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ORIGINAL ARTICLE
Year : 2022  |  Volume : 25  |  Issue : 7  |  Page : 987-996

Predictors of knowledge, attitudes and ever practice family planning among public secondary school teachers in Enugu East Senatorial District, Nigeria


Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia

Date of Submission16-Dec-2020
Date of Acceptance07-Jan-2022
Date of Web Publication20-Jul-2022

Correspondence Address:
Dr. M Z Nor Afiah
Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_688_20

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   Abstract 


Background: Family planning deficiencies are responsible for high maternal, newborn, and child mortality in Nigeria, and more than half of all death among adult female is linked to maternal death. Aim: To ascertain the predictors of good knowledge, positive attitudes, and ever practice family planning among public secondary school teachers in Enugu East Senatorial District, Nigeria. Subjects and Methods: A cross-sectional research was carried out among public secondary school teachers aged between 18 and 60 years in Enugu East Senatorial District, Nigeria, using probability proportional to size sampling and systematic random sampling from a selection of 1,000 participants. Factors considered included sources of information on family planning, partner involvement, history of family planning methods, and healthcare facilities. Bivariate and multivariable logistic regression analysis was employed to establish the relationship. An odds ratio of 95% confidence interval (CI) was estimated to ascertain the level of significance. Result: A majority (65.9%) of respondents had a good knowledge of family planning, more than half had positive attitudes (52.7%), and most of them had ever practice family planning (55.0%). Television (AOR = 2.17; 95% CI 1.54-3.06) and social media (AOR = 1.89; 95% CI 1.29-2.78) were effective sources of information to establish significant predictors of good knowledge on family planning. Healthcare (AOR = 0.68; 95% CI 0.51-0.92) and partner discussion (AOR = 3.19; 95% CI 1.94–5.27) were also significant determinants of positive attitudes towards family planning. Cost of obtaining family planning methods (AOR = 0.003; 95% CI 0.001-0.013) and proximity of family planning facilities (AOR = 0.04; 95% CI 0.02-0.10) were notable predictors of ever practice family planning. Conclusion: The level of knowledge, attitudes, and ever practiced family planning among teachers are moderate and a significant number of predictors were identified. Effective awareness is recommended and making use of television as a channel to increase levels of knowledge will hopefully encourage utilization of family planning among teachers.

Keywords: Attitudes and ever practice, family planning, knowledge, teachers


How to cite this article:
Okafor O C, Nor Afiah M Z, Muthiah S G. Predictors of knowledge, attitudes and ever practice family planning among public secondary school teachers in Enugu East Senatorial District, Nigeria. Niger J Clin Pract 2022;25:987-96

How to cite this URL:
Okafor O C, Nor Afiah M Z, Muthiah S G. Predictors of knowledge, attitudes and ever practice family planning among public secondary school teachers in Enugu East Senatorial District, Nigeria. Niger J Clin Pract [serial online] 2022 [cited 2022 Aug 14];25:987-96. Available from: https://www.njcponline.com/text.asp?2022/25/7/987/351469




   Introduction Top


The increased rate in maternal and infant mortality in sub-Saharan Africa, especially Nigeria, has contradicted the Millennium Development Goals 4 and 5 and Sustainable Development Goal 3 to lessen maternal death rates by 75% and infant and under-5 mortality by 66.6%.[1] Nigeria's maternal death rate is computed at 576 mortality per 100,000 live births. Newborn fatality and under-5 death rates are measured at 69 fatalities per 1,000 live births and 128 fatalities per 1,000 live births, respectively. The indices of maternal, infant, and newborn health in Nigeria are generally poor within rural areas. For instance, the maternal death rate is measured at 828 mortality per 100,000 live births in rural areas, compared to 351 mortality per 100,000 live births in urban areas.[2] However, global health statistics have revealed that more than 4,000 Nigerian women die because of childbirth and pregnancy complications. Nigeria accounts for 2.5% of the global population and are liable for 14% of maternal mortality worldwide every year.[3] This horrifying finding has contributed to the high demand from appropriate authorities to enhance maternal health in Nigeria. Notwithstanding the vast interest from stakeholders, nothing has been accomplished to improve maternal health in the nation. Instead, there has been an increase of 5.6% in the maternal mortality rate from 545 per 100,000 live births in 2008 to 576 per 100,000 live births in 2013.[2],[4] Literature has identified that the Enugu State maternal death ratio was evaluated at 840/100,000 live births, which is much higher than the nationwide aggregate of 545/100,000 live births. Teenage pregnancy is one of the major known contributors because of low contraceptive use, with the national contraceptive prevalence rate being 15%.[2],[4],[5] Furthermore, a study in southwest Nigeria showed that 69.5% of parents do not promote contraceptive use to adolescents because 84.2% agree on total abstinence as being the best contraceptive practice.[6]

Several factors have been found to significantly influence knowledge, attitudes, and practice of family planning in different studies. Some of these factors include sources of information (radio, television, magazine, and healthcare personnel) that were found to influence knowledge, attitudes, and practice of family planning.[7],[8],[9],[10] Partner involvement (partner discussion, partner encouragement, partner approval, partner support, and partner decision) significantly influences family planning attitudes and practice.[11],[12],[13] History of family planning methods and healthcare facilities, which include cost of obtaining family planning methods, transportation fare to family planning service points, side effects, availability of the family planning methods, operating hours of the facility, working hours, travel time to the family planning facility, and proximity of family planning facility, were found to influence the practice of family planning only.[14],[15],[16] These factors are significant in helping women to achieve their desired family size, choice of birth control, and to encourage a cordial relationship with their spouse by way of mutual communication on the preferred method of family planning. This also helps with choosing the best family planning facility to access counselling or to obtain suitable family planning methods.[7],[14],[17] It is important to obtain the teachers' knowledge, attitudes, and practice of family planning and the associated factors because teachers are role models and provide good education to students.[18] Previous similar studies have been conducted among students and parents, however, levels of knowledge, attitudes, and family planning practice have been inadequate.[6],[19] Therefore, it is preferable to choose teachers in these studies as they have a higher level of literacy. There has not been a study of this kind within the research location. The aim of this study was to ascertain the predictors of good knowledge, positive attitudes, and ever practice of family planning among public secondary school teachers in Enugu East Senatorial District, Nigeria.


   Methods Top


This research was conducted in Enugu East Senatorial District, Nigeria. The Senatorial District comprise six local government areas, namely, Isi Uzo, Enugu East, Enugu North, Enugu South, Nkanu West, and Nkanu East that are located on the eastside of the Enugu State, Southeast Nigeria with a total land area of 3,046 km2 and an estimated population of 1,166,944 people.[20] The district also has 82 public secondary schools with 3,236 teachers out of 11,873 teachers in the entire state.[21]

This study made use of a cross-sectional design to ascertain the predictors of good knowledge, positive attitudes, and ever practice family planning among public secondary school teachers in Enugu East Senatorial District. The required sample size of 1,000 participants was estimated based on two proportional comparisons (two-sided test), which were computed using the Lemeshow formula.[22] Formula P1 = 0.35, P2 = 0.45 was obtained from a previous cross-sectional study in Nigeria.[14] After adding a 20% response rate and a 90% eligibility rate, this study's required sample size was estimated. A probability proportional to size sampling technique was also applied to ascertain the total number of participants in each of six local government areas in Enugu East Senatorial District. This was achieved by sampling the entire local government area in the Senatorial District that has 3,236 teachers. The required 1,000 participants were then systematically randomly selected from 82 secondary school in the District. This number included all teachers within the civil service aged between 18 and 60 years (married, single, and those who have reached menopause) but excluded all teachers at private secondary schools within the Senatorial District, non-academic staff working in a public secondary school within the Senatorial District, and teachers in Enugu North and West Senatorial District.

A pretested self-administered structured questionnaire was employed for data collection from the participants. Pretesting was conducted among 100 teachers from public secondary schools in Enugu West Senatorial District. The knowledge questionnaire consisted of 25 items. The attitudes questionnaire consisted of 10 items and the practice questionnaire consisted of five items. The questionnaires were adapted from previous validated studies and the Cronbach's alpha 0.7 was considered valid for all the instruments in this study.[14],[15],[23],[24],[25] The dependent variables include knowledge. Each correct answer scores one mark, whereas a wrong answer scores 0 marks with a total of 25 marks. Knowledge level was determined by a median cut off mark. Participants who scored 12 marks and above have a good knowledge. Attitude questions were graded depending on the degree of agreement on a five-point Likert scale, ranging from strongly disagree, disagree, not sure, agree to strongly agree, graded as follows: 1, 2, 3, 4, and 5, respectively. The minimum and maximum scores were 10 and 50, respectively. Levels of attitude were determined by a median cut off mark, whereas those who scored 26 and above were classified to have positive attitudes and those who answered yes were ever practice family planning. Independent variables included sources of information on family planning (television, social media, radio, newspaper, book, parents or guardian, teachers, friends, church, and mosque), partner involvement (partner discussion, partner encouragement, partner approval, partner support, and partner decision), history of family planning methods (cost, transportation, availability, and side effects), and healthcare facility (working hours, closing and open time, duration, and proximity).

Data analysis

Data were analysed using the International Business Machine Statistical Package for Social Science (IBM SPSS) software version 25. A normality test was conducted to check the distribution of continuous data and the result was presented in median and interquartile range (IQR); knowledge, attitudes, cost, transportation, time, and proximity were not normally distributed. They were categorised as categorical data using a median as the cut-off point. Descriptive statistic (frequency and percentage) was used to describe categorical variable factors, such as source of information, partner involvement, history of family planning methods, healthcare facilities and level of knowledge, attitudes, and ever practiced family planning. Bivariate and multivariate logistic regression analysis was done to determine the related factor. P values of less than 0.05 and 95% CI not included 1 were considered to be of significance.

Ethical permission to conduct this research was first taken from the Ethics Committee involving Human Research of Universiti Putra Malaysia (UPM) (UPM/TNCPI/RMC/1.4.18.2 (JKEUPM), JKPUPM Ref No. JKEUPM-2010-138). Approval was also taken from the Enugu State Ministry of Education, Nigeria from where the data collection was taken. Signed consent form was obtained from the teachers of the public secondary schools in Enugu East Senatorial District, Nigeria.


   Results Top


One thousand questionnaires were distributed and received in this research, giving a response rate of 100%. A majority of the respondents cited healthcare facilities (63.6%), followed by television (60.4%), and radio (54.2%) as their sources of information. More so, most of the respondents (67.4%) discuss family planning with their spouses, and the majority (62.7%) approve of family planning methods to the partners. More than half (56.6%) of the respondents allow their partners to decide on family planning methods. Also, about 49.4% and 48.7% of respondents were encouraged and supported by their partner to utilize family planning methods. However, more than half (51.1%) of respondents spent N350 naira and above to obtain the family planning method. Also majority (54.7%) of the respondents spent N100 naira and above as transport fares for obtaining family planning methods and service. About 53.5% of respondents indicated that family planning methods and services were always available. Furthermore, more than half (53.7%) of respondents were always favoured by health facility's working hours. A half (50.8%) of the respondent's decision to utilize family planning methods and service was “never” affected by the family planning service centre's closing and open time. More so, a majority of the respondents (65.5%) use 15 minutes and above to get to the family planning service point, whereas more than half (58.7%) of the respondents indicate that the proximity of the family planning service point is 800 meters and above. The overwhelmed majority (71.9%) of the respondents state that they never had a side effect after using family planning methods. Regarding the side effect ever experienced after using the family planning method, most of the respondents mentioned pain (43.7%), whereas the least side effect mentioned was back arching (0.7%). According to the respondents, the most common family planning method that causes harm was contraceptive implants/Implanon (47.5%). In comparison, emergency contraceptive pill (0.7%) accounts for the least side effect, as illustrated in [Table 1].
Table 1: Distribution of sources of information, partner involvement, and history of family planning (n=1,000)

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Level of knowledge, attitude, and ever practice of family planning

A majority (61.3%) of respondents had a good level of knowledge on family planning, and more than half of the respondents (52.7%) were found to have positive family planning attitudes. However, more than half (55.0%) of respondents had ever practice family planning, as illustrated in [Table 2].
Table 2: Levels of knowledge, attitude, and ever practice family planning

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Sources of information factors associated with levels of knowledge on family planning

The multivariate analysis result showed that respondents who cited television as their sources of information had two times higher odds of having good knowledge of family planning than those who did not cite television as the sources (AOR = 2.17; 95%CI: 1.54-3.06). Respondents who cite social media as their source of information had almost two times higher odds of having good knowledge of family planning than those who did not cite social media (AOR = 1.89; 95%CI: 1.29-2.78). However, those who mentioned their parents or guardians as their sources of information were 57% less likely to have good knowledge of family planning than those who did not mention their parents or guardian (AOR = 0.43: 95%CI: 0.29-0.63). Also, respondents who mentioned their teachers as their sources of information had two times higher odds of having good knowledge of family planning compared to those who did not mention their teachers (AOR = 1.94: 95%CI: 1.18-2.72). Likewise, those who mention their friends as sources of information had two times higher odds of having good knowledge of family planning than those who did not mention friends as their sources of information (AOR = 1.55: 95%CI: 1.14-2.12) as presented in [Table 3].
Table 3: Bivariate and multivariate logistic regression analysis on sources of information factors associated with levels of knowledge of family planning among respondents (n=1,000)

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Factors associated with level of attitude towards family planning

The result of bivariate analysis revealed that out of 11 significant variables at the preliminary model, eight variables were significant predictors of positive attitudes, these include the following: television (AOR = 0.68: 95%CI: 0.48-0.96), healthcare (AOR = 0.68: 95%CI: 0.51-0.92), parents or guardian (AOR = 0.67: 95%CI: 0.48-0.94), partner's discussion (AOR = 3.19: 95%CI: 1.94–5.27), partner's encouragement (AOR = 0.52: 95%CI: 0.36–0.76), partner's approval (AOR = 0.43; 95%CI: 0.22-0.86), partner's support (AOR = 1.58 95%CI: 1.03-2.41), and partner's decision (AOR = 0.22: 95%CI: 0.14–0.35) as illustrated in [Table 4].
Table 4: Bivariate and multivariate logistic regression analysis on factors associated with levels of attitude towards family planning among respondents (n=1,000)

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Factors associated with ever practice family planning

The multivariable analysis result revealed that 20 variables were included in preliminary model and 10 variables were identified as significant predictors of ever practiced family planning, these are the following: television (AOR = 0.56; 95%CI: 0.32-0.98), radio (AOR = 2.56; 95%CI: 1.56–4.19), partner's discussion (AOR = 3.52; 95%CI: 1.68-7.39), partner's encouragement (AOR = 5.79; 95%CI: 3.38–9.95), partner's decision (AOR = 4.61; 95%CI: 2.65–8.01), cost (AOR = 0.003; 95%CI: 0.00–0.013), time (AOR = 0.42; 95%CI: 0.21-0.85), proximity (AOR = 0.04; 95%CI: 0.02– 0.10), levels of knowledge (AOR = 2.19; 95%CI: 1.69-2.85), and attitudes towards family planning (AOR = 0.64; 95%CI: 0.49-0.82) were predictors of ever practiced family planning as presented in [Table 5].
Table 5: Bivariate and multivariate logistic regression analysis on factors associated with ever practice family planning among respondents (n=1,000)

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   Discussion Top


Family planning plays a vital role in ascertaining family size, prevention of pregnancy-related risk in women, and population control. This study focused on the predictors of good knowledge, positive attitudes, and ever practices family planning among teachers in Enugu East Senatorial District, Nigeria. It was interesting that the outcome of this study's findings revealed that television, social media, parents or guardian, teachers, and friends were important sources of information that predict good family planning knowledge. These corroborate the findings in Nigeria and elsewhere.[2],[26],[27],[28],[29],[30] However, those who mentioned radio and parents or guardians as their information source were less likely to know much about family planning, possibly because of lack of technology and an internet-driven society globally. This could result in poor communication between parents and adolescents regarding adolescent sexual reproduction. To further enhance the teachers' current level of knowledge, it will be significant to deliver correct and appropriate information about reproductive health and family planning using the most convenient channels.[31]

Furthermore, our findings revealed that television, healthcare facility, parent or guardian, partner discussion, partner support, partner encouragement, partner approval, and partner decisions were significant factors that predict positive attitudes towards family planning. Respondents who cited television, healthcare, and parents or guardians were less likely to have positive attitudes towards family planning. This may be connected to the quality of family planning messages delivered to the respondents, as most of the participants who had ever practice family planning complained about the side effects experienced after using a family planning method. However, the benefits/side effects of family planning methods largely depend on the effectiveness of the information available through awareness, counselling, and respondents' sensitization. Also, respondents who encourage, approve, and allow their partner to decide on family planning methods were less likely to show positive attitudes towards family planning. This might be because of fear of side effects as many of them who had practiced family planning had experienced one side effect or another because of self-medication. Therefore, these respondents most sought the counselling of family planning experts before utilization. This study's findings are supported by different studies around the world.[11],[12],[32],[33],[34],[35],[36]

In this study, television, radio, partner discussion, partner encouragement, partner decision, cost, times, proximity, levels of knowledge, and attitudes were the significant predictors of ever practice family planning. This is in agreement with various researches in Ethiopia.[12],[16],[35],[37],[38] This study further revealed that the high cost of family planning methods, time (between 15 minutes and above), and proximity (800 meters and above) discourage family planning utilization. However, subsidizing the price of family planning methods by government and stakeholders in the health sector, because teachers were underpaid in Nigeria and sitting in a family planning clinic at a proximity of 800 meters, can address the challenges of long distance and time to access family planning methods and services. This finding is similar with the results of studies conducted in Ethiopia and Nepal.[13],[39] Furthermore, respondents with positive attitudes towards family planning were less likely to ever practice family planning than those with negative attitudes towards family planning. Contradictory Ethiopian studies' findings revealed that those with positive attitudes towards family planning were more likely to utilize family planning.[38],[40],[41] The discrepancies may be attributed to side effects experienced by most of the respondents in this study. This study is limited by the cross-sectional study design, that measured an outcome at a specific point of time and cannot establish a cause and effect relationship between family planning and its associated factors. Therefore, it cannot be generalized to all teachers in Nigeria.


   Conclusion/Recommendation Top


The levels of knowledge, attitudes, and ever practice family planning among teachers are moderate. A significant number of factors were identified as predictors of good knowledge, positive attitude, and ever practice family planning. Effective health education among teachers is recommended using television as media to increase the respondent's levels of knowledge and attitudes towards utilizing more family planning methods. A cohort study is also recommended to ascertain cause and effect relationship between the factors and knowledge, attitudes, and practice of family planning.

Acknowledgements

We would like to thank lecturers of Universiti Putra Malaysia and all those who assisted in data collection. We also would like to thank teachers of public secondary schools in Enugu East Senatorial Districts, Nigeria for their usual cooperation during data collection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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    Abstract
   Introduction
   Methods
   Results
   Discussion
    Conclusion/Recom...
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