Research consultancy

FACTORS ASSOCIATED WITH THE RECOMMENDATION OF LACTATION AMENORRHEA: A CASE STUDY OF NURSES IN MULAGO REFERRAL HOSPITAL

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.

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.