Intrauterine Device Use

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Research Proposal Presentation For Research Proposal Writing and Grantsmanship Module, Msc Clinical Epidemiology program, Stellenbosch University, Cape Town.

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Intrauterine Device Use

  1. 1. Contraception IUD http://intimatehealthhelp.net/wp-content/uploads/2012/09/contraception-IUD-300x213.jpeg INT Knowledge, Attitude and Use among Women Seeking Termination of Pregnancy in Gauteng, South Africa Ajibola Awotiwon | Stellenbosch University | September 2013
  2. 2. http://i.telegraph.co.uk/multimedia/archive/01450/pregnant_1450316c.jpg 250 million pregnancies globally; 33.3% unintended; 20% undergo induced abortion [1] In South Africa, 75% of pregnancies are unintended [24] ; 1 in 8 pregnancies ends up in abortion. IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013
  3. 3. Between 1997 and 2008, approx. 731’193 induced abortions were reported [8] 125,000 unsafe abortions (out of approximately 200,000 total abortions) are performed annually [9, 10– 13] Lack of access to contraceptives is the most commonly cited cause IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013
  4. 4. BC http://peacockwings.files.wordpress.com/2011/07/1309400592-16.jpg?w=300&h=248 Prevalence of contraceptive use in Africa – 20% (WHO) [28] In South Africa, 65% of sexually active women use a method [16] In Durban, 75% of those seeking abortion had previously used some form of contraception IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013
  5. 5. 5% had some knowledge of emergency contraception [23]. In Cape Town, 21% reported using contraception when they became pregnant, most commonly the condom (53%) or pill (35%). [24] IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013
  6. 6. http://www.surebaby.com/blog/wp-content/v93-15-IUD-300x232.jpg IUD retains a unique capacity as it can be used both as an emergency contraceptive method and a long-acting contraceptive method. within 5 days of unprotected intercourse. prevent pregnancy for up to ten years. IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013
  7. 7. The knowledge, usage of and attitude towards intrauterine device method of contraception(IUD) among women seeking termination of pregnancy (TOP) in Gauteng, South Africa The factors that influence the health seeking behaviour and practices of women seeking TOP with regards to the IUD contraceptive method IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013
  8. 8. 1. To determine the knowledge and use of IUD for preventing unintended pregnancy among women seeking TOP in Gauteng. 2. To determine the level of awareness and uptake of IUD by women seeking TOP in Gauteng. 3. To determine the factors that influence contraceptive choice, use and non-use by the target population. IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013
  9. 9. 02A1499R http://www.redcresearch.ie/wp-content/uploads/2011/01/F2F-interviewer-199x300.jpg A cross sectional study of women seeking TOP With assessment of contraceptive seeking behaviour through an interviewer-administered structured questionnaire IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013
  10. 10. http://upload.wikimedia.org/wikipedia/commons/6/68/Hillbrow.JPG Hillbrow Community Health Centre – a provincial health facility based in the old Hillbrow Hospital. Gauteng has consistently reported the highest abortion numbers among other provinces over the years. IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013
  11. 11. 25000 21318 The number of abortions reported in South Africa by province between 1997 and 2011 20000 15000 13497 11928 10000 3796 5000 429 0 Gauteng 1144 Northern Cape Western Cape IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013 1997 2011
  12. 12. http://workingthecity.files.wordpress.com/2012/04/iketleng-3.jpg?w=300&h=225 Inclusion criteria *Age 18 years or older *Able to communicate in English/Afrikaans/IsiZulu *Who have completed informed consent, will be included. Exclusion criteria *Less than 18 years old *Or who do not give consent to participate in the study *Mentally unstable women, will be excluded. IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013
  13. 13. All consecutively registered women will be screened for enrollment over a period of 4 months using systematic random sampling. (Feb – May 2014) Using a sampling frame of 1600 women over a period of 4 months, the sampling interval k will be 3 (k=N/n = 1600/461 = 3). A random starting point will then be picked between 1 and k and every 3rd eligible participant presenting at the community center will be sampled until the required sample size is reached. IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013
  14. 14. http://online-behavior.com/sites/default/files/imagecache/cartoon/image_field/ca_image/accurate-measurement.jpg Outcome variables will include: 1. Percentage of women seeking TOP who are aware of IUD contraceptive method. 2. Percentage of women seeking TOP who use IUD contraceptive method. Independent variables will include: 1. Knowledge of IUD contraceptive method using the validated questionnaire 2. 3. 4. Attitude to IUD contraceptive method using the validated questionnaire Socio-demographic and economic characteristics Reasons for use or non-use of IUD contraceptive method which will be measured using open-ended and multiple response questions. IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013
  15. 15. * http://78.129.201.23/mugsize2_200w.jpg IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013
  16. 16. Data collection Data will be collected by the principal investigator (PI). Validated interviewer-administered structured questionnaire Validating questionnaire and interviews Crede S et al: Is 'planning' missing from our family planning services? Data entry, storage and validation A data dictionary and a relational database will be developed in EpiData Data analysis STATA (version 12) IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013
  17. 17. http://tweakyourbiz.com/marketing/files/Online-Ethics.jpg Research ethics committee of Stellenbosch University Gauteng Province Department of Health and the management of Hillbrow Community Health Centre. Written Informed consent Confidentiality IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013
  18. 18. Through academic journals and presentation at relevant conferences. The funders, Gauteng Province Department of Health and the Stellenbosch University Library, Comm. Health Dept. Secular female health oriented newspaper/magazine IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013
  19. 19. STUDY TIMELINE /Activity Protocol development, Submission of protocol to ethics for approval and obtaining funding Developing forms and piloting Data collection and entering Data cleaning and analysis Manuscript preparation, submission of thesis and Data dissemination Sep 2013 Oct 2013 Nov 2013 x x Dec 2013 Jan 2014 x Feb 2014 Mar 2014 Apr 2014 May 2014 x x x Jun 2014 Jul 2014 Aug 2014 x x Sep 2014 Oct 2014 Nov 2014 x x x x x x x IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013
  20. 20. This will be a cross-sectional study that will rely mainly on participant recall. Due to the sensitive nature of the study (abortion), recall bias is likely to occur. While the study site is likely to be representative of the Gauteng province and its findings generalizable to other provinces It may not be generalizable to other countries IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013
  21. 21. Direct costs Amount requested http://notanotherzebra.files.wordpress.com/2012/09/sa_bank_note_r500-back_thumb5.jpg?w=490&h=483 Rand (R) Personnel Compensation Research assistantship 6000 Research Travel Travel to Gauteng 3500 Travel to clinic 4000 Other Direct Costs Internet and Email 1500 Office supplies 3000 Printing and copying 3000 Staff training 1500 Reimbursement of participants 9220 Publication costs Publication in electronic/print media 5000 Bursary supplementation 20000 Total Direct costs 56720.00 Total Expenditures 56720.00 Budget motivation Research assistant: A research assistant (who is fluent in English and Xhosa), most likely a nurse from the study hospital will be trained to obtain consent and interview participants. She will be paid R1500 per month for 4 months. Research travel includes PI’s airfare (return ticket) to and from Gauteng, South Africa, and fuel cost for traveling to and from study hospital for 4 months. Office Supplies/Consumables such as stationery, papers, printer cartridges as well as support for communication will be needed. Printing and copying of data collection forms, manuscript etc. Reimbursement of participants: 461 participants at R20 per participant. Publication fees will be required for data dissemination. Bursary supplementation for the PI to assist with accommodation and cost of living. IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013
  22. 22. http://www.youtube.com/watch?v=YVJu61BKpkI&list=PLh1fAcf0oiNu2GH2J4HV0hi8tmCPL9V9v&feature=player_detailpage VIDEO | Reducing Unwanted Pregnancies www.guttmacher.org
  23. 23. 1. WHO and Gutmacher Institute: Facts on induced abortion worldwide. 2007 [http://www.searo.who.int/LinkFiles/Publications_Facts_on_Induced_Abortion_Worldwide.pdf]. 2. Morroni C, Tibazarwa K, Myer L (2006) Combined condom and contraceptive use among South African women. S Afr Med J 96: 620-622. 3. Morroni C, Moodley J (2006) The role of urine pregnancy testing in facilitating access to antenatal care and abortion services in South Africa. BMC Pregnancy Childbirth 6: 26. 4. Jewkes R, Abrahams N (2002) The epidemiology of rape and sexual coercion in South Africa: an overview. Soc Sci Med 55:1231-44. 5. Rees H et al., The epidemiology of incomplete abortion in South Africa, South African Medical Journal, 1997, 87(4):432–437. PubMed 6. Kay BJ et al., An analysis of the cost of incomplete abortion to the public health sector in South Africa—1994, South African Medical Journal, 1997, 87(4):442–447. PubMed 7. South African Government, Choice on Termination of Pregnancy, Act No. 92, Nov. 12, 1996, art. 2(b). 8. Department of Health South Africa. Choice of Termination in South Africa (Draft). Statistical Notes Available at http://wwwdohgovza/facts/indexhtml. 2009. 9. Organization, 2011. Aahman E and Shah I, eds., Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2008, sixth ed., Geneva: World Health 10. Epidemiology and Surveillance Directorate, Statistical Notes: Choice on Termination in South Africa, Pretoria, South Africa: National Department of Health, 2009. 11. Blaauw D and Penn-Kekana L, Maternal health, in: Fonn S and Padarath A, eds., South African Health Review, Durban, South Africa: Health Systems Trust, 2010, pp. 3–28. 12. Daulaire N et al., Promises to Keep: The Toll of Unintended Pregnancies on Women’s Lives in the Developing World, Washington, DC: Global Health Council, 2002. 13. Statistics South Africa, Mid-Year Population Estimates, 2010, Pretoria, South Africa: Statistics South Africa, 2010. 14. Mookodi, G., Ntshebe, O. & Taylor, I. (2003). Contraception, Abortion, and Population Planning 93. http://www.kinseyinstitude.org.ccies/bw.php 15. Tamire, W. & Enqueselassie, F. (2007). Knowledge, attitude, and practices on emergency contraceptives among female university students in Addis Ababa, Ethiopia. Ethiopia Journal of Health Development, 21(2), 111–116. 16. Department of Health, Medical Research Council, South Africa: Demographic and Health Survey 2003, Pretoria: Department of Health; 2007. 17. Ross J, Hardee K, Mumford E, Eid S: Contraceptive Method Choice in Developing Countries. Int Fam Plan Perspect 2002, 28(1): 32-40 18. Delvaux T, Nostlinger C: Reproductive choice for women and men living with HIV: contraception, abortion and fertility. Reprod Health Matters 2007, 15(29 suppl):S46-S66 19. Pariani S, Heer DM, Van Arsdol MD: Does Choice Make a Difference to Contraceptive Use? Evidence from East Java. Stud Fam Plann 1991, 22(6):384. 20. Crede et al: Factors impacting knowledge and use of long acting and permanent contraceptive methods by postpartum HIV positive and negative women in Cape Town, South Africa: a cross-sectional study. BMC Public Health 2012 12:197 21. Thonneau P, Almont T: Contraceptive efficacy of intrauterine devices. Am J Obstet Gynecol 2008, 198(3):248. 22. Schunmann C, Glasier A. Measuring pregnancy intention and its relationship with contraceptive use among women undergoing therapeutic abortion. Contraception. 2006; 73:520-4. 23. Adanlawo M, Moodley J. Demograhy and social profile of women requesting termination of pregnancy in King Edward VIII Hospital. The South African Journal of Epidemiology and Infection. 1999; 14(4):99-102. 24. Morroni C, Moodley J. Characteristics of clients seeking first and second trimester terminations of pregnancy in public health facilities in Cape Town. SAMJ. 2006; 96(7):574. 25. Crede S, Harries J, Constant D, Hoke TH, Green M, Moodley J. Is 'planning' missing from our family planning services? SAMJ. 2010;100(9):579-80. 26. Glasier A, Shields WC. Can we improve contraceptive use? Contraception. 2006;73:1-3. 27. Reddy SP, James S, Sewpaul R, Koopman F, Funani NI, Sifunda S, Josie J, Masuka P, Kambaran NS, Omardien RG. Umthente Uhlaba Usamila – The South African Youth Risk Behaviour Survey 2008. Cape Town: South African Medical Research Council, 2010 28. UNFPA 2010. How Universal is Access to Reproductive Health? http://www.unfpa.org/public/home/publications/pid/6526 29. Peter Barron, Dr Yogan Pillay – Contraceptive policy overhauled. http://www.mg.co.za/article/2013-06-13-contraceptive-policy-overhauled IUD| Knowledge, Attitude and Use among Women Seeking TOP in Gauteng, South Africa | September 18th , 2013

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