Research proposal sample

FACTORS INFLUENCING FAMILY PLANNING USE AMONG HIV POSITIVE MOTHERS OF CHILD BEARING AGE IN HOIMA DISTRICT

LIST OF ACRONYMS AND ABBREVIATIONS

ACQUIRE: Access, Quality, and Use in Reproductive Health

AIDS: Acquired Immune Deficiency Syndrome

ART: Anti-retroviral Therapy

ARV: Anti-retroviral Drugs

BTL: Bilateral Tubal Ligation

CCP: Center for Communication Programs

COCS: Combined Oral Contraceptives

DHO: District Health Officer

FP: Family Planning

HAART: Highly Active Anti-retroviral Therapy

HIV: Human Immunodeficiency Virus

HIV/AIDS: Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome

IUD: Intrauterine Device

MDGs: Millennium Development Goals

MoH: Ministry of Health

PEP: Post Exposure Prophylaxis

PEPFAR: President’s Emergency Plan for AIDS Relief

PLWHA: People living with HIV/AIDS

PMTCT: Prevention of Mother to Child Transmission

PO: Progestin Only

RHR: Reproductive Health and Research

RHU: Reproductive Health Uganda

SSA: Sub Saharan African

STIs: Sexually Transmitted Infections

TASO: The AIDS Support Organization

UAC: Uganda AIDS Commission

UBOS: Uganda Bureau of Statistics

UDHS: Uganda Demographic Health Survey

UNFPA: United Nations Population Fund

UNICEF: United Nations International Emergency Fund

USAID: United States Agency for International Development

VCT: Voluntary Counseling and Testing

WHO: World Health Organization

OPERATIONAL DEFINITIONS

Micro organisms: Any organism too small germs to be viewed by the unaided eye, as bacteria, protozoa, and some fungi and algae.

Morbidity: Is another term for illness. A person can have several co-illnesses simultaneously.

Morbidity: It is another term for Illness, is a measure often used to determine the level of morbidity in a population

Prevalence: The percentage of a population that is affected with a particular disease at a given time

Factors: A circumstance, fact, or influence that contributes to a result or outcome; a number or quantity that when multiplied with another produces a given number or expression

Family: A group of persons consisting of parents and children living together in a household it may also consists of all the descendants of a common ancestor.

Family planning: Refers to the factors that are considered by a couple in a committed relationship and each individual involved in deciding if and when to have children it involves consideration of the number a couple wishes to have as well as the age at which they wish to have them.

Positive: This means the person’s blood tests evidence or presence of HIV in the blood of a person or consisting in or characterized by the presence or possession of features or qualities rather than their absence or a statement or decision expressing or implying affirmation, agreement, or permission.

CHAPTER ONE

INTRODUCTION

1.1 Introduction

This chapter presents the introduction, background of the study, problem statement, and purpose of the study, the Specific objectives, Research questions and Justification for the study.

Background of the Study

WHO in conjunction with United States department of Health and Human Services, Office (USDHSO) of Population Affairs defined family planning as a factor that allows individuals and couples to anticipate and attain their desired number of children, spacing and timing of their births, this is achieved through use of contraceptive methods and the treatment of involuntary infertility, (WHO April, 2016).

WHO has in its guidelines the traditional methods consisting of Lactation Amenorrhea Method (LAM) and Fertility Awareness Based (FAB). Current guide indicate that virtually all these methods are safe for nearly every person with HIV. FP services have been integrated into HIV care and treatment facilities just as the reverse is true; what is noticeable is the fact that there has not been a lot of information published focused to FP use among HIV positive clients, (WHO, 2008).

Globally four different analyses have confirmed that the importance to eMTCT effort of preventing unintended pregnancies in women with HIV is vital, and it was stated that moderate decrease in the number of pregnancy to HIV infected women ranging from 6% to 35% depending on the country, could result in numbers of averted HIV positive birth equivalent to those averted by Arts according to (WHO 2009).

In the same way another study demonstrated that adding family planning to PMTCT services in high-HIV prevalence countries could avert 71,000 child HIV infection compared with the 39000 HIV positive birth averted with PMTCT only (Janet Fleischman, 2006).

In some cases women with unintended pregnancies are more likely to carry out unsafe abortion, which predisposes them to infections such as puerperal sepsis; FP plays a key role in reducing such incidences, improving maternal health and minimizing the cost of caring for the child in case infected with HIV alongside prevention of unintended pregnancies; condoms specifically prevent against sexually transmitted infections including HIV cross and re-infection (WHO, 2009).

A third analysis in the same study suggested that recurrent levels of contraceptive use in sub Sahara Africa may be already preventing 173,000 (22%) of HIV positive birth annually, despite contraceptives not being widely available in sub Sahara Africa (WHO 2009)

According WHO (2009), If all women in the region who did not wish to get pregnant access contraceptive services, as many as an addition 160,000 HIV positive birth could be averted every year.

Access to FP services is vital as it was found in a study conducted by MOH in western Uganda that the married women in urban settings were twice as likely to use FP as those in the rural areas, women prefer getting at least one child before accepting using these methods because they may be assumed to be barren in case of no child, this is affected by age differences among women, yet by age 15, 14.2% are already sexually active (MoH 2009).

Elements of PMTCT program that could reach women and their partners outside ANC settings before they get infected thus; prevention of primary HIV infection in women before they become pregnant; prevention of unwanted pregnancy; preventing those already infected from infecting their infants and providing appropriate treatment, care and support to them and their children and families, (MOH 2012)

Implementing element 2 (prevention of primary HIV infection in women before they become pregnant) can be accomplished in two ways. One approach is to strengthen vertical family planning services; the other is to ingrate family planning services into HIV prevention, care and treatment services, (MoH PMTCT guidelines 2012).

Global family planning and HIV/AIDS program a funded though separate mechanism. While resources for HIV/Aids have dramatically increased in recent years, effort to strengthen international family planning program have been hampered by a decline in funds. In 2008 US$ 3600 million for HIV service went to the 15 PEPFAR focus countries compared to 67.5 million for family planning PEPFAR, report (2008).

1.3 Problem Statement

Factors influencing use of FP in the general population are known but what is lacking is linking these and other factors to HIV care. Factors that have been highlighted among the general population include socio-demographic characteristics like age, educational background, place of residence like rural or urban, desire for children and partner approval. HIV positive clients are a special population that has a regular follow up schedule, unique challenges are access to family planning services. On top of the factors faced by the general population, they could be having other additional issues that need to be addressed. It is therefore vital to determine the possible factors influencing the use of FP services among HIV positive clients (UDHS, 2011).

United Nations, Department of Economic and Social Affairs during its latest national survey, noted that one in three married women of reproductive age have unmet need for family planning, which translates into approximately 1.6 million women of these, about 60% wanted to space their next birth, and the other 40% did not want to have any more children, (UNDESA, 2013).

Family Planning utilization in south western Uganda stands at 30% among female users in comparison with northern Uganda which has a high level of knowledge about family planning methods among the PLHIV which is at 96%, with significantly higher proportion of males (52%) than females (25%) who report the use of contraceptives, (UBOS and ICF International, 2011).

There is no information documented on the proportion of HIV positive clients using FP for contraceptive purpose and yet the services are being provided, with low levels of FP use in the general public, hence there is a possibility of it being lower among HIV positive clients as well. If FP use among HIV positive clients remains low, negative effects can be realized such as unwanted pregnancies which in turn lead to poor health conditions among the HIV positive women who already have a weak immunity; the new born child may contract HIV infection which may lead to death; increased family expenses incurred for treatment and its associated costs due to client’s illness may be too costly for many Ugandans. Therefore this research seeks to assess the factors influencing the use of family planning services among HIV positive mothers in Hoima district in order to come up with solution to overcome the challenges on the ground.

1.4 Purpose of the Study

To determine the factors affecting family planning use among HIV positive mothers in Hoima district, in order to identify the gaps and find interventions required to over come challenges

1.5 Specific Objectives

To determine the socio-economic factors influencing family planning services uptake among HIV positive mothers in Azur Christian health centre IV Hoima district.
To assess the Knowledge of HIV positive mother on the use of family planning methods in Azur Christian health centre IV Hoima district.
To establish the individual related factors influencing family planning use in HIV positive mothers in Azur Christian health centre IV Hoima district.

1.6 Research Question

What are the socio-economic factors influencing family planning services uptake among HIV positive mothers in Azur Christian health centre IV Hoima district?
What is the Knowledge of HIV positive mother on the use of family planning methods in Azur Christian health centre IV Hoima district?
What are the individual related factors influencing family planning use among HIV positive mothers in Azur Christian health centre IV Hoima district?

1.7 Justification to the Study

The study will come up with intervention to increase use of family planning in HIV positive mothers in Hoima district.

This findings helps health workers in the area come up with measures aimed to improve FP services among mothers who are HIV positive in the area.

The findings could assist the health planners and policy makers by identifying the potential areas which require improvements in funding, development and support programs targeting to improved family planning among women who are HIV positive in Hoima district.

The findings of this study may be beneficial to stakeholders such as the Ministry of Gender and community development, The Uganda Human Rights commission, the Ministry of Health and UNICEF and other stakeholders operating in the region.

The findings of this study will act as a research reference for further studies by other nursing scholars or researchers.

The study will be of great importance to the researcher for the award of the requirement of a diploma in Nursing