures of data collection. 22
3.9 Data Validity and Reliability. 22
PRESENTATION, ANALYSIS AND INTERPRETATION OF FINDINGS. 23
4.1 Background information of the respondents. 23
4.1.1 Gender of respondents. 23
4.1.2 Age range of respondents in years. 24
4.1.3 Marital status of the respondent 24
4.1.4 Religious background of respondents. 25
4.1.5 Highest level of education a attained by respondents. 26
4.1.5 Period spent in service. 27
4.3 The demographic factors associated with the recommendation of lactation amenorrhea by nurses. 32
DISCUSSION, CONCLUSION AND RECOMMENDATIONS. 37
List of tables
ABSTRACT
The problem was that in Uganda, the use lactation amenorrhea is limited compared to other developing countries, its utilization being at the rate of 5% compared to other methods such as use of injectable, pills, condoms and this poses a big threat to the use of this method. Therefore the study sought to understand the factors associated with the recommendation of lactation amenorrhea by nurses in Mulago National Referral Hospital. It was guided by three objectives which include; understanding the socio-economic factors associated with the recommendation of lactation amenorrhea by nurses, to understand demographic factors associated with the recommendation of lactation amenorrhea among mothers and to understand the intermediate factors associated with the recommendation of lactation amenorrhea among mothers in Mulago National Referral Hospital.
The study used a cross-sectional research design taking a consideration of both quantitative and qualitative data. It aimed at describing and understanding the factors associated with the recommendation of lactation amenorrhea by nurses in Mulago National Referral Hospital.
The study concluded that 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.
The study recommended that the Ministry of Health should promote nurses knowledge, attitude and most of all promote the recommendation of LAM and other family planning methods to mothers who visit Mulago National Referral Hospital. It also recommended that training family planning to nurses should be taken seriously right from nursing training schools putting emphasis on Natural planning methods like LAM.
CHAPTER ONE
INTRODUCTION
1.0 Introduction.
This chapter contains the Background of the study, Statement of the problem, Purpose of the study, Objectives, Research questions, Scope of the study, Significances of the study and the definition of key terms in relation to the topic.
1.1 Background of the Study
Globally, 12% of married or in union women are estimated to have an unmet need for family planning and levels were higher in Africa at 22 percent and Oceania at 15 percent compared to other regions (United Nations, 2017). Lactation amenorrhea is a family planning method whose efficient rate was at 78% compared to other methods of family planning and yet has been considered the slowest recommended by health workers worldwide (WHO, 2015). Despite its efficiency, nurses in the hospitals and nurses in training institutions have not been able to recommend this method to the mothers because of the social and demographic nature of the mothers (WHO, 2015). It was therefore recommended in the same report by family planning initiative in western countries that much effort is needed to teach nurses about the importance of the lactation amenorrhea method as this will be the best initiative to ensure that the nurses recommend this method to the mothers(WHO, 2015)
While every region in the world experienced decline in maternal mortality levels between 1990 and 2015, maternal mortality and morbidity levels remain unacceptably high in sub Saharan Africa which is attributed to the slow uptake of family planning in these regions at 56% and above 75% in all other regions in developing countries (UNICEF, 2015). The use of lactation amenorrhea is considered to be the most efficient and safe method of family planning but is at a low rate of 17% only compared to the targeted and expected rate of 46% (WHO, 2016). Basing on the WHO 2016 analysis conducted on the slow adoption and use of this method it revealed that the nurses have not bothered to recommend the use of this method to the mothers in the sub-Saharan countries which has posed to a big threat to the use of this method. In East Africa, Kenya being one of the countries that use the family planning methods it was revealed that the use of family planning is at rate of 90% but the use of the lactation amenorrhea is considered to be at 10%, Uganda is second to Kenya and the uptake of lactation amenorrhea is at 5% (UDHS, 2016).
In Uganda, the use of lactation amenorrhea is considered to be at the rate of 5% compared to other methods such as use of injectable, pills, condoms and this poses a big threat to the use of this method (UDHS, 2016). The report further attributes the slow uptake of this method to the fact that the nurses in the nursing schools and the government hospitals have not recommended this method to the mothers but instead put emphasis on other methods of family planning.
In Mulago national referral hospital according to the 2017 annual report noted that the most utilized method was the injection (Depo-Provera) at 46%, implants were second at 21% followed by the pill and the least utilized was the lactation ammenhoea at 4%. This concurs with the UDHS (2016) findings that the recommendation of the lactation amenorrhea method of family planning is slow and poor. This study therefore seeks to understand the factors that have driven the recommendation of lactation amenorrhea.
1.2 Statement of the Problem
In Uganda, the use lactation amenorrhea is limited compared to other developing countries, its utilization being at the rate of 5% compared to other methods such as use of injectable, pills, condoms and this poses a big threat to the use of this method (UDHS, 2016). Most of the nursing students from Mulago national referral hospital have not been able to support and recommend the use of this method among the mothers (Atuyambe, Kansiime and Mirembe 2011). 2017 records on FP utilization in mulago national referral, LAM is at 4% in comparison to other FP methods (FP unit register, 2017) There is a growing amount of evidence that, when used perfectly (correct and consistent), LAM provides 98% to 99% contraceptive effectiveness (WHO, 2015).
Consequently, nonuse of lactation of amenorrhea will increase the rates of unintended pregnancies, maternal mortality, whereas close spacing and ill-timed pregnancies and births contribute highly to Uganda’s infant mortality rates. (MOH, 2017) However, the benefits of family planning go beyond improvements in maternal and child health. For girls and women, for example, family planning can result in higher educational attainment, better employment opportunities, higher socioeconomic status and empowerment (Canning and Schultz 2012).
In 2014, Ministry of Health (MOH) conducted a research in regional referral hospitals on the factors associated with the uptake of LAM by mothers and the mothers major concern was lack of awareness and failure to practice exclusive breast feeding due to work demand. Although demographers and family planning organizations continued to emphasize its value for example encouraging health workers to aggressively recommend the use of lactation ammenhoea, promoting work place breast feeding practices for the employed mothers and creating an enabling environment for exclusive breastfeeding, the uptake of lactation amenorrhea still remains low. Therefore, this study sought to understand the factors that have driven the recommendation of lactation amenorrhea among nurses and how it has affected the use of the LAM method such that remedies can be got to improve on the recommendations of LAM contraceptive method.
1.3 Purpose of the Study
The overall purpose of the study was to understand the factors associated with the recommendation of lactation amenorrhea by nurses in Mulago National Referral Hospital.
1.4 Objectives of the Study
- To understand the socio-economic factors associated with the recommendation of lactation amenorrhea by nurses in Mulago National Referral Hospital.
- To understand demographic factors associated with the recommendation of lactation amenorrhea among mothers in Mulago National Referral Hospital
- To understand the intermediate factors associated with the recommendation of lactation amenorrhea among mothers in Mulago National Referral Hospital.
1.5 Research Questions
- What are the socio-economic factors associated with the recommendation of lactation amenorrhea by nurses in Mulago nursing school?
- What are the demographic factors associated with the recommendation of lactation amenorrhea among mothers in Mulago nursing school?
- What are the intermediate factors associated with the recommendation of lactation amenorrhea among mothers in Mulago nursing school?
1.6 Scope of the Study
The scope of the study covered the subject /conceptual scope, geographical area to be covered and the time frame of the study.
1.6.1 Geographical Scope
The study was confined to Mulago National Referral Hospital located on P.O.Box 5225 Kampala which is the Uganda National referral hospital that receives patients from all over Uganda and therefore is a good representative of the situation in the entire country.
1.6.3 Time Scope
The study was conducted in November 2018, the period of data consideration was 2010-2018 and the period of body of knowledge (literature review was 2000 -2018).
1.7 Justification of the study
Despite the fact that the government sector remains the major provider of family planning services, about one third of currently married women have an unmet need of family planning services. Majority of women and youths in Uganda need to better plan their families although they do not always receive to the maximum the services they need. Therefore, this study will help the Government of Uganda in particular the MOH and other stakeholders in giving family planning services because it will add to the existing knowledge about the utilized methods and factors that hinder maximum utilization. It will identify factors associated with the recommendation of lactation amenorrhea among mothers and then generate information that will help to formulate evidence based decisions by programme implementers to strengthen the uptake of family planning services.
1.8 Significance of the Study
- The findings of the study would help the management of Mulago National Referral Hospital to understand the factors associated with the recommendation of lactation amenorrhea among mothers in Mulago National Referral Hospital as a birth control method.
- The study would help fellow researchers and add more information to the already exiting literature on issues to do with lactation amenorrhea.
- The study would also help the stakeholders of Mulago National Referral Hospital on how best they can improve the recommendation of lactation amenorrhea as a birth control method among mothers.
1.8 Conceptual Framework
The conceptual frame work was developed basing on the Health Belief Model (HBM). This model attempts to explain and predict health behaviors and is fit in motivating people to take action, (like recommending use of LAM). The modifying factors in this case would be both the demographic and the socio-economic factors, the enabling factors would be the intermediate factors and the likelihood of action will actually be the recommendation of lactation amenorrhea by the nurses.
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Source: (Peng, 2016) and modified by the researcher
Nurses do not bother to recommend Lactation amenorrhea to young mothers since young mothers tend not to breast feed for various reasons including pain while breastfeeding, to avoid excessive enlargement of the breast among others whereas older mothers are willing to breastfeed with minimal excuses.
Marital status is associated with the dependence on the spouse to make decisions the husband tends to dictate whether the wife should or not breastfeed therefore whenever nurses are recommending the method, married mothers always have no independent decisions. In addition, the type of occupation a woman returns to after her pregnancy also influences the initiation and duration of breastfeeding. This could be because those with professional occupations are entitled to longer maternity leave than those in nonprofessional occupations and this makes the nurses make their own judgment on whether to or not recommend lactation amenorrhea basing on ones occupation.
CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction
This chapter presented the review of literature related to the factors associated with the recommendation of Lactation amenorrhea by nurses in Mulago referral hospital. The study is sectioned between three themes namely; to understand the socio-economic factor, demographic factors and intermediate factors associated with the recommendation of Lactation amenorrhea by nurses in Mulago national referral hospital.
2.1. Lactational Ammenhoea.
This 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 (or LAM) (Brogen, 2016).
Breastfeeding is a temporary contraceptive method which takes advantage of the way in which breastfeeding naturally makes a woman much less likely to conceive. Health professionals often refer to this as the lactational amenorrhoea contraception method. While breastfeeding, the amount of oestrogen produced by a woman’s body is reduced. Ovulation (the release of an egg from the ovaries into the fallopian tubes) only occurs when a woman produces high levels of oestrogen, because high levels of oestrogen trigger ovulation. Because a breastfeeding woman produces less oestrogen than normally, she does not ovulate and cannot become pregnant (WHO, 2015).
If a woman breastfeeds exclusively and does not give her baby any supplementary foods in the first six months after childbirth, the lactational amenorrhoea method is highly effective (98%) as long as the woman’s menstrual cycle has not returned. The method requires no special devices or procedures, and is easy to use. However, it can only be used effectively in the first six months after childbirth.
2.2 The socio-economic factors associated with the recommendation of Lactation amenorrhea by nurses in referral hospitals
Socioeconomic factors are lifestyle components and measurements of both financial viability and social standing. They directly influence social privilege and levels of financial independence. Factors such as health status, income, employment status, religion environment and maternal education are studied by sociologists in terms of how they each affect the recommendation of the Lactation amenorrhea method by the nurses to the mothers. Much as they are many social economic factors, this study will focus on the following.
The level of maternal education has influenced much the recommendation of the Lactation amenorrhea. This is 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 (Hight-Laukaran, 2014). Most nurses look at the maternal education level before determining the family planning method to recommend and in most cases mothers who are more learnt are not recommended the Lactation amenorrhea method of family planning. This is because most mothers who have attained higher levels of education do not breast feed their children for so long compared to those who have not attained much education.
On the other hand in Belgium, majority of the highly educated mothers were in use of this method of family panning compared to the low educated ones and the nurses recommendation was dependent upon highly educated and motivated mothers (WHO, 2013).This makes contradiction with the WHO report 2016 in the USA. Therefore it is not a guarantee that Lactation amenorrhea is for mothers who are less educated but both the more educated and the less educated can use it and nurses can recommend it to both.
In some cases 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. According to 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 International health organization (2016), in the African countries like Somalia and Tunisia in which are also Muslim countries, it was revealed that religion was not a factor to consider while recommendation lactation amenorrhoea.
The maternal employment status has affected the recommendation of the Lactation amenorrhea method of family planning by others. According to the World Health Organization survey report on the use of family panning in the Denmark, nurses revealed that they recommend the use of the Lactation amenorrhea method basing on the employment status of the mothers. They revealed that mothers who have white collar jobs in most cases do not have time to breast feed their children for a long period of time because it is hard to breast feed in offices compared to the mothers who work in other places ;like markets and street vendors who have time and favorable environment for breast feeding. Therefore the report showed that nurses have been able to recommend this method of family planning to mothers who have white collar job or office jobs but they recommend it to mothers with blue collar jobs. However the same report also reveal that in some countries breast feeding initiation is nondependent on occupation therefore recommendation of Lactation amenorrhea was regardless of maternal occupation status
Nurses’ education level has been a factor in the recommendation of Lactation amenorrhea. Nurses who have not acquired a high level of education in most cases do not understand how best this method of family planning works and it is hard for them to recommend it to the mothers compared to the nurses who have acquired much education. This means that the more education the nurses are is the recommendation of the Lactation amenorrhea method to the mothers. According to the world health Organization report 2017, it provided that nurse who have acquired much education ion the family planning practices have been able understand much on the use of the Lactation amenorrhea method of family planning and this has made most often to recommend this method to the mothers. However according to the same report, it revealed that regardless of the education levels of the nurses, even nurses at the lowest grades and in the village hospitals have been able to recommend this method of family planning.
2.3 The demographic factors associated with the recommendation of Lactation amenorrhea by Nurses in referral hospitals.
They are many demographic factors associated with the recommendation of Lactation amenorrhea by Nurses in referral hospitals like age of the mother, parity, marital status, parenthood, ethnicity and size of the family. However, this study shall focus on the following.
The 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 (Kennedy, 2015). 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.
The 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 (Huffman, 2015). According to the 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. On the contrary a 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. (Zziwa, 2016)
Parity has 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 world health Organization report (2016)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 kid or child. However the same report suggested that some others with one kind has been able to breast feed their children for so long compared to those with many children and this was attributed to being the first kid, the mother lobes that that kid and in most cases the kid is beast fed up to the age of 5 years. Therefore 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.
2.4 The intermediate factors associated with the recommendation of Lactation amenorrhea by Nurses in referral hospitals.
They are many enabling factors to the recommendation of Lactation amenorrhea by Nurses in referral hospitals like side effect, cultural beliefs, health status, and level of weakness, efficiency and effectiveness of the method, hospital policies. However the study shall focus on the following.
The 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.
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. According to the WHO report 2016 breast feeding that was considered I Nigeria, it revealed that Hausa culture breast fed up to one year, the Yoruba culture breastfeed up to four years and the d Igbo culture do not have limitation on which age to breast feeding the child. Therefore nurses have to consider this factor in the recommendation of this method of family planning.
The health status of the mother is important in recommendation of the Lactation amenorrhea by the nurses. According to the WHO report 2014 on breast feeding among the mothers with HIV which was conducted in Ghana revealed that mothers who are affected with the HIV virus are not supposed to breastfeed the babies for more than 6 mothers. This therefore makes the nurses not to recommend this method of family planning to mothers who have HIV.Anna, Coutsoudis, Kubendran and Elizabeth (2015) estimated the proportion of infants that were HIV-1 infected by 3 months to be significantly lower for those exclusively breastfed to 3 months than in those who received mixed feeding before 3 months there by not compromising the recommendation of Lactation amenorrhea.
CHAPTER THREE
METHODOLOGY
3.0. Introduction
This chapter presented the research design, area of the study, study population, sample size, sampling procedure, data collection methods, data collection instruments, data analysis, research procedures, ethical procedures, measurements of variables and anticipated problems clearly shown.
3.1. Study design
The researcher used a cross-sectional research design taking a consideration of both quantitative and qualitative data. It aimed at describing and understanding the factors associated with the recommendation of lactation amenorrhea by nurses in Mulago National Referral Hospital.
3.2. Area of the study and Population of the study
This study was carried out in Mulago National Referral Hospital. The researcher targeted the nurses, nursing students, deputy in charges and section heads. This population was chosen because they handle mothers that have reproductive related issues.
3.3 Sample size and sample selection procedures.
3.3.1 Sample size
Using the Krejcie, &Morgan, (1970) table of determining Sample size from a given Population, this Study used a sample size of 59 respondents and these were selected from a population of 70 using pro-rata proportions as illustrated in the table below.
Table 1 showing sample size
| Category | Population | Sample probability | Sample size |
| Nurses | 10 | 14.29 | 9 |
| Nursing students | 50 | 71.43 | 42 |
| Deputy in charges | 5 | 7.14 | 4 |
| Section heads | 5 | 7.14 | 4 |
| Total | 70 | 100 | 59 |
3.3.2 Sampling Method
Sample probabilities were generated from the population and sample proportions generated using pro-rata. Sample selection was done according to the respondent’s convenience that is whoever was found on duty was the one that was selected for the study.
3.4 Data collection methods
3.4.1 Questionnaire
A questionnaire is a reformulated written set of questions to which respondents record their answers, usually within rather closely defined alternatives (Kothari, 2014).
A semi-structured questionnaire was adopted and administered to the nurses and the nursing students who are the primary targets for this study. This consisted of closed ended questions purely structured in nature. Data collection took a period of one week.
3.4.2 Key informant interviews
Key informants interview were used and this involved setting questions concerning the study objective and the researcher made appointments with the respondents. This tool was administered to the people considered to have higher expertise like the section heads and the deputy in charges in order to help the researcher get enough ,accurate and reliable information.
3.5 Data analysis and presentation
The researcher used both qualitative and quantitative methods of data analysis. Quantitative data described and quantitative data additionally explained the data content.
3.5.1 Quantitative data
The quantitative analysis was done using SPSS. The analysis was done with respect to research objectives. Data was presented at three levels; univariate, bivariate and at multivariate levels.
3.5.2 Qualitative data
Qualitative data was coded during the collection with respect to the research objectives and was the basis for developing the analysis.
3.7 Procedures of data collection
The researcher will got an introduction letter from the Research Coordinator Faculty of Arts and Social Science authorizing and recommending the conducting of research in Mulago National Referral Hospital. This letter was then taken to the Mulago National Referral Hospital to obtain acceptance and permission for conducting the study from their area. Appointments and coordination of questioning and interviewing were formulated with the chosen respondents.
3.8. Ethical procedure
In the process of research exercise, ethical concerns were be treated with great care regarding the rules of conduct while conducting research. Informed consent and permission were sought from the respondents themselves. The researcher endeavored to offer sufficient verbal and written explanations in relation to the purpose of the study. No bribery temptations occurred to the respondents in order to answer any question because the researcher presented herself as a student only doing research for academic purposes. No persons were either forced to participate in the study or answer any question against their will and this made the exercise successful.
3.9 Data Validity and Reliability
3.9.1 Validity
Validity refers to the truthfulness of findings or the extent to which the instrument is relevant in measuring what it is supposed to measure (Amin, 2015). The validity of the instrument quantitatively were established using the Content Validity Index (CVI). This involved the expert scoring of the relevance of the questions in the instrument in relation to the study variables.
3.9.2 Reliability
Reliability of the instruments were established through a pilot test. Cronbach’s Alpha Reliability Coefficient tests were used to establish the reliability of the instruments. Upon performing the test, if the values 0.7 and above, the items in the instrument would be regarded reliable. Based on Cronbach’s Alpha Coefficient, the scales for the variables were reliable. In the case of psychometric tests, fell within the range of 0.7 above for the test and were considered reliable (Katebire, 2012).
CHAPTER FOUR
PRESENTATION, ANALYSIS AND INTERPRETATION OF FINDINGS
4.0 Introduction
The study looked at s factors associated with the recommendation of lactation amenorrhea: a case study of nurses in mulago national referral hospital. This chapter on addition lays out the analysis and interpretation of study findings as per the formulated objectives in the previous chapter of this report. This was done with the aid of computer packages SPSS and Ms Excel where by data was presented in tables, graphs and charts.
It specifically presents the background information of respondents, the socio-economic factors associated with the recommendation of lactation amenorrhea by nurses to understand the demographic factors associated with the recommendation of lactation amenorrhea among mothers and to understand the intermediate factors associated with the recommendation of lactation amenorrhea among mothers in Mulago National Referral Hospital.
4.1 Background information of the respondents
In order to enrich the quality of the report in analysis, the background information of respondents was taken note of and variables such as; gender, age and marital status were considered in the study as looked at below;
4.1.1 Gender of respondents
The study findings first and foremost, females were more than males as presented in table 1 below.
Table 2 Gender of Respondents
| Frequency | Percent | Valid Percent | Cumulative Percent | ||
| Valid | Male | 11 | 18.6 | 18.6 | 18.6 |
| Female | 48 | 81.4 | 81.4 | 100.0 | |
| Total | 59 | 100.0 | 100.0 | ||
Source Primary data.
From the findings of the study, it was revealed that majority (81.4%) of the respondents were females while the rest (18.6%) were males. This implies that most of the nursing section in Mulago national referralHospital is dominated by women.
4.1.2 Age range of respondents in years
The study also explored the age ranges of respondents and four age ranges were established namely; below 20-29 Yrs, 30-39 Yrs, 40-49 Yrs and 50 Yrs and above years as presented in table 4.2 below.
Table 3 Shows Age bracket of respondents
| Frequency | Percentage | Valid Percent | Cumulative Percent | ||
| Valid | 20-29 Yrs | 24 | 40.7 | 40.7 | 40.7 |
| 30-39 Yrs | 30 | 50.8 | 50.8 | 91.5 | |
| 40-49 Yrs | 4 | 6.8 | 6.8 | 98.3 | |
| 50 Yrs and above | 1 | 1.7 | 1.7 | 100.0 | |
| Total | 59 | 100.0 | 100.0 | ||
Source Primary data
Table 2 results showed that 40% of respondents were 20-29 years and these were found to be majorly students doing their practical placement at Mulago National Referral Hospital. It is also showed that 50% of respondents were between 30-39 years and these were also newly enrolled nurses, 6.8% were 40-49 year who were majorly senior nurses while 1.7% was above 50 years. This implies the study collected information from well trained professionals who could respond factually.
4.1.3 Marital status of the respondent
Marital status of respondents was another variable explored and the respondents were; married single and others widowed as looked at below;
Figure 1: Marital status of the respondent
Source Primary data
From the figure 1 above, it was found out that the majority of study respondents were single and this comprised 65.6% of total respondents. The study further established that this group of nurses was basically student nurses doing their practice at the hospital 29.5% were married and these were basically senior nurses while only 3.3% of the nurses were widowed. This implies that most of the nurses were single since a significant number of them were still students.
4.1.4 Religious background of respondents.
The study was also interested in finding out the religious background of respondents and these were categorized into Catholic, Anglican, Muslim, and other religions as presented in the table below;.
Figure 2 Shows religion of respondents
Source Primary data
The results from the figure above show that majority of respondents 47.5% were from other religions like the born again faith, Seventh Day Adventists, orthodox Christians. While on the other hand 29.9% were Anglicans, 18% were Catholics while 3.3 were Muslims. This implies that the study got responses from different religious backgrounds.
4.1.5 Highest level of education a attained by respondents
The study background characteristic of respondents looked at the level of education attained by respondents and this was at the establishing whether education level had a connection with LAM recommendation.
Figure 3 Showing education level of respondents
Source Primary data
From the figure 3 above indicated that most (37.3%) of the respondents were still students doing their practice with in the hospital, (13.6%) were certificate holders, (33.9%) were diploma holders while 15.3% were degree holders. This implies that the study was carried out among literate respondents who could read and understand all the questions asked in the questionnaire.
4.1.5 Period spent in service
It was put to respondents to reveal the period spent working at Mulago National referral hospital and ranges were less than 1 year, 6-10 years and 11 and above years.
Table 4 Years of Service
| Frequency | Percent | Valid Percent | Cumulative Percent | ||
| Valid | Les than a yr | 26 | 44.1 | 44.1 | 44.1 |
| 1-5yrs | 7 | 11.9 | 11.9 | 55.9 | |
| 6-10 Yrs | 15 | 25.4 | 25.4 | 81.4 | |
| 11 and above Years | 11 | 18.6 | 18.6 | 100.0 | |
| Total | 59 | 100.0 | 100.0 | ||
Source Primary data
From the table 6 above, it is revealed that majority (44.1%) of respondents had worked at Mulago National Referral Hospital for less than a year and these were basically students ,(11.9%) had worked for 1-5 Yrs , and this category of respondents were newly enrolled nurses while 25.4% had worked for 6-10 and 18.6% had worked for 11 and above years at Mulago National referral hospital and this category comprised of senior nurses who were well experienced.
4.2 Factors associated with the recommendation of lactation amenorrhea by nurses in Mulago National referral hospital
According to the interview carried out with two senior nurses, they described Lactation amenorrhea as the temporary postnatal infertility that occurs when a woman is amenorrheic and fully breastfeeding.
Table 5 Whether Mothers Education Level influences nurses Recommendation of LAM
| Frequency | Percent | Valid Percent | Cumulative Percent | ||
| Valid | Yes | 27 | 45.8 | 45.8 | 45.8 |
| No | 32 | 54.2 | 54.2 | 100.0 | |
| Total | 59 | 100.0 | 100.0 | ||
Source Primary data
The findings in the table above revealed that 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 implies that most nurses don’t pay attention to the mother’s education when recommending LAM.
“Most nurses argued that mothers education level does not determine whether they should breast feed or not therefore they didn’t consider mother education as a determinant factor to recommend LAM”
Table 6 Whether Mothers religion influences nurses Recommendation of LAM
| Frequency | Percent | Valid Percent | Cumulative Percent | ||
| Valid | Yes | 5 | 8.5 | 8.5 | 8.5 |
| No | 54 | 91.5 | 91.5 | 100.0 | |
| Total | 59 | 100.0 | 100.0 | ||
Source Primary data
The results from the study showed that 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.
“The reason most nurses were not considering mothers religion was that there is no religion the discourages breast feeding therefore a mothers religious background could not influence their uptake of LAM if recommended by the nurse”.
Table 7 Whether nurses had attended any trainings on LAM
| Frequency | Percent | Valid Percent | Cumulative Percent | ||
| Valid | Yes | 56 | 94.9 | 94.9 | 94.9 |
| No | 3 | 5.1 | 5.1 | 100.0 | |
| Total | 59 | 100.0 | 100.0 | ||
Source Primary data
It was revealed from the table above 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.
Table 8 How nurses benefit from the trainings of recommending LAM to mothers.
| Response | Frequency | Percentage |
| Acquired Knowledge about LAM | 2 | 3.4 |
| Got the skills necessary to recommend LAM to a mother | 4 | 6.8 |
| Changed my attitude towards the method | 12 | 20.3 |
| All the above | 41 | 73.2 |
| Total | 59 | 100 |
Source Primary data
The findings from table 7 above indicate that most 73.2 of the respondents agreed that the training they received benefited them by giving them enough knowledge about LAM, skills and it also changed their attitude about the family planning method. This implies that the training nurses receives helps them to advise mother on how to utilize LAM as a family planning method
Table 9 Frequency nurses have attended LAM training
| Frequency | Percent | Valid Percent | Cumulative Percent | ||
| Valid | Once in 4 Months | 38 | 64.4 | 64.4 | 64.4 |
| Twice in 4 months | 10 | 16.9 | 16.9 | 81.4 | |
| Three times and more in 4 Months | 11 | 18.6 | 18.6 | 100.0 | |
| Total | 59 | 100.0 | 100.0 | ||
Source Primary data
According to the findings in the table above, majority 64.4% of the respondents said that they had attended LAM training once in 4 Months, 16.9% had attended LAM training twice in 4 months for while 18.6% had attended three times and more in 4 Months. This implies that majority of the respondents do not regularly attend LAM training the is carried out every month with in the hospital.
Figure 4 Frequency nurses have attended LAM training
Source Primary data
According to the findings in the table above, majority 64.4% of the respondents said that they had attended LAM training once in 4 Months, 16.9% had attended Lam training twice in 4 months for while 18.6% had attended three times and more in 4 Months. This implies that majority of the respondents do not regularly attend LAM training that is carried out every quarter with in the hospital.
Table 10: Whether nurses had recommended LAM basing on the training acquired
| Frequency | Percent | Valid Percent | Cumulative Percent | ||
| Valid | Yes | 11 | 18.6 | 18.6 | 18.6 |
| No | 48 | 81.4 | 81.4 | 100.0 | |
| Total | 59 | 100.0 | 100.0 | ||
Source Primary data
The results in the study show that majority of respondents 81.4% said that they don’t recommend the use of LAM to mothers basing on the training acquired while minority 18.6% said that they follow the training received. This implied that most nurses do not use the training they received while recommending the use of LAM to mothers.
4.3 The demographic factors associated with the recommendation of lactation amenorrhea by nurses
Table 11 Whether nurses had considered the mothers age when recommending LAM
| Frequency | Percent | Valid Percent | Cumulative Percent | ||
| Valid | Yes | 6 | 10.2 | 10.2 | 10.2 |
| No | 53 | 89.8 | 89.8 | 100.0 | |
| Total | 59 | 100.0 | 100.0 | ||
Source Primary data
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,
However according to 10.2% who were basically senior nurses, revealed that mother’s age greatly matters when recommending the use of LAM. This according to them was that age is the strongest predictor of ovarian reserve. Reproductive success diminishes exponentially with advancing maternal age therefore nurses should consider maternal age when recommending the use of LAM.
Table 12 Whether nurses had considered the mothers marital status when recommending LAM
| Frequency | Percent | Valid Percent | Cumulative Percent | ||
| Valid | Yes | 4 | 6.8 | 6.8 | 6.8 |
| No | 55 | 93.2 | 93.2 | 100.0 | |
| Total | 59 | 100.0 | 100.0 | ||
Source Primary data
The results in the table above showed majority of respondents (93.2%) 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.
However according to the interviews with some senior nurses, they revealed that marital status has to be considered while recommending LAM. This was because there is a possibility for married mothers to have regular sexual intercourse than the ones who are not married. There for its considered poor practice if consider marital status is not put in consideration when nurses are recommending LAM.
Table 13: Whether nurses had considered the mothers parity when recommending LAM
| Frequency | Percent | Valid Percent | Cumulative Percent | ||
| Valid | Yes | 10 | 16.9 | 16.9 | 16.9 |
| No | 49 | 83.1 | 83.1 | 100.0 | |
| Total | 59 | 100.0 | 100.0 | ||
Source Primary data
The results of the study revealed that majority of respondents 83.1% don’t consider the mothers parity when recommending LAM while minority 16.9% said they consider parity. This implies that nurses don’t take into account the mothers’ parity when recommending LAM to the mothers.
However while in an interview with a small number of nurses, they suggested that “mothers parity should be considered by nurses while recommending the use of LAM to mothers. Where by this method should be emphasized to those mothers with many un spaced children”
4.4 The intermediate factors associated with the recommendation of lactation amenorrhea by nurses.
Table 14 Whether nurses had considered the mothers culture when recommending LAM
| Frequency | Percent | Valid Percent | Cumulative Percent | ||
| Valid | Yes | 5 | 8.5 | 8.5 | 8.5 |
| No | 54 | 91.5 | 91.5 | 100.0 | |
| Total | 59 | 100.0 | 100.0 | ||
Source Primary data
The results of the study showed that majority of respondents 91.5% showed that nurses do not consider mothers’ culture when recommending the two used 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.
According to the interviews carried out with some senior nurses, they agreed that culture is sometimes very influential in determining the uptake of LAM by mothers with recommendation from nurses.
Table 15: Whether mothers report side effects associated with LAM
| Frequency | Percent | Valid Percent | Cumulative Percent | ||
| Valid | Yes | 35 | 59.3 | 59.3 | 59.3 |
| No | 24 | 40.7 | 40.7 | 100.0 | |
| Total | 59 | 100.0 | 100.0 | ||
Source Primary data
The results in the figure above show 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.
However in an interview with some nurse, they suggested that method does not cause any side effects to the mother or the baby and mothers have never reported to them any side effects as a result of LAM.
Table 16 Whether nurses had considered the mothers job when recommending LAM
| Frequency | Percent | Valid Percent | Cumulative Percent | ||
| Valid | Yes | 12 | 20.3 | 20.3 | 20.3 |
| No | 47 | 79.7 | 79.7 | 100.0 | |
| Total | 59 | 100.0 | 100.0 | ||
Source Primary data
The results of the study revealed that majority 79.7% of respondents don’t consider the mothers job when recommending LAM while 20.3% said that they consider the mothers job. This implies that most nurses did not take in account the occupation of mothers when recommending LAM.
It was revealed in the interview by some nurses that a mothers occupation has to be considered while recommending LAM. Some mothers have very demanding jobs that they can’t keep up with exclusive breast feeding while some jobs can allow for exclusive breast feeding. Therefore LAM should be recommended to those mothers who can afford to exclusively breast feed and those who can’t should try other methods.
Figure 6: Whether nurses had recommended LAM a mother in the past three months
Source Primary data
It was also revealed that most of the respondents 84.7% said that they had never recommended LAM to a mother I the past three months while minority 15.3% said they had ever recommended. This implies that nurses in Mulago National Referral Hospital rarely recommend the use of LAM to mother.
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.
