This study examined factors influencing family planning use among 440 married or cohabiting women in Mwanza, Tanzania. The findings showed that 73.2% of respondents had not used family planning. Wealth, religion, communication between couples, social networks, and knowledge were all positively associated with family planning use. Specifically, wealthier women were 3.7 times more likely to use family planning. Those who discussed family planning with their partners were less likely to use it. Social network influence and knowledge about family planning also increased the likelihood of its use. Urban and semi-urban areas had higher family planning utilization than rural areas. The study concluded that improving communication, social influence, knowledge and access could help promote family planning in Tanz
Apart from limited attempts to understand the sexual and reproductive health situations of street children in general, little is known about the overall psycho-social and health related circumstances surrounding pregnancy and child bearing practices of homeless women. The present research was at assessing the overall psycho-social circumstances surrounding Incidences of pregnancy and child bearing among homeless women in Shashemene town. A cross-sectional study design was used in which data were collected between December, 2018 and January, 2019. 163 homeless women, selected on the basis of purposive sampling procedure have participated in the study. Both qualitative and quantitative data were collected using survey and depth interview methods (methodical triangulation). While quantifi able data were entered in to SPSS version. 20 for further analysis, qualitative data were transcribed, organized, and narratively presented after fi nding themes in the data. Marriage between homeless women and their men counterparts is a common feature of social interaction in the study area. This social context may justify the fact that most (93.7%) women conceived their last babies intentionally. While respondents were relatively. better off in terms of receiving prenatal care (50.3%), the experience of attending postnatal health care services has been moderately low
(40.6%). Above all, street sides and religious compounds (2.8% & 2.8%, respectively) were also among the places where babies were delivered. Attendance of prenatal care was signifi cantly associated to education (-.284, P < 0.01) and postnatal care (.590, P < 0.01) while post-natal health care seeking behavior was signifi cantly associated to the number of children a woman have (.228, P < 0.01), age of respondents (.278, P < 0.01), experiences of attending prenatal care (.590, P < 0.01) and education (-.389, P < 0.01). Patterns of psycho-social relationships prevalent among the homeless women in Shashemene town hold similarity with the pattern existing in the mainstream society. The concerned governmental and non-governmental organizations should work to enhance the
awareness of the homeless women about contraceptive methods, its advantage, and how it is relevant to their living situations.
In every society in the world, certain level of participation of male in reproductive health exists It depends upon many socio-cultural and value related aspects. In India, situation is different may be because of traditional and cultural aspects. This study is based on empirical field based data, published in Communicator.
Apart from limited attempts to understand the sexual and reproductive health situations of street children in general, little is known about the overall psycho-social and health related circumstances surrounding pregnancy and child bearing practices of homeless women. The present research was at assessing the overall psycho-social circumstances surrounding Incidences of pregnancy and child bearing among homeless women in Shashemene town. A cross-sectional study design was used in which data were collected between December, 2018 and January, 2019. 163 homeless women, selected on the basis of purposive sampling procedure have participated in the study. Both qualitative and quantitative data were collected using survey and depth interview methods (methodical triangulation). While quantifi able data were entered in to SPSS version. 20 for further analysis, qualitative data were transcribed, organized, and narratively presented after fi nding themes in the data. Marriage between homeless women and their men counterparts is a common feature of social interaction in the study area. This social context may justify the fact that most (93.7%) women conceived their last babies intentionally. While respondents were relatively. better off in terms of receiving prenatal care (50.3%), the experience of attending postnatal health care services has been moderately low
(40.6%). Above all, street sides and religious compounds (2.8% & 2.8%, respectively) were also among the places where babies were delivered. Attendance of prenatal care was signifi cantly associated to education (-.284, P < 0.01) and postnatal care (.590, P < 0.01) while post-natal health care seeking behavior was signifi cantly associated to the number of children a woman have (.228, P < 0.01), age of respondents (.278, P < 0.01), experiences of attending prenatal care (.590, P < 0.01) and education (-.389, P < 0.01). Patterns of psycho-social relationships prevalent among the homeless women in Shashemene town hold similarity with the pattern existing in the mainstream society. The concerned governmental and non-governmental organizations should work to enhance the
awareness of the homeless women about contraceptive methods, its advantage, and how it is relevant to their living situations.
In every society in the world, certain level of participation of male in reproductive health exists It depends upon many socio-cultural and value related aspects. In India, situation is different may be because of traditional and cultural aspects. This study is based on empirical field based data, published in Communicator.
PREMARURE ENGAGEMENT IN SEXUAL ACTIVITIES BY ADOLESCENTS: AN ASSESSMENT OF ITS IMPACTS ON THEIR HEALTH, ACADEMIC AND SOCIAL-WELFARE. The case of Government High School Kendem, Mbeme and Kendem Communities – Mamfe, South West Region of Cameroon.
Presented by JOHN NYAH MBOUT
Over the past decade, Kenya has made tremendous efforts to enhance maternal and child health. Secure maternity policies such as free maternity care are one of the initiatives that have enhanced maternal and child health in all public health facilities. Despite these attempts, public health facilities for maternal and child health are still underused. This study employed a cross-sectional descriptive study design to identify determinants of free maternal health services by evaluating factors determining perceptions and health-seeking behavior of 384 pregnant mothers in Malava Sub-County, Kakamega County. The study used a mixed-method (quantitative and qualitative approaches). Questionnaires were administered to pregnant mothers selected for the study. The study employed a purposive sampling of research participants. Quantitative data were collected using the questionnaire administered by the research assistants whereas qualitative data were collected by the researcher through interview schedules. Quantitative data analysis was carried out using SPSS 23. However, qualitative data were analyzed through content analysis. Quantitative data representation was done in terms of frequency and percentages. Analysis of chi-square testing was used to assess the association between the variables of socio-economic and health facilities and the provision of free maternity facilities (p<0.05). The study established that the uptake of free maternal service by pregnant mothers was influenced by their level of primitivism and religious beliefs. In addition, this study found out that 53.8% and 77.7% of the pregnant mothers could not attend antenatal and post-natal care because government facilities were located far away from their residences and they also had less access to some information about free maternal health care. The results of this research would be disseminated to the hospital management team, Sub-Country health management team, County health management team, and other stakeholders, thereby demonstrating reasons for low uptake of free maternity services and helping to strategize for better service delivery. Based on the finding, the study recommends that to improve access to free maternal health care, the county government ought to place health services as close as possible to the community where people live. Secondly, there is a need to embrace the usage of the existing media network to sensitize pregnant mothers to the danger signs and the need to have decision-making powers over their safety. Lastly, hospital management ought to increase the awareness of free maternal health care and to include it among the community priorities during dialog days, action days, and other group discussions.
Filipinos getting infected with HIV-AIDS continued to balloon notwithstanding the intervention through comprehensive prevention, dissemination and control programs. In Eastern Visayas there were 69 cases coming from most risk population primarily Men Having Sex with Men (MSM) either homosexual, heterosexual and bisexual modes of transmissions. Bearing this epidemic, sexual networking, using the internet for sex served as cruising sites for casual sex and promiscuity maybe accounted for this surge. This study made use of descriptive cross sectional method with 214 active users from different social sites using time- location sampling through interviews, group discussions and questionnaires. Results showed that most of the respondents joined the site for sex and had an average of 1-5 different sexual intercourse for the past three months. Sexual practices were oral, anal and oral-anal. Respondents were aware on the different modes of transmission but fully unaware of existing services of the DOH and were willing to be screened for HIV.
Background: Incidence and prevalence of reproductive health difficulties have been shown to be higher among younger people. In Ghana, youthfriendly sexual and reproductive health services and facilities are very limited. The study aimed at examining the friendliness of sexual and reproductive health service delivery and utilization.
Methods: Across sectional design with both qualitative and quantitative methods was conducted to examine the friendliness and utilization of reproductive health services among youth in the Kwadaso Sub-Metro of Ashanti Region, Ghana. A multistage stratified sampling was used to enroll 170 youth (150 in-school and 20 out of school youth) aged 10 - 24years. Data analysis involved descriptive statistics using SPSS software version 20.
Results: Findings demonstrated that out of the 150 in-school youth sampled, 56% ever had a boyfriend or girlfriend, however, about one third(39.3%) did not recall the length of stay with partner, 58% have heard about sexual reproductive health services offered in the study area. A total of 55.8% of all categories of youth had used at least one or more reproductive health service before. Findings again revealed that 37.2% and 44% respectively of youth who had used sexual reproductive health considered the services received at a facility to be very friendly and friendly, yet, a few 18.6% indicated unfriendliness with services received at the facility.
Conclusion: An integrative and comprehensive approach is required to scale up youth utilization of sexual reproductive health services especially facility based. This requires baseline survey of youth users of reproductive health services and the quality of services offered.
Background: With the widespread use of highly active antiretroviral therapy, the epidemic of HIV has evolved into a chronic disease. HIV is extremely stigmatizing, resulting in highly emotionally charged responses to disclosure. World Health Organization (WHO) recommends that children should be informed of their HIV status at ages of 6 to 12 years and full disclosure at about 8 to 10 years. Disclosure process is much more difficult when the person being disclosed to is an adolescent. However, disclosure of HIV to a child should be an ongoing process that may last several years depending on the cognitive development of the child.
Methods: This study investigated the determinants of HIV status disclosure among HIV infected adolescents. A total of 209 HIV infected adolescents (10-19 years) who have been on treatment for at least six months, and are taking lifelong anti-retroviral therapy from Bondo County Hospital, Got Agulu and Uyawi Sub County Hospital in Bondo Sub County were enrolled. Simple random sampling was employed in selecting the adolescents. Data was collected using a structured questionnaire. Quantitative data was analysed using both descriptive and inferential statistics while statistical tests including Pearson Correlation analysis and multiple linear regression were used to test the hypotheses.
Results: Findings on the overall parental perceptions regarding risks and benefits of disclosure and disclosure of HIV status to adolescents show that 180 (86.12%) of the respondents had a negative attitude compared to 29 (13.88%) who held a positive attitude. 122 (58.37%) of the respondents believed that overall availability and quality of counselling was moderate. 10 (4.78%) of the respondents believed that the overall availability and quality of counselling was high. Quality services and perception of the parents have been found to be good predictors of disclosure of HIV status among the newly diagnosed adolescents in Bondo sub-County, p-value<0.05.
Conclusion and recommendation: This study identified quality of service and perception of the parents as the two factors determining the disclosure of HIV status. There is a correlation between the parental perceptions regarding risks and benefits of disclosure and the quality of counselling to parental disclosure of HIV status to adolescents. Therefore the study recommends deliberate efforts to ensure quality service delivery and age specific disclosure counselling to caregivers to equip them with adequate knowledge on disclosure.
Proximate Determinants of Fertility in Eastern Africa: The case of Kenya, Rw...Scientific Review SR
This study presents some determinants of fertility for three countries in east Africa. It examines the
role of the proximate determinants of fertility to total births during last five years before the surveys in Kenya,
Rwanda and Tanzania. The study is based on the analysis of secondary data obtained from Demographic and
Health Surveys in the three countries. The surveys were conducted between 2014 and 2016. The response
variable used in this study is the number of births in the last five years before the survey. The study employed
Quasi-Poisson regression model as the main method of data analysis. The results show that place of residence,
working status, number of union, age at first birth, age at first cohabitation, age at first sex, contraceptive use
and intention, unmet need and educational level mothers are significant determinants of fertility. Moreover, the
findings of this study indicate that educational level of mothers has negative impact on fertility. For current
contraceptive users, the mean birth for the last five years is highest for Kenya followed by Tanzania. For those
who never use contraception, the mean births for the last five years for Rwanda is lower as compared to
Tanzania and Kenya. The mean births for working mothers is also lower than that of non-working mothers for
all three countries. The study suggests that improving the educational level of mothers, increasing the use of
contraception, and involving more women to work force can reduce fertility in the three countries.
American Research Journal of Humanities & Social Science (ARJHSS) is a double blind peer reviewed, open access journal published by (ARJHSS).
The main objective of ARJHSS is to provide an intellectual platform for the international scholars. ARJHSS aims to promote interdisciplinary studies in Humanities & Social Science and become the leading journal in Humanities & Social Science in the world.
In Africa, the concept of Guidance and Counseling although relatively new in educational systems, has been embraced by most governments. Although most African countries recognize the essential role of organized Guidance and Counseling Programmes, there are limited researches studies conducted to assess the effectiveness of the programmed services being implemented to improve the student’s decision making processes that lead to improved future benefits. Research is yet to identify gender specific strategies to positive psychosexual development in boys and girls that can promote safe reproductive health. A wide spread ignorance on the subject of sex is due to the fact that the subject has been surrounded with mystery and beclouded by dark silence. The result has increased curiosity and desire to acquire more knowledge on this forbidden subject; yet, the people entrusted with the responsibility of educating the adolescents on the subject have not made appropriate information readily available. The study investigated effectiveness of guidance and counselling programmes on academic achievement among public secondary school students in Bungoma South Sub-County, Kenya. The study adopted Albert Bandura’s Social Cognitive Theory postulated in 1986. A descriptive research design was used with target population of 52 guiding and counselling teachers. A sample of 16 participants was selected using, using 30% of Mugenda and Mugenda (2003) and randomly selected from 52 schools. Data was collected using structured interview schedule and questionnaire and analyzed descriptively. Results highlights teacher counselling and peer counselling were the most effective strategies in guidance and counselling as compared to students suspension and corporal punishment. More than half of guidance and counselling teachers asserted that schools had inadequate policy and manual procedures and code of ethics and regulation governing sexual behaviour. This paper points at need of guidance and counselling departments to develop policies and manual procedures on sex and relationship education that acts as a reference point to all members of the school. In addition, the Government should set up reproductive health institutions for the youth, promote peer counseling, talks by health providers in schools which has a bearing on students’ performance.
PREMARURE ENGAGEMENT IN SEXUAL ACTIVITIES BY ADOLESCENTS: AN ASSESSMENT OF ITS IMPACTS ON THEIR HEALTH, ACADEMIC AND SOCIAL-WELFARE. The case of Government High School Kendem, Mbeme and Kendem Communities – Mamfe, South West Region of Cameroon.
Presented by JOHN NYAH MBOUT
Over the past decade, Kenya has made tremendous efforts to enhance maternal and child health. Secure maternity policies such as free maternity care are one of the initiatives that have enhanced maternal and child health in all public health facilities. Despite these attempts, public health facilities for maternal and child health are still underused. This study employed a cross-sectional descriptive study design to identify determinants of free maternal health services by evaluating factors determining perceptions and health-seeking behavior of 384 pregnant mothers in Malava Sub-County, Kakamega County. The study used a mixed-method (quantitative and qualitative approaches). Questionnaires were administered to pregnant mothers selected for the study. The study employed a purposive sampling of research participants. Quantitative data were collected using the questionnaire administered by the research assistants whereas qualitative data were collected by the researcher through interview schedules. Quantitative data analysis was carried out using SPSS 23. However, qualitative data were analyzed through content analysis. Quantitative data representation was done in terms of frequency and percentages. Analysis of chi-square testing was used to assess the association between the variables of socio-economic and health facilities and the provision of free maternity facilities (p<0.05). The study established that the uptake of free maternal service by pregnant mothers was influenced by their level of primitivism and religious beliefs. In addition, this study found out that 53.8% and 77.7% of the pregnant mothers could not attend antenatal and post-natal care because government facilities were located far away from their residences and they also had less access to some information about free maternal health care. The results of this research would be disseminated to the hospital management team, Sub-Country health management team, County health management team, and other stakeholders, thereby demonstrating reasons for low uptake of free maternity services and helping to strategize for better service delivery. Based on the finding, the study recommends that to improve access to free maternal health care, the county government ought to place health services as close as possible to the community where people live. Secondly, there is a need to embrace the usage of the existing media network to sensitize pregnant mothers to the danger signs and the need to have decision-making powers over their safety. Lastly, hospital management ought to increase the awareness of free maternal health care and to include it among the community priorities during dialog days, action days, and other group discussions.
Filipinos getting infected with HIV-AIDS continued to balloon notwithstanding the intervention through comprehensive prevention, dissemination and control programs. In Eastern Visayas there were 69 cases coming from most risk population primarily Men Having Sex with Men (MSM) either homosexual, heterosexual and bisexual modes of transmissions. Bearing this epidemic, sexual networking, using the internet for sex served as cruising sites for casual sex and promiscuity maybe accounted for this surge. This study made use of descriptive cross sectional method with 214 active users from different social sites using time- location sampling through interviews, group discussions and questionnaires. Results showed that most of the respondents joined the site for sex and had an average of 1-5 different sexual intercourse for the past three months. Sexual practices were oral, anal and oral-anal. Respondents were aware on the different modes of transmission but fully unaware of existing services of the DOH and were willing to be screened for HIV.
Background: Incidence and prevalence of reproductive health difficulties have been shown to be higher among younger people. In Ghana, youthfriendly sexual and reproductive health services and facilities are very limited. The study aimed at examining the friendliness of sexual and reproductive health service delivery and utilization.
Methods: Across sectional design with both qualitative and quantitative methods was conducted to examine the friendliness and utilization of reproductive health services among youth in the Kwadaso Sub-Metro of Ashanti Region, Ghana. A multistage stratified sampling was used to enroll 170 youth (150 in-school and 20 out of school youth) aged 10 - 24years. Data analysis involved descriptive statistics using SPSS software version 20.
Results: Findings demonstrated that out of the 150 in-school youth sampled, 56% ever had a boyfriend or girlfriend, however, about one third(39.3%) did not recall the length of stay with partner, 58% have heard about sexual reproductive health services offered in the study area. A total of 55.8% of all categories of youth had used at least one or more reproductive health service before. Findings again revealed that 37.2% and 44% respectively of youth who had used sexual reproductive health considered the services received at a facility to be very friendly and friendly, yet, a few 18.6% indicated unfriendliness with services received at the facility.
Conclusion: An integrative and comprehensive approach is required to scale up youth utilization of sexual reproductive health services especially facility based. This requires baseline survey of youth users of reproductive health services and the quality of services offered.
Background: With the widespread use of highly active antiretroviral therapy, the epidemic of HIV has evolved into a chronic disease. HIV is extremely stigmatizing, resulting in highly emotionally charged responses to disclosure. World Health Organization (WHO) recommends that children should be informed of their HIV status at ages of 6 to 12 years and full disclosure at about 8 to 10 years. Disclosure process is much more difficult when the person being disclosed to is an adolescent. However, disclosure of HIV to a child should be an ongoing process that may last several years depending on the cognitive development of the child.
Methods: This study investigated the determinants of HIV status disclosure among HIV infected adolescents. A total of 209 HIV infected adolescents (10-19 years) who have been on treatment for at least six months, and are taking lifelong anti-retroviral therapy from Bondo County Hospital, Got Agulu and Uyawi Sub County Hospital in Bondo Sub County were enrolled. Simple random sampling was employed in selecting the adolescents. Data was collected using a structured questionnaire. Quantitative data was analysed using both descriptive and inferential statistics while statistical tests including Pearson Correlation analysis and multiple linear regression were used to test the hypotheses.
Results: Findings on the overall parental perceptions regarding risks and benefits of disclosure and disclosure of HIV status to adolescents show that 180 (86.12%) of the respondents had a negative attitude compared to 29 (13.88%) who held a positive attitude. 122 (58.37%) of the respondents believed that overall availability and quality of counselling was moderate. 10 (4.78%) of the respondents believed that the overall availability and quality of counselling was high. Quality services and perception of the parents have been found to be good predictors of disclosure of HIV status among the newly diagnosed adolescents in Bondo sub-County, p-value<0.05.
Conclusion and recommendation: This study identified quality of service and perception of the parents as the two factors determining the disclosure of HIV status. There is a correlation between the parental perceptions regarding risks and benefits of disclosure and the quality of counselling to parental disclosure of HIV status to adolescents. Therefore the study recommends deliberate efforts to ensure quality service delivery and age specific disclosure counselling to caregivers to equip them with adequate knowledge on disclosure.
Proximate Determinants of Fertility in Eastern Africa: The case of Kenya, Rw...Scientific Review SR
This study presents some determinants of fertility for three countries in east Africa. It examines the
role of the proximate determinants of fertility to total births during last five years before the surveys in Kenya,
Rwanda and Tanzania. The study is based on the analysis of secondary data obtained from Demographic and
Health Surveys in the three countries. The surveys were conducted between 2014 and 2016. The response
variable used in this study is the number of births in the last five years before the survey. The study employed
Quasi-Poisson regression model as the main method of data analysis. The results show that place of residence,
working status, number of union, age at first birth, age at first cohabitation, age at first sex, contraceptive use
and intention, unmet need and educational level mothers are significant determinants of fertility. Moreover, the
findings of this study indicate that educational level of mothers has negative impact on fertility. For current
contraceptive users, the mean birth for the last five years is highest for Kenya followed by Tanzania. For those
who never use contraception, the mean births for the last five years for Rwanda is lower as compared to
Tanzania and Kenya. The mean births for working mothers is also lower than that of non-working mothers for
all three countries. The study suggests that improving the educational level of mothers, increasing the use of
contraception, and involving more women to work force can reduce fertility in the three countries.
American Research Journal of Humanities & Social Science (ARJHSS) is a double blind peer reviewed, open access journal published by (ARJHSS).
The main objective of ARJHSS is to provide an intellectual platform for the international scholars. ARJHSS aims to promote interdisciplinary studies in Humanities & Social Science and become the leading journal in Humanities & Social Science in the world.
In Africa, the concept of Guidance and Counseling although relatively new in educational systems, has been embraced by most governments. Although most African countries recognize the essential role of organized Guidance and Counseling Programmes, there are limited researches studies conducted to assess the effectiveness of the programmed services being implemented to improve the student’s decision making processes that lead to improved future benefits. Research is yet to identify gender specific strategies to positive psychosexual development in boys and girls that can promote safe reproductive health. A wide spread ignorance on the subject of sex is due to the fact that the subject has been surrounded with mystery and beclouded by dark silence. The result has increased curiosity and desire to acquire more knowledge on this forbidden subject; yet, the people entrusted with the responsibility of educating the adolescents on the subject have not made appropriate information readily available. The study investigated effectiveness of guidance and counselling programmes on academic achievement among public secondary school students in Bungoma South Sub-County, Kenya. The study adopted Albert Bandura’s Social Cognitive Theory postulated in 1986. A descriptive research design was used with target population of 52 guiding and counselling teachers. A sample of 16 participants was selected using, using 30% of Mugenda and Mugenda (2003) and randomly selected from 52 schools. Data was collected using structured interview schedule and questionnaire and analyzed descriptively. Results highlights teacher counselling and peer counselling were the most effective strategies in guidance and counselling as compared to students suspension and corporal punishment. More than half of guidance and counselling teachers asserted that schools had inadequate policy and manual procedures and code of ethics and regulation governing sexual behaviour. This paper points at need of guidance and counselling departments to develop policies and manual procedures on sex and relationship education that acts as a reference point to all members of the school. In addition, the Government should set up reproductive health institutions for the youth, promote peer counseling, talks by health providers in schools which has a bearing on students’ performance.
Knowledge and Practice of Family Planning by Women of Childbearing Age in Del...inventionjournals
The problem of rising population, caused by high fertility rates, low death rates and aggravated by low contraceptive practice has taken a frightening dimension in most developing nations, including Nigeria, hence different authors have voiced their concerns and advocated ways out of the dilemma as a means of having a better society by the practice of contraception. This study investigates the knowledge and practice of family planning by women of child bearing age in Delta State with a view of knowing the current status of family planning and making relevant policy recommendations to the State. The study adopted a quantitative approach using a descriptive survey design in a cross sectional study using 582 structured questionnaires. The result of the research indicate that the women in this study showed good attitude to family planning and have very high knowledge of family methods (93.2%) which tilted towards condom (91.3%), pills (72.3%), and injectables (64.2%) with relatively low contraceptive prevalence (31.2%), thus indicating a wide gap between knowledge and current usage promoted by expectations of side effects of family planning methods. The conclusion of the study was that women should be educated on the benefits of family planning as well as on more family planning methods by using sources identified in this study as a way of improving population control and enhancing the standard of lives of the women in Delta State and Nigeria
The Effectiveness of HIV/Aids Education in Promoting Interventions for A Supp...QUESTJOURNAL
ABSTRACT: HIV/AIDS education is supposed to not only be a medium of creating awareness but also most importantly promote practices and skills to enable HIV prevention among youth in schools. This article reports on a study whose purpose was to assess the effectiveness of HIV/AIDS education in promoting interventions for a supportive environment in secondary schools. Specifically, the study sought to find out the extent to which interventions for a supportive environment for HIV/AIDS prevention were emphasized to youth; and explore the factors that influenced the promotion of the interventions. The study focused on youth involvement, parental involvement and HIV/AIDS prevention friendly school policies. The findings of the study established that the potential of the youth in enabling HIV/AIDS prevention among their fellow peers was not fully exploited. Parental involvement was low especially among the fathers. Parents rarely engaged in discussions on topics that dealt with sexuality. HIV/AIDS prevention friendly policies were ineffectively promoted in schools. Factors that influenced the promotion of the interventions were explored.
The adolescent stage is a period of turmoil marked with enormous vibrancy, discovery, innovation and hope and also the time when many of them initiate sexual relationships and involvement. This can be a challenging time for young people who are becoming aware of their sexual and reproductive rights and needs, and who rely on their families, peers, schools, media and health service providers for affirmation, advice, information and the skills to navigate is sometimes a difficult transition to adulthood. The subject on sex has been surrounded by mystery and beclouded by dark silence as neither parents nor teachers are ready to discuss it with teenagers despite unplanned pregnancies, dropping out of school by students, Sexually Transmitted Infections among teenagers. The study investigated influence of teen contraceptive use) on academic achievement among public secondary school students in Bungoma South Sub-County, Kenya. The study adopted Albert Bandura’s Social Cognitive Theory postulated in 1986. A descriptive research design was used with target population of 3774 Form 3 students. A sample of 400 students was selected using, Miller, L.R. & Brewer, J.D. (2003) mathematical formula and stratified randomly from 52 schools and conveniently selected equally between boys and girls. Data was collected using structured interview schedule and questionnaire and analyzed descriptively. Results highlights most students were aware about contraceptive use with females slightly more than males and media was the major source of information on contraceptive use while parents/guardians had no significant contribution since teenagers rarely receive their first information on sexual matters from their parents. More than half of the sexually active students used contraceptives though it still interfered with their academic performance. This paper points at sex education curriculum in schools, setting up reproductive health institutions for the youth and distribution of contraceptives among teenagers which has a bearing on students’ performance.
Cameron, L., Erkal, N., Gangadharan, L., Meng, X. (2013). Little emperors: Behavioral impacts of China's one-child policy. Science, 339, 953-957. doi: 10.3886/ICPSR34521.v1.
This article investigated the effect of China’s one-child policy on different behaviors, comparing behavioral trends in people who were born in the years just before and just after the implementation of the one-child policy. One of the more notable results was that participants born under the one-child policy scored higher in neuroticism and lower in contentiousness in comparison with those born before the policy. The study concluded that the observed behavioral differences between those born just before and just after the one-child policy would greatly magnify as time went on, due to very limited extended family and living in a world of predominantly only children. This article provides valuable insight into the behavioral changes of the average person in China as a result of the one-child policy. The authors were able to use data that was actively generated for this article, rather than piecing together already-existing data like many other studies on the subject, which was very refreshing to see. This article would provide a solid resource to use as it presents a very data-based approach to this aspect of the one-child policy.
Huang, W., Lei, X., Zhao, Y. (2016). One-child policy and the rise of man-made twins. Review of Economics and Statistics, 98(3), 467-476. doi: 10.1162/REST_a_00567
The authors of this study examined the correlation between China’s one-child policy and China’s sharp increase of reported twin births. The authors found that although China’s fertility rate was already decreasing before the advent of the policy, the number of reported twins had increased by one third in the last 30 years, sharply rising in 1979 when the one-child policy was fully implemented. The data suggested that there was a strong correlation between reported twin births and areas of China with higher fines for having more children than allowed. One of the key indicators used by the authors to determine fake twins was height differences between the children. Some of the limitations of this study included that the evidence for fake twins was merely suggestive, as the authors could not observe instances of fake twins directly. Additionally, the data used for the study was the largest pool to be found on height data, but the research was still limited by the sample size. This article is a good starting point for researching this unintended effect of the one-child policy and adding supplementary information, but does not provide enough thorough research to be used as a core resource.
Min, J., Xue, H., Wang, VHC., Li, M., Wang, Y. (2017). Are single children likely to be more overweight or obese than those with siblings? The influence of China's one-child policy on childhood obesity. Preventative Medicine, 103, 8-13. https://doi.org/10.1016/j.ypme d.2017.07.018
The purpose of this re ...
This fact sheet shows the strength of the existing evidence that demonstrates the impact health communication has on other HIV prevention strategies like partner reduction and discouraging cross-generational sex.
International Journal of Humanities and Social Science Invention (IJHSSI)inventionjournals
International Journal of Humanities and Social Science Invention (IJHSSI) is an international journal intended for professionals and researchers in all fields of Humanities and Social Science. IJHSSI publishes research articles and reviews within the whole field Humanities and Social Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
[[INOSR ES 11(2)108-121, 2023.Evaluation of Male partner participation in pre...PUBLISHERJOURNAL
Evaluation of Male partner participation in prevention of mother to child transmission of HIV/AIDs at Hoima Referral hospital
Sebwami Richard
School of Allied Health Sciences, Kampala International University Uganda.
________________________________________
ABSTRACT
The purpose of the study was to assess the knowledge and attitude, the level of male involvement and factors associated with male involvement in the prevention of mother-to-child transmission of HIV in Hoima municipality. This study was a descriptive cross section in which quantitative method of data collection was employed in collection of data from respondents. Questionnaires were distributed to participants to assess the knowledge and attitude, the level of male involvement and factors associated with male involvement in prevention of mother-to-child transmission of HIV (PMTCT) in Hoima municipality. Sample size of 200 participants were used, this included the Male partners who hard escorted their pregnant partners to the antenatal clinic aged between 20-50years.The predominant religion were Catholics 59% and seventh day Adventists. Regarding educational levels, majority of respondents had completed secondary level and above (61%) and the predominant ages were between 20-29 years. The study revealed that very few males partner were involved in the PMTCT program especially during HIV counseling and testing (HCT) because of being at old age group above 30years couples, couples not living together, high number of wife’s pregnancies four and above, having no knowledge on methods of MTCT, and husbands failure to discuss HCT with their wives. From the findings, majority of the respondents have ever had about the male involvement in the PMTCT but there was still low male involvement in PMTCT programs at antenatal clinics. There is a need to do an in-depth assessment of women’s experiences when tested HIV-positive in the presence of their partners at the ANC, as well as to develop strategies to improve male involvement. The study again recommends formative research on the use of incentives to promote male involvement in the PMTCT program and the government should train more of the health promoters and the Village Health Teams in order to reach even those that are deep in the village that are not having easy access to the health facility.
Keywords: HIV, Hoima municipality, Male partner, counseling
Reaching Health Messages to Women in India: Evidences from District Level Hea...inventionjournals
Change in behavior is a process that depends on many factors. Mass media plays an effective role
in creating awareness and influencing beliefs, attitude and practices. Since it is an effective instrument in
guiding social norms, it is an equally important factor for behavioral change. The main objectives of this paper
are to examine the extent of reach of messages and it also examines the major source of the health messages for
women in select states. For the present study data of District Level Household Survey, 2007-08 (DLHS3) has
been analyzed. In DLHS 3 data was collected from 720,320 households from 34 states and union territories of
India (excluding Nagaland). DLHS 3 interviewed 643,944 married women aged 15-49. For the present study
simple cross tab analyses has been done. To have a better insight into communication of different health
messages, health information index has been calculated. There is a significant rural-urban, caste and religion
differential in reach and accessibility of health messages through mass media. Health professionals and friends/
relatives are the major sources to receive health messages. Electronic media is the third largest source for
health information but it is also influenced by background characteristics like place of residence, education of
women, economic states etc
Similar to 93748 article text-240107-1-10-20130906 (20)
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
1. Mosha et al. Family planning in Tanzania
African Journal of Reproductive Health September 2013; 17(3): 57
RESEARCH ARTICLE
Communication, knowledge, social network and family planning
utilization among couples in Mwanza, Tanzania
Idda H. Mosha*1
, Ruerd Ruben2
1
Behavioural Sciences Department, Muhimbili University of Health and Allied Sciences, PO Box 65015, Dar es Salaam
Tanzania; 2
Centre for International Development Initiatives Nijmegen (CIDIN) and Faculty of Social Science Studies University
of Radboad, Th.v. Aquinostraat 4 Postbus 9104, 6500 HE Nijmegen, the Netherlands.
*For correspondence: E-mail: ihmosha@yahoo.co.uk; Phone: +255 717050748
Abstract
Family planning utilization in Tanzania is low. This study was cross sectional. It examined family planning use and socio
demographic variables, social networks, knowledge and communication among the couples, whereby a stratified sample of 440
women of reproductive age (18-49), married or cohabiting was studied in Mwanza, Tanzania. A structured questionnaire with
questions on knowledge, communication among the couples and practice of family planning was used. Descriptive statistics and
Logistic regression were used to identify factors associated with family planning (FP) use at four levels. The findings showed that
majority (73.2%) of respondents have not used family planning. Wealth was positive related to FP use (p=.000, OR = 3.696, and
95% C.I = 1.936 lower and upper 7.055). Religion was associated with FP use (p=.002, OR =2.802, 95% C.I = 1.476 lower and
5.321 upper), communication and FP use were significantly associated, (p=.000, OR = 0.323 and 95% C.I = 0.215) lower and
upper = 0.483), social network and FP use (p=.000, OR = 2.162 and 95% C.I = 1.495 lower and upper =3.125) and knowledge
and FP use(p=.000 , OR = 2.224 and 95% C.I = 1.509 lower and upper =3.278). Wealth showed a significant association with
FP use (p=.001, OR = 1.897, 95% C.I = 0.817 lower and 4.404).Urban area was positively associated with FP use (p= .000, OR =
0.008 and 95% C.I = 0.001 lower and upper =0.09), semi urban was significant at (p= .004, OR = 3.733 and C.I = 1.513 lower
and upper =9.211). Information, education and communication materials and to promote family planning in Tanzania should
designed and promoted. (Afr J Reprod Health 2013; 17[3]: 57-69).
Résumé
Contexte: L'utilisation de la planification familiale en Tanzanie est faible. Il s’agit d’une étude transversale. Elle a examiné
l'utilisation de la planification familiale et les variables sociodémographiques, les réseaux sociaux, la connaissance et la
communication chez les couples, selon laquelle un échantillon stratifié de 440 femmes en âge de procréer (18-49 ans), mariés ou
vivant en concubinage a été étudié à Mwanza, en Tanzanie. Un questionnaire structuré avec des questions qui portaient sur la
connaissance, la communication chez les couples et la pratique de la planification familiale a été utilisée. L’on s’est servi des
statistiques descriptives et de régression logistique pour identifier les facteurs associés à l’utilisation de la planification
Familiale (PF) à quatre niveaux. Les résultats ont montré que la majorité (73,2%) des interviewés n'ont pas utilisé la planification
familiale. La richesse était lié positivement à l'utilisation de la PF (p = .000, OR = 3.696, et IC 95% = 1,936 inférieure et
supérieure 7,055). La religion a été associée à l'utilisation de la PF (p = .002, OR = 2,802, IC à 95% = 1,476 inférieure et
supérieure 5,321), la communication et l’utilisation de la PF étaient significativement associées, (p = .000, OR = 0,323 et 95%
CI = 0,215) inférieur et supérieure = 0,483), le réseau social et l’utilisation de la PF ( p = .000, OR = 2,162 et CI à 95% = 1,495
inférieure et supérieure = 3,125) et la connaissance et l'utilisation de la PF (p = .000, OR = 2,224 et 95% CI = 1,509 inférieure et
supérieure = 3,278). La richesse a montré une association significative avec l’utilisation de la PF (p = .001, OR = 1,897, 95% CI
= 0,817 inférieur et 4,404). Le milieu urbain était positivement associé à l'utilisation de la PF (p =, 000, OR = 0,008 et 95% CI =
0,001 inférieure et supérieure = 0,09), le milieu semi urbain était significatif à (p =, 004, OR = 3,733 et CI = 1,513 inférieure et
supérieure = 9,211). Il faut concevoir des matériels d'information, d'éducation et de communication et pour promouvoir la
planification familiale en Tanzanie. (Afr J Reprod Health 2013; 17[3]: 57-69).
Keywords: Family planning, communication and social network
Introduction
Millions of women in the developing world die
each year during pregnancy or childbirth.
Ronsmans & Graham1
noted that one woman dies
in every minute due to pregnancy and child birth
complications. Another million women suffer
permanent pregnancy related disabilities. Much of
2. Mosha et al. Family planning in Tanzania
African Journal of Reproductive Health September 2013; 17(3): 58
this suffering and death could be prevented
through effective use of modern family planning
(FP) methods. Family planning use can protect
women from the health risk of unplanned
pregnancies and disabilities2
. Family planning use
continues to be low especially in developing
countries where use of any method is only 27 %3
.
In Africa, there are many obstacles that impede
people from using contraceptives ranging from
cultural, social factors and structural factors like
less access, availability and affordability of
contraceptives4.
Most research on use of FP in Tanzania have
focused on factors contributing to the non-
adoption of FP methods. For instance, Msoffe &
Kiondo5
found that 69% of the surveyed
population was aware of the availability of FP
services in rural areas, but less than 50% actually
used the services. Keefe6
concluded that
perceptions of Islamic rules about FP were
constraining FP use in Northern Tanzania.
Similarly, Hollos & Larsen7
indicate that the
change from a traditional marital union to
companionate marriage was instrumental in
accepting modern contraception.
However, none of these studies addressed the
importance of factors, like the communication and
bargaining among couples, the available
knowledge and beliefs on FP, and the role of
social networks for FP use. It is against this
background that this study becomes relevant in
filling this knowledge gap. It is hypothesized that,
communication among couples, social network
and knowledge on FP might have a positive effect
on FP use. Moreover, FP use depends on relevant
individual socio-demographic characteristics like
age, religion, wealth, household size and
educational level.
Factors Influencing FP Use
Communication & bargaining
Several studies have found that the status of
women in the family is related to the ability to
communicate with their husbands about the
number and timing of children birth and the use of
FP methods8-10
. Rutenberg and Watkins11
underscored the importance of communication
within the conjugal unit and the gossip networks
of women in Kenya on FP use. Low contraceptive
prevalence rate prevails in a situation where
women have low education, low socio-economic
status and live in extended patriarchal families 11
.
Ezeh8
found that ancestral customs in sub Saharan
Africa give men right over women’s proactive
power. In such situations the husband’s approval
may often be a precondition for a woman to use
family FP.
Communication between spouses is very
important in fertility making decisions12.
Such
communication should be among the most
important precursors of lower desired family size
and increase contraceptive use. Several studies
have reported a low level of communication
between spouses about family size and FP12-14
.
However, in most countries in sub Saharan Africa,
the communication practice on FP use remains
low, even though FP knowledge is high
occasionally among men and women15
.
In a similar vein, Nyablade and Menken16
,
examined the effect of husband and wife
communication on contraceptive use. They found
a significant association between couples
communication and their contraceptive use. Also,
Bawah17
found that spousal communication predict
contraceptive behaviour, even when other factors
were controlled. Furthermore, Lasee and Becker 10
in Kenya found that wife’s perception of
husband’s approval of FP was highly associated
with current use of contraceptive. They found out
that dialogue appears to increase the effectiveness
of communication. Specifically, one spouse’s
perception of the other spouse’s approval is more
likely to be correct if they have discussed FP than
if they have not10.
Social networks
Individuals do not make decisions in social
isolation but with interactions with others.
Theoretical analyses of contraceptive choice and
fertility dynamics show that social interactions can
help to explain changes in patterns of fertility or
contraceptive behaviour18, 19
, as well as more
general individual’s behaviour20
. Bongaarts and
Watkins21
suggest that social networks may work
through social influences and social learning by
3. Mosha et al. Family planning in Tanzania
African Journal of Reproductive Health September 2013; 17(3): 59
providing examples of behaviour that may then be
considered and copied by others.
Analyses from Kenya and Thailand have
provided evidence that women chat with each
other about family size and FP22
. Behrman and
Kohler23
found that social networks have
significant and substantial effects on contraceptive
use in rural Kenya. They found that women in
their social network discuss about FP and through
that way FP information were spreading.
New attitudes are seen as being transmitted
when members of social networks interact with
each other24.
Interpersonal communication has
been identified as essential to persuade the average
receiver to adopt an innovation, especially
communication from peers such as friends and
neighbours24
.
The acceptance of new beliefs, norms and
fertility behaviour can be explained by two
processes that occur during social interaction,
which are social learning and social influence25.
Social networks encompass both the social aspect
of information acquisition and the filtering of that
information into terms that are meaningful to
individual use25
.
Social networks include the extended family,
friends, neighbours, political groups, church
group, youth groups, and other formal and
informal associations26
. For many women,
informal communication is a primary source of FP
information11
. Gayen and Raeside27
, found that the
informal social networks of women are important
on contraception use. They further found out that
both structure and attitudinal properties of one’s
interpersonal networks are associated with their
contraception use27
.
The influence of social networks is crucial to
informed choice. Most people seek the approval of
others and modify their own behaviour to please
others or to meet others’ expectations21,22
. In
Nigeria and other West African countries for
example, some women said it was difficult for
them to use FP because their relatives or friends
were not using it. These women were reluctant to
be the first in their social group to use FP22
.
People choose contraceptive methods that are
commonly used in their community because they
know that it is socially acceptable to do so, and
they tend to know more about these methods24
.
Individual characteristics
Several studies have established the influence of
religion on the demographic behaviours of
individuals. For instance, Doctor, Phillips and
Sakeah28
found strong association of contraceptive
use and change of parity with the shift from
traditional religion to the practice of Christianity
and Islam in Ghana. They found that African
traditions subordinate individual agency to the
traditional family and kindred norms and
customs28
. A study by Hirsch29
in rural Mexico
among the Catholics on contraceptive use found
the creativity with which people use to religious
frameworks to justify their contraceptive use
behaviour.
Many studies found that women who
participate in paid employment, and especially
those pursuing demanding career limit their
fertility and either have relatively few children or
none30,31.
This negative correlation economic
theory is emphasized by the opportunity costs to
women, pointing out rational calculations of the
costs of having children against opportunities in
the labour market. To explain the relations
between work and fertility decisions, economic
theory emphasizes the effect of economic
considerations on both domains in women’s
lives32
.
Women’s work decisions depend on their
educational level because women take into
account their opportunity costs that are their
forgone earnings while staying at home.
Accordingly higher education, which is translated
into higher wages, is expected to have strong
positive effect on women’s labour force
participation33
.
Fertility differentials by socio economic status
have attracted renewed attention because of
potential importance to relative growth rates of
sub-populations and long term changes in
population composition. They found that rich
families had higher net fertility34
. Wang et al.35
reported positive associations between socio
economic status and fertility. Bengtsson & Dribe 36
identified a positive correlation between total
fertility rate and household’s landholding status in
Southern Sweden. However, a study on the
population living in the city of Venice in Italy
4. Mosha et al. Family planning in Tanzania
African Journal of Reproductive Health September 2013; 17(3): 60
reveals a negative association between income and
fertility; that artisan and shopkeepers had lower
fertility than day labourers37
.
Location
Several studies on FP have been conducted in rural
and urban areas. For instance38
in urban area in
Nigeria found that knowledge on FP was high
81.7% but only 20% of the women were practicing
FP method. Furthermore, Njogu39
, examined trends
in contraceptive use in Kenya comparing data
between 1977 - 1978 and 1989 at both the
aggregate and the subgroup level. He found that
better educated, urban women were more likely to
use contraceptives during both periods39
.
Odhiambo40
, in Kenya found out that region of
residence was an important factor that exerts a
strong positive influence on current use of
contraception. Direct and indirect effects of region
of residence were equally important, the indirect
effect operating through couple communication,
desire for children, number of living children,
wife's education, and age at first marriage. To be
more specific urban rather than rural areas was
positively related to use of contraception40
.
A study in Uganda rural by Ntozi, and Kabera41
finds that the use of both traditional and modern
contraceptive methods was low. However, the
women reported using traditional methods much
more than they had used the modern
contraceptives. Low use of modern methods was
associated with lack of knowledge of sources of
supplies, low education, low levels of employment
outside the home, un- availability of supplies, and
pronatalist cultures41
). Msoffe & Kiondo5
found
that 69% of the respondents in rural areas were
aware of the availability of FP services and out of
those 47% accessed FP services. Forty four percent
of the respondents were using FP methods to
control births5
. Furthermore, Plummer et al.42
,
examined condom knowledge, attitude, access and
practices in rural Mwanza, Tanzania. They found
out that condom use was very low primary as a
result of limited demand42.
In addition, Chen, and
Guilkey43
found that the use of FP methods in most
areas of rural Tanzania was quite low. Pile and
Simbakalia44
found that current use of any modern
FP method varies with urban- rural and regional
residence. Women in urban areas were twice as
likely to use contraception as were women in rural
areas 41.8% against 21.6 % for any method and
34.3% against 15.5% for a modern method44
.
ANALYTICAL FRAMEWORK
We start from the hypothesis that knowledge on
FP and availability of FP can lead to FP use.
However, FP availability and knowledge can
reinforce intra-household bargaining processes.
Similarly, FP use is also influenced by social
norms and attitudes. It is argued that FP use is
mediated by several intra-household and village
factors, including culture, traditions, values, social
norms and attitudes that again shape the
bargaining power among the couples. Figure 1
below outlines our analytical model.
Figure 1: Analytical model
Earlier studies have analyzed several components
of this model. It is shown that FP methods can be
available but due to several obstacles people do
not use them. For instance, Caldwell & Caldwell4
5. Mosha et al. Family planning in Tanzania
African Journal of Reproductive Health September 2013; 17(3): 61
pointed out that in Africa there are many obstacles
impeding people from using FP methods which
range from cultural, social and structural factors
related to FP methods. Ezeh8
found that ancestral
customs in sub Saharan Africa give men right over
women. In such situations the husband’s approval
may often be a precondition for a woman to use
family FP. The status of women in society can
affect FP use. For instance, Ezeh; Kritz et al., and
Lasee and Becker8-10
, found that the status of
women in the family is related to the ability to
communicate with their husbands about the
number and timing of children birth and the use of
FP methods.
Several studies have pointed out the importance
of social networks and how it affects the FP use.
For example, Rutenberg and Watkins11
underscored the importance of communication
among the social networks in Kenya. They also
found that low contraceptive prevalence rate
prevails in a situation where women have low
education, low socioeconomic status and live in
extended patriarchal families11
.
Communication or bargaining among husbands
and wives is an important determinant for FP use.
For instance, Nyablade, and Menken16
, examined
the effect of husband and wife communication on
contraceptive use. They found that communication
is associated with FP use. Also, Bawah17
found
that spousal communication predicts contraceptive
behaviour, even when other factors were
controlled. It was on this line of empirical findings
evidence that the above analytical model was
selected to guide this study.
Hypothesis
1. We hypothesized that, knowledge, FP
availability, communication among couples,
have a positive effect on FP use.
Communication among the couples facilitates
the use of FP among the couples compared to
the couples who do not communicate on FP.
2. We also hypothesized that there is a positive
relationship between socio demographic
characteristics (age, religion, wealth, number
of people in the household, education) and FP
use. (Asset index as a proxy for wealth) was
constructed from the ownership of durable
goods within the households including;
ownership of a bank account, car, bicycle,
cattle, also source of energy, water, house
materials, number of meals per day, number of
days that they consumed meat in past week
prior this study, were used to construct an
asset index as proxy of wealth in this study.)
Wealth and education play a significant role
on FP use44
.
3. We hypothesized that social network have a
positive effect on FP use. Contraceptive
choices and fertility pattern can be affected by
social network that prevails in a certain area18.
Through social network work people get
information and learn new ideas and apply
them in their daily lives.
Methods
Data was collected between June and September
2010 in three districts of Mwanza region. Multi-
stage sampling was adopted to identify the study
areas. Stratified random sampling was employed
to obtain 440 females of reproductive age 18 – 49
cohabiting or married, with children were selected
to participate in the study.
Mwanza is located in the Northern part of
Tanzania. According to the 2002 Tanzania
National Census Mwanza had the population of
2,929,644 of whom 26.7% live in urban area and
73.3% live in rural area45.
The main economic
activities are agriculture, fishery and mining.
Mwanza has an area of 19,592km2
, (divided into
eight districts at the time of the study namely
Ukerewe, Magu, Sengerema, Kwimba,
Nyamagana, Geita, Misungwi and Ilemela). The
study was done in Ilemela, Magu and Misungwi
districts.
In Mwanza, contraceptive prevalence rate is
15% for all methods, out of those 12% were using
modern contraceptive methods46
. Likewise,
Mwanza is among the regions in Tanzania with
high unmet needs for contraceptives (21.6%) and
has high fertility rate of 5.7%. Accordingly, the
region has a population growth rate of 3.2%46.
Mwanza has relatively well established and
functioning public and private health facilities
offering FP services. According to Tanzania
Ministry of Health and Social Welfare (MoHSW),
6. Mosha et al. Family planning in Tanzania
African Journal of Reproductive Health September 2013; 17(3): 62
Mwanza has a total of 377 health facilities47
. The
facilities in the region range from dispensaries,
health centres, district hospitals, one regional
hospital and a referral hospital (Bugando).
Data Collection
Prior to the main fieldwork, a pilot study was
conducted in one street in Ilemela district. This
street in which pilot was done was excluded from
the main study. The pilot test was useful in
identifying any problems as well as checking time
spent in responding to questions. Pilot testing of
instruments was also intended to improve the
precision, reliability, and cross-cultural validity of
data. Following the analysis of the pilot study data,
questions were rephrased for the good flow and
some few questions were removed.
We used structured questionnaires to collect
data on education, religion, number of people in
the household, wealth, knowledge on FP, FP
communication among spouses and social
networks. Questionnaire was prepared in English
and later translated into Kiswahili. In order to
check the validity of translated version, there was
a back-translation of the questionnaire from
Kiswahili to English.
The researcher and research assistants
administered the questionnaires at the households’
levels. The administration of the questionnaire
took place in a convenient place with no
interference of other household members, and this
place was secured according to the interviewee’s
preference given that solitude can be assured. The
questionnaire took a maximum of fifty minutes.
Every day after field work the researcher and
assistants held a meeting. The researcher used the
meetings as an opportunity for controlling the
quality of information through checking the
questionnaires for completeness.
Data analysis
Descriptive statistics are presented; also logistic
regression was employed to identify variables
associated with FP use.
There were seven statements measuring family
planning knowledge and effectiveness of the pills
and assumed modern family planning methods
effects. Five point Likert scale was used to rate
these statements from one (strongly agree) to five
(strongly disagree). Factor analysis was used to
reduce data. One question was dropped because of
strong correlation. From the remained 6 questions
one factor on FP knowledge was made.
On communication among couples there were 2
statements on communication among the couples
on 5 point Likert scale from strongly agree to
strongly disagree. From these statements one
factor on communication was created. Likewise
for questions on social networks, there were
eleven statements on 5 point Likert scale from
strongly agree to strongly disagree. The statements
largely based upon the themes on FP and to extent
of which the respondent will seek advice, discuss,
seek support, and approval of the friends and
relative on decision to use FP. Two questions were
dropped because of strong correlations. One factor
on social network was made from the remained
nine statements.
A logistic binary model was used to examine
the effect of the factor analyzed knowledge
statement and FP use/non use. The dependent
variable for each observation takes on a value of
one if the respondent was using FP and a value of
zero if the respondent was not.
The wealth index was used as a proxy of wealth
to reflect the economic status of the household.
Five wealth quintiles were constructed; lower
quintiles representing poor people while higher
quintiles represented wealthy people. Therefore,
durable goods owned within the household,
ownership of bank account, car, bicycle, source of
energy, source of water, house materials, number
of meals per day, number of days that they
consumed meat in past week prior this study, were
used to construct an asset index as a proxy of
wealth. Variables included in the asset index
construction were adopted from the TDHS-2004
questionnaire. Since the study included rural areas,
inclusion of animals such as cattle, became
necessary. This is because ownership of animals in
rural areas of Tanzania is an indication of wealth,
even if animals are not commonly regarded as
durable goods. Variables used to construct the
asset index were binary in nature. The information
was therefore converted into dummy variables i.e.
(1 for those who had those assets, and 0 for those
7. Mosha et al. Family planning in Tanzania
African Journal of Reproductive Health September 2013; 17(3): 63
who did not have). By using dummy variable (a
move from 0 to 1), weights have an easy
interpretation of variation between owning a
certain type of durable good and not owning it.
The statistical procedure of one factor extraction in
the SPSS software was used to create one factor
score as a proxy for wealth.
Also independent variables (were coded into
dummies), age of the respondent, religion and type
of job were included as independent variables.
Question on religion was coded into dummies (1=
Muslim and 0= Christians), Education, (Primary =
0, secondary 1) Family size( 0 = 2-4 family
members, 1 = 5 to 11 members, wealth ( 0= low
quintile, 1= High quintile), type of job was coded
into dummies, (1= employed, and 0=
unemployed).
Results
Characteristics of study respondents
Majority of the respondents had primary education
(n=347) and majority of them were Christians
(n=371). On the area of residence there were
roughly equal numbers of participants from urban,
semi urban and rural. Furthermore, majority of
respondent preferred to have 1 to 2 children
(n=215). Also majority of them have not used FP
(n=322). On the family size, majority of the
households have more than 4 people (n= 224).
Furthermore, majority of them were employed or
doing informal business (n=275). On wealth,
majority of them were in high quintile (266).
Table 1: Characteristics of respondents
Characteristics Number (n) Percentage (%)
Education Primary 347 78.9
Secondary 93 21.1
Religion Moslem 69 15.7
Christian 371 83.3
Residence Rural149 33.9
Semi-urban 145 34.0
Urban 144 32.1
Number of children they want 1-2 215 64.8
3-4 117 35.2
Family size 2-4 216 48.5
5-11 224 51.5
Ever use family planning Never 322 73.2
Used 118 26.8
Employment Unemployed 165 37.5
Employed 275 63.5
Wealth Low 174 39.5
High 266 60.5
Annex 1: a) Attitudinal and perception statements, its mean and STD and number
Knowledge statement Mean Std N
Knowledge Cronbach’s alpha = 0.700
The pill can induce infertility 2.77 0.852 440
The pill increases the risk of cancer 2.71 0.829 440
Modern contraceptive causes cancer 2.59 1.152 440
Modern contraceptive causes infertility 3.13 0.919 440
Modern contraceptive injections causes infertility 2.95 0.989 440
Modern contraceptive are not effective in preventing pregnancy 3.06 0.797 440
b) Communication statements among spouses
Cronbach’s alpha =0.772 Mean Std N
I discuss family planning freely with my
partner/spouse
2.41 1.014 440
I discuss freely with my partner on ways to 2.34 1.304 440
8. Mosha et al. Family planning in Tanzania
African Journal of Reproductive Health September 2013; 17(3): 64
prevent pregnancy
c) Social network on FP Information
Statement Mean Std N
Cronbach’s alpha =0.517 440
If you decide to use FP how much would you like to seek advice from
your relatives about suitable contraceptive?
2.86 0.761 440
If you decide to use FP how much would you like to seek advice from
your friends about suitable contraceptive?
2.96 0.681 440
If you decide to use FP how much would you like to seek advice from
health workers about suitable contraceptive?
1.29 0.689 440
How likely do you think that your mother in law would approve if they
were to know that you use FP
2.76 1.178 440
How likely do you think that your husband/partner would approve if they
were to know that you use FP
3.16 1.035 440
How likely do you think that your relatives would approve if they were to
know that you use FP
2.35 1.276 440
How likely do you think that your neighbours would approve if they were
to know that you use FP
3.47 0.917 440
How likely do you think that your best friend would approve if they were
to know that you use FP
2.94 1.220 440
How likely do you think that your pastors/religious leaders would approve
if they were to know that you use FP
2.25 1.338 440
Socio demographic characteristics and FP use
Among the study participants more Christians
have used FP compared to Muslims (n= 86), while
more employed people have used FP compared to
the unemployed (n= 72), wealthier people have
used FP compared to the poor ones (n= 95), and
majority of primary school holders (n= 88), have
used FP compared to secondary school holders.
Also, majority of participants with more than
four people in the households have used FP (n=64)
compared to participants with four or less people
in the households. Moreover, majority of
participants in urban areas have used FP (n=87)
compared to people in the semi urban and rural
areas (See Table 2).
Table 2: Socio demographic characteristics and
FP use among respondents (who ever used FP) (n=
440)
Religion N %
Christian 86 72.9
Muslims 32 27.1
Employment
Employed 72 61
Unemployed 46 39
Wealth
Low 21 18.1
High 95 81.9
Education
Primary 88 80
Secondary 22 20
Family size
0- 4 54 45.8
Above 4 people 64 54.2
Residence
Urban 87 73.7
Semi urban 29 24.6
Rural 2 1.7
Annex 2: Individual and Household characteristics
(descriptive)
Variables Mean Std N
Employment (1 = employed, 0=
unemployed
0.62 0.49 440
Family size (number of household
members)
4.85 1.97 440
Education (0=no education, 1=primary
education, 2= secondary, 3= post
secondary
2.26 .85 440
Age (years) 28.59 6.10 440
Religion (Christian= 0, Muslim=1) .16629 .37 440
Regression analysis
Model 1: In our initial logistic regression we
included five individual variables which were;
employment, religion, education, wealth and
family size. As it was hypothesized, wealth was
9. Mosha et al. Family planning in Tanzania
African Journal of Reproductive Health September 2013; 17(3): 65
positive related to FP use (p=.000, OR = 3.696,
and 95% C.I = 1.936% lower and upper 7.055%).
Also, in this model, religion was slightly
associated with FP use (p=.002, OR =2.802, 95%
C.I = 1.476% lower and 5.321% upper). Family
size and employment in this model were positively
associated with FP use, although were not
significant.
Model 2: In our second logistic regression model
we included three behavioural characteristics
which were; communication among the couples,
social network and knowledge. There was a
statistical significance between communication
and FP use, (p=.000, OR = 0.323 and 95% C.I =
0.215% lower and upper = 0.483%), social
network (p=.000, OR = 2.162 and 95% C.I =
1.495% lower and upper =3.125%) and knowledge
(p=.000, OR = 2.224 and 95% C.I = 1.509% lower
and upper =3.278%). Wealth in this model showed
a significant association with FP use (p=.001, OR
= 1.897, 95% C.I = 0.817% lower and 4.404%).
Table 3: Factors explaining FP use (Binary Logistic Regression; N = 436)
Model 1 and 2
95.0% C.I for
Exp (B)
Model 2 N = 436 95.0 C.I for Exp (B)
B S.E Sig Exp (B) Lower Upper B S.E Sig Exp
(B)
Lower Upper
Constants -2.121 364 .000 0.12 -2.073 0.477 .000 0.126
Individual
factors
Employment 0.2 0.275 0.942 1.02 0.596 1.747 -286 0.375 -
0.446
0.751 0.36 1.568
Religion 1.03 0.327 .002 2.802 1.476 5.321 0.936 0.45 0.038 2.55 1.055 6.162
Education 0.583 0.339 0.085 1.791 0.922 3.479 -0.015 0.48 0.975 1.015 0.396 2.603
Wealth 1.307 0.33 .000 3.696 1.936 7.055 0.64 2.217 .001 1.897 0.817 4.404
Family Size .-105 0.293 0.72 0.9 0.507 1.598 0.397 0.961 0.327 0.673 0.304 1.486
Behavioural
factors
1.132 30.217 .000 0.323 0.215 0.483
Bargaining/com
munication
0.771 16.794 .000 2.162 1.495 3.125
Network 0.771 16.794 .000 2.162 1.495 3.125
Knowledge 0.799 16.326 .000 2.224 1.509 0.799
Nagelkerke R2 =.159 Nagelkerke R2 = .672
Annex 3: Contraceptive use in Mwanza Region
Residence Have you and your partner ever used anything or tried in any way to delay or avoid getting pregnancy
(n; Men=50, Women =440)
YES NO
Females Males Females Males
No % No % No % No %
Urban 87 60.8 0 0 56 39.2 7 56.5
Semi-urban 29 19.9 10 50 117 80.1 10 50
Rural 2 1.3 10 43.5 149 98.7 13 100
Model 3: In our third logistic regression model we
included regional dummies and communication
showed a statistic significance with FP use
(p=.000, OR = 0.333 and 95% C.I = 0.215% lower
and upper = 0.517%) knowledge (p= .000, OR =
1.742 and 95% C.I = 1.161% lower and upper
=2.615%) and social network (p= .007, OR =
2.317 and 95% C.I = 1.537% lower and upper =
3.494%). Urban was positively associated with FP
use (p= .000, OR = 0.008, 95% C.I =0.001% lower
and upper 0.09%) likewise semi urban was
significant at (p= .004, OR = 3.733 and 95% C.I =
1.513% lower and upper =9.211%).
10. Mosha et al. Family planning in Tanzania
African Journal of Reproductive Health September 2013; 17(3): 66
Model 4: In our fourth logistic regression step we
included Interaction effect of communication and
regional variables (rural, semi urban and urban). In
this model, there was a significance relationship
between communication, (p= .001, OR = 0.189
and C.I = 0.072% lower and upper =0.492%)
social network and FP use (p= .000, OR = 2.165
and 95% C.I = 1.417% lower and upper =
3.307%) knowledge also was significant at
(p=.021, OR = 1.65 and 95% C.I = 1.078% lower
and upper = 2.525%) and communication in
urban has significant association with FP at
(p=.000, OR = 0.01 and 95% C.I = 0.001% lower
and upper = 0.123%) and semi urban significant
at (p= .003, OR = 5.687 and 95% C.I = 1.784%
lower and upper = 18.133%).
Table 4: Factors explaining FP use (Binary Logistic Regression; N = 436)
Model 3 and 4
Model 3 N = 436 95.0% C.I for
Exp (B)
Model 4 N = 436 95.0% C.I for
Exp (B)
Constant -1.301 .654 .047 -1.251 .675 .064
Location B SE Sig Exp
(B)
lower Upper B S.E Sig Exp
(B)
Lower Upper
Urban 4.843 1.244 .000 0.008 0.001 0.09 -4.584 1.268 0.000 0.01 .001 0.123
Semi urban 1.317 0.461 .004 3.733 1.513 9.211 -1.738 0.592 .003 5.687 1.784 18.133
Interaction effects
Communication *
urban
0.605 1.219 0.62 1.831 0.168 19.961
Communication * semi
urban
0.753 0.557 0.176 2.124 0.712 6.331
Nagelkerke R2 =.686 Nagelkerke R2 =.667
*1= Rural reference category *
Annex 4: Contraceptives use among women in
Mwanza.
Have you ever used anything to avoid getting pregnant?
(n=440)
Residence Yes No
N % N %
Urban 29 19.9 117 80.1
Semi-urban 2 1.3 149 98.7
Rural 87 60.8 56 39.2
Discussion
In this article we studied the link between FP use
individual characteristics and behavioural
characteristics. We further explored the interaction
effect on communication and places of residence
on FP use. The study findings showed a significant
association between wealth and FP use. This could
suggest that access as important determinant to FP
use. People who are wealth are able to access
family planning compared to those who are poor.
This finding is supported by other studies, for
instance Bresch et al.; Onwuzurike &
Uzochukwi37,38
. Also this corroborates with other
studies for instance, Pile and Simbakalia44
found
significant associations between modern FP
methods and wealth.
However, when wealth was analyzed together
with regional dummies and interaction effect we
found that wealth was no longer a significant
influence on FP use. This could suggest that
wealth was not positively correlated with place of
residence.
As it was expected in model two, the study
findings showed that communication had a
significant associations with FP use, this could be
caused by the fact that the more couples
communicate facilitate the use of FP. This
corroborates other studies; for instance, a study
done by Hollerbach12
which contends that
communication among the spouses is important in
fertility decline. Also, Nyablade and Menken16
11. Mosha et al. Family planning in Tanzania
African Journal of Reproductive Health September 2013; 17(3): 67
found a statistical significant association between
couples communication and their contraceptive
use. Also, in this study communication in urban
area was significantly associated with FP use. The
issue of positive relationship between
communication and FP use could suggest that
urban areas are exposed to more information on
FP methods.
The study findings also showed a significant
association between social network and FP use.
This could be caused by the fact that people learn
about the use of FP and FP information from the
close friends/relatives. These findings are in the
same line with other studies with the same
findings, for example Casterine; Palloni; Behrman
& Kohler18, 19, 23
.
In addition, the study findings showed a
significant association between knowledge on FP
methods and FP use. This could be caused by the
fact that if people are exposed to information and
ranges of FP methods then it is easy for them to
make a choice on FP method. These findings are
consistent with other studies done elsewhere. For
instance, a study by Msoffe & Kiondo5
found that
lack of knowledge and information about FP
methods led to low use of FP in rural areas.
Moreover, Bruce48
pointed out that it is important
to provide information about FP methods
available, their scientific documented
contraindications and the advantages and
disadvantages associated with each method as
clients would be more ready to adopt and use FP
methods which they are adequately knowledgeable
about. Also, when knowledge, communication and
social network were put together in model three
with regional dummies, all of these variables have
significant influence on FP use. This could suggest
that communication, knowledge and social
networks are important factors for family planning
use in any place. In model four, communication,
knowledge, social network, urban and semi urban
areas have significant association with FP use.
This suggests that these variables are associated
with family planning use.
Furthermore, family planning use was
associated with wealth; those who are wealthier
used FP methods more compared to those who
were poor. This could suggest that access as
important determinant to FP use. This finding is
supported by other studies, for instance Bengtsson
& Dribe; Bresch et al.36, 37
, who found a positive
correlation between socio economic status and
fertility. Also Pile and Simbakalia44
found
association between FP use and wealth that FP
method use was high in the highest wealth
quintiles.
There was a significance association between
all variables of communication, social network and
knowledge. This implies that knowledge,
communication and social network are important
determinant to facilitate FP use among the people.
When people are knowledgeable about FP,
communicate with their spouses on FP and social
networks where they can get information
regarding FP are more likely to use FP methods.
This is in line with other studies for instance a
study done by Hollerbach12
, which contends that
communication among the spouses is important in
fertility decline. Education was not significantly
associated with FP use. This could be caused by
the fact that majority of respondents had primary
education. Also, employment was negatively
associated with FP use. This suggests that
employment interact negatively with these
behavioural characteristics on FP use. This was
contrary to other studies which found a positive
association between employment and education
for example a study by Hakim; Becker and
Lewis31,32
who found a positive correlation
between fertility and career; also Pile and
Simbakalia44
found relationship between education
and FP methods use. Urban and semi urban had a
significant association with FP Use. This suggests
that area of residence is an important determinant
for FP use. This agrees with other studies for
instance TDHS45
shows that women in urban areas
are more likely to use FP methods compared to
people living in rural areas.
Conclusion
The study findings showed significant associations
between, wealth, social network, knowledge and
communication among spouses. Therefore,
interventions targeting to increase family planning
information, communication among the couples,
and social networks among the people should be
designed and implemented. Others include raising
12. Mosha et al. Family planning in Tanzania
African Journal of Reproductive Health September 2013; 17(3): 68
public awareness on the importance of using FP
methods in all areas. In addition, it is important for
policy makers to make sure that family planning
methods are available to all people in rural and
urban areas at all time.
Competing interest
The authors declare that they have no competing
interests.
Author’s contributions
Idda Mosha and Ruerd Ruben took part in
designing the study, tools development, data
analysis and manuscript writing. Both authors
approved the final version of the manuscript
Acknowledgements
This study was funded by the Netherlands
Organization for Scientific Research (WOTRO).
We express our sincere gratitude to Radboad
University and Muhimbili University of Health
and Allied Sciences (MUHAS) for their
collaborations and supporting the research and sub
study that led to this paper. We express our sincere
gratitude to all participants and research assistants.
We thank, regional, districts and local authorities,
and others involved in support of the logistics
arrangements for conducting this study. We
convey special thanks to Liesbeth Linssen for her
helpful statistical advice to this paper.
References
1. Ronsmans C and Graham WJ. Maternal mortality: Who,
when, where, and why. On behalf of The Lancet
Maternal Survival Series Steering Group. Lancet
2006; 368: (9542), 1189-1200.
2. Singh S et al. Adding it up: The benefits of investing in
sexual and reproductive health care 2003. New York:
Alan Guttmacher Institute.
3. UN Department of Economic and Social Affairs
(UNDESA) 2004. World Contraceptive Use. (wall
chart). New York: 2003.
4. Caldwell J C and Caldwell P. Cultural Forces Tending to
Sustain High Fertility in Tropical Africa. World Bank
PHN Technical Note. World Bank, Washington, DC.
1985.
5. Msoffe GE and Kiondo E. Accessibility and use of Family
Planning Information by Rural People in Kilombero
District, Tanzania. African Journal of Library,
Archives and Information Sciences 2009; 13(1) 43-53.
6. Keefe SK. Women do what they want. Islam and
permanent Contraceptive and contraception in
Northern Tanzania. Soc Sci and Medicine 2006; 63(2):
418-429.
7. Hollos M and Larsen U. Marriage and contraception
among the Pare of northern Tanzania. Journal of
Biosocial Science 2003; 36(3): 255-278.
8. Ezeh AC. Gender differences in reproductive orientation
in Ghana: A new approach to understanding fertility
and family planning issues in sub-Saharan Africa.
Paper presented at the Demographic and Health
Surveys World Conference, Washington, DC. August
5-7. 1991.
9. Kritz MM, Gurak DT and Fapohunda B. Socio-cultural
and economic determinants of women’s status and
fertility among the Yoruba. Paper presented at the
annual meeting of the Population Association of
America, Denver, and Co.1992.
10. Lasee A and Becker S. Husband Wife communication
About Family Planning and Contraceptive Use in
Kenya. Intern Fam Plann Perspective 1997; 23 (1):
15-20 and 33.
11. Rutenberg N and Watkins SC. The buzz outside and
clinics: Conversations and contraception in Nyanza
Province, Kenya. Stud Fam Plann 2002; 28 (4): 290-
307.
12. Hollerbach PE. Fertility Decision-Making Process: A
Critical Essay in Bulatao RA and Lee RD (Eds).
Determinants of Fertility in Developing Countries,
Academic Press, New York, 1985, 340-380.
13. Shah NM. The Role of Inter-Spousal Communication in
the Adoption of Family Planning Methods. Pakistan
Development Review 1974; 13: 454-469.
14. Odimegwu CO. Family Planning Use and Attitudes in
Nigeria: A factor Analysis. Intern Fam Plann Persp
1999; 25 (2): 86-91.
15. Ebong RD. (Sexual Promiscuity: Knowledge of Dangers
in Institutions of Higher Learning. Journal of the
Royal Society of Health 1999; 114:137-139.
16. Nyablade L and Menken J. Husband wife communication:
Meditating the relationship of households’ structure
and polygyny to contraceptive knowledge, attitudes
and use. A social network analysis of the 1989 Kenya
Demographic and Health Survey: In International
Population Conference: International Union for
Scientific Study of Population. Montreal. 24 August –
1 September. 1993.
17. Bawah AA. Spousal Communication and Family
Planning Behaviour in Navrongo: A longitudinal
Assessment. Stud Fam Plann 2002; 33 (2): 185-194.
18. Casterline JB. Diffusion Processes and Fertility
Transition: Introduction. in Diffusion Processes and
Fertility Transition, edited by Casterline JB.
Washington, DC: National Academy Press. 2001, 1-
38.
19. Palloni A. Diffusion in Sociological Analysis. in
Diffusion Processes and Fertility Transition. Edited by
J.B Casterline. Washington, DC: National Academy
Press. 2001, 66-114.
13. Mosha et al. Family planning in Tanzania
African Journal of Reproductive Health September 2013; 17(3): 69
20. Brock WA and Durlauf SN. Discrete Choice With Social
Interactions. Review of Economic Studies 2001; 6(2):
235-60.
21. Bongaarts J and Watkins SC. Social Interactions and
Contemporary Fertility Transitions. Pop and Devt
Review 1996; 22(4): 639 - 682.
22. Watkins SC. Local and Foreign Models of Reproduction
in Nyanza Province, Kenya, 1930 -. 1998. Pop and
Devt Review 2000; 26(4): 725 - 60.
23. Behrman JR, Kohler HP and Watkins SC. Social
Networks and Changes in Contraceptive Use over
Time: Evidence from Longitudinal Study in Rural
Kenya. Demography 2002; 39(4): 713-738.
24. Rogers EM & Kincaid DL. Communication networks
towards a new paradigm for research. New York: Free
press.1981.
25. Montgomery MR and Casterline JB. Social learning,
social influence and new models of fertility. Pop and
Devt Review 1996; Supplement to Volume 22: 151-
175.
26. Montgomery MR and Chung W. Social network and
diffusion of fertility control: The Korean case
presented at the seminar on values and fertility
changes sponsored by the International Union for
Scientific Study of Population, Sion, Switzerland,
2000, 16-19. (Unpublished).
27. Gayen K and Raeside R. Social networks and
contraception practice of women in rural Bangladesh.
Soc Sci & Medicine 2010; 71(9): 1584 – 1592.
28. Doctor HV, Phillips JF and Sakeah E. The influence of
Changes in Women’s Religious Affiliation on
Contraceptive Use and Fertility Among the Kassena
Nankana of Northern Ghana. Stud Fam Plann 2009;
40(2):113- 122.
29. Hirsch JS. Catholics Using Contraceptives: Religion,
Family Planning, and Interpretive Agency in Rural
Mexico. Stud Fam Plann 2008; 39(2): 93-104.
30. Budig MJ. Are women’s employment and fertility
histories interdependent? An examination of causal
order using event history analysis. Soc Sci Research
2003; 32(3): 376-401.
31. Hakim C. A new approach to explaining fertility patterns:
Preference theory. Pop and Devt Review 2003; 29(3):
349 -374.
32. Becker GS. and Lewis, G.H On the interaction between
quantity and quality of children. Journal of Political
Economy 1973; 81(2):279-288.
33. Spain D and Bianchi S. Balancing act, Motherhood
marriage and employment among American women.
Russell Sage: New York.1996.
34. Clark G and Hamilton, G. Survival of the richest: The
Malthusian mechanism in pre-industrial England.
Journal of Economic History 2006; 66(3):1-30.
35. Wang F, Lee JZ, Tsuya NO and Kurosu S. Household
organization, co-resident kin, and reproduction. In:
Noriko OT, Wang F, George A, James ZL et al (Ed.).
Prudence and Pressure: Reproduction and human
agency in Europe and Asia, 1700-1900. Cambridge,
Mass: MIT Press. 2010, 287- 316.
36. Bengtsson T and Dribe M. Agency, social class, and
fertility in Southern Sweden, 1766
37. to 1865. In: Noriko O. Tsuya, Feng Wang, George Alter,
James Z. Lee, et al. (Ed).
38. Prudence and pressure: Reproduction and human agency
in Europe and Asia, 1700– 1900. Cambrige, Mass:
MIT Press. 2010, 159-194.
39. Bresch M, Derosas R, Manfredini M and Rettaroli R.
Patterns of reproductive behavior in preindustrial
Italy: Casalguidi, 1819 to 1859, and Venice, 1850 to
1869. In: Noriko
40. O. Tsuya, Feng Wang, George Alter James Z. Lee et
al(Ed.). Prudence and pressure: Reproduction and
human agency in Europe and Asia. 1700–1900.
Cambrige, Mass: MIT Press. 2010, 217-248.
41. Onwuzurike BK and Uzochukwu, B.S.C, Knowledge,
Attitude and Practice of Family Planning amongst
Women in a High Density Low income Urban of
Enugu, Nigeria. Afr J Reprod Health 2001; 5(2):83-
89.
42. Njogu W. Trends and determinants of contraceptive use in
Kenya. Demography 1991; 28(1): 83-99.
43. Odhiambo O. Men’s participation in Family Planning
Decisions in Kenya. Pop Studies 1997; 51(1): 29-40.
44. Ntozi JP. M and Kabera, J.B Family Planning in Rural
Uganda. Knowledge and Use of Modern and
Traditional Methods in Ankole. Stud Fam Plann
1991; 22(2):116-123.
45. Plummer ML, Wight D, Wamoyi J. Mshana G, Hayes RJ
and Ross DA. Farming with Your Hoe in a Sack;
Condom Attitudes, Access and Use in Rural Tanzania.
Stud Fam Plann 2006; 37(1): 29-40.
46. Chen S and David KG. Determinants of Contraceptive
Method Choice in Rural Tanzania between 1991 and
1999. Stud in Fam Planning 2003; 34(4):263–276.
47. Pile JM and Simbakalia C. Tanzania Case Study: A
successful Program Loses
48. Momentum. A Repositioning Family Planning Case
Study. Acquire Project. December, 2006.
49. National Bureau of Statistics [Tanzania] and ORC Macro.
Tanzania Demographic and Health Survey 2004/05
Report. Dar es Salaam, Tanzania: National Bureau of
Statistics and ORC Macro, 2005.
50. National Bureau of Statistics [Tanzania] and ORC Macro.
Tanzania Demographic and Health Survey 2010
Report. Dar es Salaam, Tanzania: National Bureau of
Statistics and ORC Macro, 2010.
51. Health facility data report, Tanzania Ministry of Health
and Social Welfare.2009, Unpublished.
52. Bruce J. Fundamental elements of quality of care: A
simple framework. Stud Fam Plann 1990;
21(2):61-91.