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KNOWLEDGE
AND PRACTICE OF CONTRACEPTIVES AMONG FEMALE STUDENTS
ABSTRACT
Access to
contraceptive has become increasingly crucial for adolescents because many are
sexually active at earlier ages than in the past. This will further compound
overall levels of maternal mortality in Nigeria tertiary institutions.This
research was specifically designed to determine the knowledge and utilization
of contraceptives among female students in Delta State University, Abraka. A
total of 107 questionnaires were distributed and 97 were retrieved. majority of
respondents were within the age bracket of 20-24 years of 35.1%. 79.4 % of the
respondents were single. More than half (95%) of the respondents knew about
contraceptives.reason for the lack of detailed knowledge on this subject may be
linked to the sources of information; majority of the students got to know
about contraception from their friends/peers (39.2%). The study disclosed that
there is a high number of females students who practiced sexual intercourse
which may result into unintended pregnancy. Also revealed that there is a low
trend of use of modern contraceptives for inadequate knowledge. It is therefore
recommended that the use of contraceptives amongst undergraduate female
students that are attributed to esteem and habit of students should be reviewed
for preferred methods and legally backed practice and use of contraceptives by
undergraduates.
CHAPTER ONE
INTRODUCTION
UNAIDS
(2007) estimated that 33.2 million women had HIV infection worldwide. In many
regions of the world more women than men are at risk of HIV infection with not
less 50% of all new daily infections in sub-Saharan Africa being in women.
Children account for 12% of all new infections and globally 2.5 million
children less than 15years of age were living with HIV in 2007, about 1,200 children
under the age of 15years became infected with HIV daily (UNAID/WHO, 2007),
without appropriate care and treatment, more than 50% of newly infected
children will die before the second birthday. In 2008, around 430,000 children
under 15years become infected with HIV, mainly through mothers –to child
transmission (MTCT), infection occurred in Africa where AIDS is beginning to
reverse decades of steady progress in child survival. In high income countries
MTCT has been virtually eliminated thanks to effective HIV counseling and
testing, access to antiretroviral therapy ART, Safe delivery practices, and the
widespread availability and safe use of breast-milk substitutes. If these
interventions were used worldwide, they could save the lives of thousands of children
each year. Owing to the transmissibility of HIV from mother to child, the
feeding of HIV-exposed infants remains a significant challenge in controlling
the spread of HIV/AIDS. The dilemma concerning feeding infants of HIV-positive
mothers is how to balance the risk of HIV transmission through breastfeeding
with the risk of death from causes other than HIV such as pneumonia, diarrhoeal
diseases and malnutrition among formula-fed infants (WHO, 2010). Exclusive
breastfeeding (EBF) plays a critical role in the overall health of infants. It
is estimated that 3% of all under-5 mortalities in low-income countries could
be prevented through optimal breastfeeding during the crucial first year of
life (WHO, 2013). Optimal breastfeeding is considered to be EBF for the first 6
months of life, followed by continued breastfeeding combined with safe and
nutritionally adequate complementary feeding up to 24 months of age (WHO,
2009).EBF is regarded as a global health goal given its strong association with
reduced morbidity and mortality, particularly in low-income countries where
safe water and sanitation are often lacking. The HIV/AIDS epidemic is one of
the major factors challenging women's health with 20 million women living with
the virus and more than 2 million pregnancies occurring in HIV sero-positive
women annually. Thus, HIV infection has become a major problem complicating the
management of pregnancy. In Africa, HIV prevalence varies considerably, with
most countries in Southern Africa having more than one in five pregnant women
infected, and in a few sub-Saharan countries, median HIV prevalence in
antenatal clinics in 2003 exceeded 10% (McIntyre,2005). As at 2005 the
prevalence in Nigeria was 4. 4%, and by the end of 2006, it was estimated that
there are 2. 99 million Nigerians living with HIV, with 305, 080 adult new
infections and 74, 520 in children, largely (up to 90%) acquired through
mother-to-child transmission (MTCT). Between 25 and 44% of mother-to-child
transmission (MTCT) of HIV occurs through breastfeeding (FMOH, 2007) The
promotion of breastfeeding is a key component of infant health polices globally
because of its obvious health benefits. It is widely practiced not only in
Nigeria, but most of Africa, as it is socially and culturally acceptable and natural.
However, in the present context of HIV epidemic, this has become a public
health dilemma as the overwhelming source of HIV infection in young children is
through MTCT (FMOH, 2007). There is also the dilemma of infant feeding
decisions by HIV sero-positive mothers, because most breast milk transmission
of HIV- 1 occurs in the first four months of life, a time when replacement
feeding carries the greatest risk of increasing infectious disease morbidity
and the benefits of the breastfeeding are highest. In developing countries,
decisions regarding the best mode of infant feeding can be difficult due to
social, economic and practical constraints. The relative risks of morbidity and
mortality associated with replacement feeding vary according to many factors:
the environment, individual circumstances of the mother and her family
including her education and economic status (WHO, 2004). The WHO/UNAIDS
strategic response to prevention of HIV infection in infants centered on four
'pillars': primary prevention of infection generally in women, prevention of
transmission from HIV infected women to their infants and provision of
treatment, care and support to HIV infected women and their families (WHO,
2004) . Thus, the option most likely to be chosen by HIV infected women who do
not wish to risk breastfeeding their infants is replacement feeding with
formula or other foods. However, WHO recommended that HIV infected women avoid
breastfeeding when replacement feeding is acceptable, feasible, affordable,
sustainable and safe (AFASS) (Throne C., Semenenko I., Pilipenko T., Malyuta,
2009). Most women in sub-Saharan Africa have their human immunodeficiency virus
(HIV) status diagnosed during pregnancy because of testing available through
programmes for the prevention of mother-to-child transmission (PMTCT) of HIV.
The programme commenced in Nigeria in 2001, and has since undergone several
scale-up of both in scope and coverage mainly in secondary and tertiary health
facilities. Despite all these, participation/enrollment has been very low. It
is in the light of this, that an assessment of feeding practices and
determinants of feeding practices among HIV sero-positive mothers was carried
out in one each of secondary and tertiary health facilities in Abuja, the
capital of Nigeria, with a view of identifying relevant and appropriate
interventions for resolving some of the problems faced by these mothers
PURPOSE /AIM
OF STUDY The study is carried out to explore the knowledge and practice of safe
infant feeding amongst mothers living with HIV attending postnatal clinic of
Central Hospital Sapele, Delta State.
STATEMENT OF
PROBLEM The 2010 HIV Sero-prevalence sentinel survey conducted among women
attending antenatal clinics in Nigeria. Shows that HIV/AIDS is still on the
increase among pregnant women, HIV/AIDS still remain one of the leading causes
of morbidity and mortality in Sub-Saharan Africa. According to the study
reports by the former Minister of Health Nigeria Professor Onyebuchi Chukwu,
the epidemic has affected all parts of the country with varying degrees of
severity. The current national prevalence of 4.1%, the number of people
infected is estimated at about 3.1 million. This means that Nigeria still has
the second largest number of people living with HIV/AIDS in sub-Saharan Africa
and the highest in West African Sub-region. As at 2009, there were 1,074 health
facilities where HIV counselling and testing services can be accessed.
Presently there are 875 facilities providing services on PMTCT of HIV and 393
health facilities providing Anti-retroviral drugs. The problem is; are they
adequately utilised? Very few persons go to such centres. Despite the awareness
of HIV/AIDS and the facilities provided by the Government of Nigeria, most HIV
positive pregnant women are still reluctant to enroll for the prevention of
mother-to-child transmission of HIV programmes. In order to offer better
services, the attitude of the women to child feeding would help programme
designers to better understand the target services audience for specific
intervention (Bulawayo Health Services report, 2006). The problems so
identified above are not different from what the researcher observed in Sapele.
Hence this study which investigated the knowledge and practice of infant
feeding amongst mothers living with HIV attending postnatal clinic.
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