Knowledge, attitude and acceptability of the postpartum instra-uterine contraceptive device in Lusaka, Zambia

Abstract

Postpartum intrauterine contraceptive device (PPIUD) is a long acting reversible contraceptive. Since its introduction in Zambia in 2009, the uptake has remained low accounting for less than 10 percent of IUD insertions whose prevalence is less than one percent of modern contraceptive methods. Worldwide, the low uptake of the PPIUD is due, in part, to lack of knowledge about PPIUD, medical staff advising against PPIUD based on out-dated information, lack of trained staff to provide the service and failure of clients to return for insertion due to logistic challenges, among other reasons. The low uptake is despite the numerous advantages offered by the method including easy insertion, cost effectiveness, lack of hormone-associated side effects and being a reliable and effective contraceptive. In addition, the method does not interfere with lactation. This study aimed to determine the level of knowledge and attitudes about the PPIUD among antenatal and postnatal clients at University Teaching Hospital (UTH) and in Lusaka clinics where the service is provided. It also aimed to determine socio-demographic and attitudinal factors influencing the acceptability of the PPIUD amongst clients. This was a cross sectional study conducted at UTH and three urban Lusaka health facilities that provide PPIUD. A structured interviewer administered questionnaire was used to obtain data related to knowledge and attitudes on PPIUD of antenatal and postnatal women. Analysis consisted of descriptive analyses related to participants’ knowledge and attitudes. Bivariate analyses were conducted to select candidate variables for the multivariable analysis to identify their independent effects of determinants of knowledge and attitudes. The study found that most of the 316 clients were aged 25-35 years old (38.7%), married (85.8%), multiparous (52.2%), from high density residential areas (80.7%). Most obtained knowledge from a health worker (68.7%) and 70.2% had high knowledge of PPIUD. Their attitude was positive regarding effectiveness, privacy, pain, activity, though almost half expressed concern over bleeding (48.7%). Only over a quarter (27.5%) would agree to accept PPIUD mainly due to preference for another method - injectable and the pill being popular choices. Apart from the facility site, no other factors were associated with poor knowledge. With facility Chipata as referent, the other 3 facilities had between 5.65 to 7.59 odds of poor to moderate knowledge. Participants at UTH had odds of 5.65 (95% CI 2.22 to 14.36) of poor to moderate knowledge Although knowledge of the PPIUD was high and attitude was good among clients and healthcare providers, this did not translate into improved acceptance of the method. Participants at some facilities had better knowledge than at others.