Research consultancy

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

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).