Research consultancy

Research consultancy

CHAPTER ONE: INTRODUCTION

1.0 Introduction

This chapter outlines the background, problem statement, purpose, objectives, research questions, scope, significance, and key definitions of the study.

1.1 Background of the Study

Globally, 12% of married or partnered women have an unmet need for family planning, with rates higher in Africa (22%) and Oceania (15%) (United Nations, 2017). Despite LAM’s efficacy (78%), it remains underutilized due to insufficient promotion by healthcare workers (WHO, 2015). Sub-Saharan Africa continues to experience high maternal mortality rates, partly due to low family planning uptake (UNICEF, 2015). While LAM is a safe and effective contraceptive method, its adoption remains low (17%) compared to the WHO’s target of 46% (WHO, 2016).

In East Africa, Kenya reports a 10% LAM utilization rate, while Uganda lags at 5% (UDHS, 2016). Mulago National Referral Hospital’s 2017 records indicate that injectables (46%) and implants (21%) dominate contraceptive use, with LAM at only 4%. This study explores the factors contributing to this disparity.

1.2 Statement of the Problem

Despite its effectiveness (98–99% when correctly applied), LAM utilization in Uganda remains critically low (5%), far below other contraceptive methods (UDHS, 2016). Nurses at Mulago National Referral Hospital seldom recommend LAM, contributing to its underuse (FP Unit Register, 2017). Poor LAM adoption increases unintended pregnancies, maternal mortality, and infant health risks (MOH, 2017).

A 2014 MOH study identified lack of awareness and work-related breastfeeding challenges as key barriers. Despite advocacy efforts, LAM uptake remains stagnant. This study investigates the factors influencing nurses’ recommendation of LAM to inform policy and practice improvements.

1.3 Purpose of the Study

The study aimed to assess the factors affecting nurses’ recommendation of LAM at Mulago National Referral Hospital.

1.4 Objectives of the Study

1. To examine socio-economic factors influencing nurses’ recommendation of LAM.
2. To assess demographic factors affecting LAM recommendation among mothers.
3. To identify intermediate factors impacting LAM recommendation.

1.5 Research Questions

1. What socio-economic factors influence nurses’ recommendation of LAM?
2. What demographic factors affect LAM recommendation among mothers?
3. What intermediate factors hinder or promote LAM recommendation?

1.6 Scope of the Study

1.6.1 Geographical Scope

The study was conducted at Mulago National Referral Hospital, Kampala, a representative setting for Uganda’s healthcare system.

1.6.2 Time Scope

Data collection occurred in November 2018, with literature reviewed from 2000–2018 and data considered from 2010–2018.

1.7 Justification of the Study

With one-third of Ugandan women having an unmet need for family planning, this study provides insights to improve LAM promotion, aiding policymakers and healthcare providers in enhancing contraceptive services.

1.8 Significance of the Study

• Informs hospital management on barriers to LAM recommendation.
• Contributes to academic literature on contraceptive methods.
• Guides stakeholders in improving LAM advocacy and maternal health strategies.

1.9 Conceptual Framework

The study employed the Health Belief Model (HBM) to analyze nurses’ recommendation behaviors. Modifying factors (demographic and socio-economic) and enabling factors (intermediate influences) shape nurses’ likelihood of promoting LAM.

(Conceptual model adapted from Peng, 2016, and modified by the researcher.)

Nurses often hesitate to recommend LAM to younger mothers due to breastfeeding reluctance, while older mothers show higher compliance. Marital status and occupation further influence recommendation patterns, as workplace demands and spousal decisions impact breastfeeding practices.