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Original Article
Knowledge and attitude toward vasectomy among antenatal clinic attendees in a tertiary health facility in Nigeria Nyengidiki Kennedy Tamunomie, Oriji Vademene, Olaka Ebienju Walter Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
A B S T R A C T Background: Nigeria is the most populous nation in Africa and has a high fertility rate and low contraceptive prevalence. Various strategies have been developed to reduce the fertility rates, all aimed toward increasing contraceptive prevalence. Male sterilization is a safe, cheap, and effective method of contraception, but female perception and awareness of vasectomy may greatly affect its utilization. Objective: To determine the knowledge and attitude of antenatal patients in a Nigerian tertiary health facility toward vasectomy. Subjects and Methods: A cross‑sectional study was conducted among antenatal clinic attendees. The participants were selected via systematic random sampling technique and a structured pretested questionnaire was used to assess their knowledge and attitude toward vasectomy. Data analysis was done using SPSS version 17 statistical software for windows XP and results were expressed in percentages. Results: One hundred and fifty respondents participated in the study, 83 (55.3%) were aware of vasectomy, 59 (71.08%) accepted it as a method of male contraception, and only 23 (38.98%) approved its use for their spouse. The main source of information on vasectomy was from health workers 53 (63.86%). Almost half of the women (47.8%) who accepted vasectomy did so because they felt men should also participate in family planning. Most of the women who disapproved of vasectomy cited it as an unpopular method. Conclusion: The approval of use of vasectomy by female partners is poor. Majority of these patients would not recommend it to their spouse as they have wrong perception of the procedure. Re‑education of medical workers and wider public education through mass media may improve the approval of vasectomy by women for their spouses. Keywords: Awareness, choice, perception, Port Harcourt, vasectomy
INTRODUCTION The 2006 census revealed that the population of Nigeria was a little above 140 million persons with a national population growth rate of 3.2% per annum. [1] Current estimates have it that the population of Nigeria is well over 170 million and rising with a high fertility rate of 5.5 births per woman and a relatively Corresponding Author: Dr. Nyengidiki Kennedy Tamunomie, Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria. E‑mail:
[email protected] Access this article online Quick Response Code: Website: www.smjonline.org DOI: 10.4103/1118-8561.196363
high mortality ratio of 576 per 100,000 live births. [1] These data suggest that more Nigerian women get pregnant and more are dying from pregnancy and its related complications. Thus, there is a need to limit family size by reducing the number of unwanted pregnancies. The Safe Motherhood Initiative, a global campaign to reduce maternal mortality, launched in 1987, identified family planning as one of four strategies to reduce maternal mortality in developing countries, where 99% of all maternal deaths occur. [2] Family planning or contraceptive services have helped reduce This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms. For reprints contact:
[email protected] Cite this article as: Tamunomie NK, Vademene O, Walter OE. Knowledge and attitude toward vasectomy among antenatal clinic attendees in a tertiary health facility in Nigeria. Sahel Med J 2016;19:201-5.
© 2016 Sahel Medical Journal | Published by Wolters Kluwer ‑ Medknow
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Tamunomie, et al.: Vasectomy choice for spouses by antenatal clinic attendees in Port Harcourt
maternal mortality and population growth in developed countries. The contraceptive prevalence rate in Nigeria is low compared to those of Ghana, South Africa, and the United Kingdom.[2,3] The low rates of contraceptive use in Nigeria and other developing countries is largely influenced by cultural perceptions and misconceptions about family planning methods, poverty, low levels of female education, as well as the unmet need for family planning from unavailability, and lack of access to family planning services.[3] In Nigeria, the level of unmet need for family planning (20%) exceeds the level of contraceptive use (15.1%).[1,3] Male contraception is a viable addition to the range of contraceptive options, but there are, however, few options for male contraception and account for only 14% of contraception worldwide.[4] Vasectomy is a safe and simple outpatient procedure which has been performed worldwide with low failure rates and less incidence of complications.[4] While high acceptance rates have been reported in developed countries such as the USA, vasectomy is still not widely accepted in many African countries including Nigeria.[5] It is seen as a neglected form of permanent contraception in Nigeria and has very low acceptability rates.[5‑7] This low level of use may be attributable to lack of public awareness of its effectiveness, safety profile, and convenience.[5,8] The Nigerian demographic and health survey 2013 reported that the knowledge of vasectomy was 15.5% among all women and 42.8% among men.[1] Most of the information women had heard were incomplete or incorrect and their perceptions of vasectomy were driven by information which were influenced by some cultural beliefs and practices which might discourage their partners from having a vasectomy.[9] Women just like men have doubts about vasectomy and have great influence on the choice of contraceptive method by their spouse.[8] It is against this background that this study aims to determine the influence of awareness and perception of vasectomy among women attending antenatal clinic in the University of Port Harcourt Teaching Hospital (UPTH) and how it will influence the choice of vasectomy by their husbands.
SUBJECTS AND METHODS This is a cross‑sectional study involving 150 antenatal clinic attendees at the UPTH. The study recruited 150 women who attended routine antenatal care between July 07, 2014 and July 21, 2014 following the administration of 150 pretested structured 202
questionnaires after due consent was obtained from the patients. The antenatal clinic runs Monday to Friday every week and had an average antenatal attendance of 150 women per day. The prestructured questionnaires were administered on every 15 women as they presented to the antenatal clinic over period of 3 weeks. Ten women were systematically randomly selected each day and questionnaires administered to them. Women who refused to give consent for the study were excluded; in addition, women who had already received the questionnaire previously were excluded subsequently. Sample size was determined using the formula proposed by Kish for the estimation of single proportions.[10] The required minimum sample was 150. Information obtained included: Age, educational status, religion, parity, awareness, and perceptions of male sterilization (vasectomy). The data was analyzed using SPSS version 17 statistical software (SPSS, Inc; Chicago USA). The data were presented in a tabular format and compared using simple percentages. Regression equation was applied when indicated and Chi‑square test was used to test categorical variables with P
