Assessment of availability of contraceptives in health facilities and their acceptability in Kinondoni municipality

Abstract

ABSTRACT Background: Majority of unintended pregnancies worldwide are results of contraceptive non-use, inconsistent use, or a reliance on ineffective methods of contraception. Key barriers to contraceptive use include financial constraints, lack of knowledge about the safety and efficacy of the various methods as well as the unavailability of contraceptives. Tanzania being one of the resources limited (developing) countries that face a myriad of socio-economic problems. For such countries family planning, which include usage of contraceptives, cannot be overemphasized Objective: The study aimed to assess the availability of contraceptives in health facilities and their acceptability in Kinondoni Municipal residents aged between 18 and 55 years. It was designed to provide baseline data on contraceptive availability and documentations in health facilities, and knowledge as well as attitude towards contraceptives usage among Kinondoni residents. Methods: This was a cross-sectional study involving collection of prospective and retrospective data for assessment of availability and acceptability of contraceptives. The study was carried out in Kinondoni Municipal between July 2008 to March 2011. The following settings were involved namely Mwananyamala Municipal Hospital, 3 Health facilities (Sinza, Magomeni and Mburahati) and 2 secondary schools (Mugabe and Manzese). Pharmacists in-charge for each health facility (Municipal hospital and health centers) were interviewed and from them permission to the records/data was obtained. Face to face interviews guided by structured questionnaire and checklists were employed for data collection from 156 voluntary respondents. Representative contraceptives namely vasectomies, condoms, inter uterine devices [IUD], implants, hormonal injectable, emergency contraceptives and hormonal pills were used for this purpose. There were seven items to measure knowledge of an individual. If an individual gets all seven item correct then he/she was very knowledgeable. Knowledge on contraceptives was ix measured on a scale of 0-7 based on 7 tracer items, whereby 80%-100%= implies very knowledgeable and 0%-49%= not knowledgeable at all. The tracer disease conditions that can be prevented by using contraceptives were malaria, STIs, HIV, Unwanted pregnancy, TB, Typhoid and not Effective at all. Results: Three (3) health facilities were involved in assessment of availability of contraceptives. Overall availability of contraceptives was measured based on availability of at least three contraceptives (method mix). Out of 3 health facilities, 2 facilities used the method mix however they were in small amount. In a period between July 2008 and March 2011 there were no emergency contraceptives, spermicides nor implants in all health facilities. Documentation was generally poor especially at Sinza health center, which led to failure to obtain record on availability of contraceptives during that period. The following contraceptives namely hormonal and condoms were available in larger quantities in all health facilities. The relatively more abundantly encountered hormonal contraceptives were micrognon (20%) and Lo-feminal (10%). Availability of male condom was (39%) while female (1%). The selection criteria in all three health facilities were according to customer demand/need of contraceptives. Forecasting and/ or quantification of contraceptives were by consumption method in all three health facilities visited. On the other hand procurement was mainly by donation while distribution was by vehicles. Slightly more than half of respondents 83 (53.2%) were not using contraceptives and out of these, 17 (10.9%) had used them before. Seventy three 73 (46.8%) were still using contraceptives. Sixty six respondents (42.3%) had never used any kind of contraceptives methods. Of those who had never used contraception methods, 10(15.2%) said they are not aware of contraceptive methods. Conclusion: Availability of modern contraceptives was generally low in all three health facilities, and documentation was generally unsatisfactory especially at Sinza health center. x Majority of respondents (96.8%) had moderate knowledge of contraceptives however, demonstrated negative attitudes towards contraceptive usage. Contraceptives were not very much accepted by respondents due to the purported side effects, being unaware of the commodities and/or negative perception like being against their religious belief. The selection criteria for procurement of contraceptives were consumers demands oriented. Forecasting and Quantification of contraceptives was mainly by consumption based method. Procurement of contraceptives was mainly by donation and the products were fundamentally distributed by vehicles.