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1. KNOWLEDGE, ATTITUDE, AND PERCEPTIONS TOWARDS INTRAUTERINE CONTRACEPTIVE DEVICE USE AMONG WOMEN AGED 15-49 YEARS, ATTENDING KAWEMPE REFERRAL HOSPITAL By: HER - - NAME - - REG NO: HER REG. NO.- - Supervisor: HER SUPERVISOR

2. - “Family planning refers to a conscious effort by a couple to limit or space the number of children through the use of contraceptive methods. Modern contraceptive methods include combined oral contraceptives (COCs) or “the pill”, Progestogen only pills (POPs) or “the mini-pill”, Progestogen only injectables, Monthly injectables or combined injectable contraceptives (CIC), Combined contraceptive patch and combined contraceptive vaginal ring (CVR), Intrauterine device (IUD) and many others (WHO, 2018). The intrauterine methods are top tier contraceptives as they are long lasting, convenient, well-liked by users, cost-effective, unobtrusive, reversible, and have failure rates less than 1% per year for perfect and typical use and thus rivaling the efficacy of permanent tubal sterilisation. - Despite the government efforts to reduce the high fertility levels and increase uptake of family planning services in Uganda, data from the Uganda Demographic and Health Survey (UDHS) of 2016 and UDHS 2022, shows that family planning use was still low at 30% which is the lowest in the East African region. - This study will aim at exploring the knowledge, attitudes and perceptions regarding IUD among women aged 15-49 years, attending Kawempe Referral hospital. INTRODUCTION

3. PROBLEM STATEMENT - IUCD has established itself as an effective, reliable, and safe method of contraception with minimal complications. However, its acceptance remains low (Valliappan A. et. al, 2017). - While relevant family planning (FP) services and products are provided by Government of Uganda and implementing partners, preliminary insights from the Uganda Demographic and Health Survey (UDHS) 2022, highlight low uptake and high unmet need for contraception among married women. - Findings made by different researchers, show that the utilization of IUD is very low in Uganda and other African countries. And there is insufficient information regarding its knowledge, attitude and perception towards its use among women in Uganda. - It is thus imperative to determine the knowledge, attitude and perceptions toward the use of intrauterine contraceptive devices (IUDs) among women ages 15-49 years, attending Kawempe Referral hospital.

4. Objectives of the Study and Research Questions Specific objectives To determine the level of knowledge among clients regarding the use of intrauterine contraceptive devices. To explore the attitudes of women towards the use of intrauterine contraceptive devices as a contraceptive method. To examine the perceptions of women towards using intrauterine contraceptive devices. Research Questions What is the level of knowledge among clients regarding the use of intrauterine contraceptive devices? To what extent does attitudes of women towards the use of intrauterine contraceptive devices as a contraceptive method, influence their use? iii. What are the perceptions of women towards using intrauterine contraceptive devices?

5. Significance, Scope of the study & Narrative of the conceptual framework SIGNIFICANCE : By understanding the knowledge, attitudes, and perceptions towards use of IUDs, the findings of the study may benefit the following stakeholders; Healthcare providers, Policymakers, and educators to develop targeted interventions and educational programs to address the barriers and promote informed decision-making regarding IUD use, thus improving reproductive health outcomes, contributing to empowering women and promoting their reproductive autonomy. Scope of the study : The study will be conducted between the months of February and March 2024, and will focus on determining the level of knowledge of IUD, among clients attending Kawempe referral hospital, their attitude towards the use of IUD and their perception of the IUD as a contraceptive method. Conceptual framework : The study will be strictly limited to the influence of Knowledge, Attitude and Perception (KAP) on clients’ use of IUDs. The study will examine in details how independent variables (Knowledge, Attitude and Perception) affect the dependent variable (use of IUDs).

6. Literature review Knowledge of IUCD contraceptives Studies by Blanchard K. et. al, (2014) conducted in South Africa and Zimbabwe as well as that done in Malawi by Mwafulirwa T. et. al., (2016) all reported less than 50% of HCW respondents having training on IUCDs. Contrary to this, 86% (95% CI: 79%, 91%) of HCWs in the Amhara Region of Ethiopia were seen to have IUCD insertion training. The overall proportion of HCWs across seven studies in East, West and Southern Africa who had received IUCD insertion training was 50% (95% CI: 34% to 67%; Chi2=285.18; df= 6; p<0.001; I2= 97.90%). Attitudes and perceptions concerning IUCD contraceptives In his study about safety of IUDs for WLWHIV, Blanchard K (2014), showed that the IUD contraceptive is safe for WLWHIV was observed in nationally representative surveys in South Africa. While in Zimbabwe (5%; 95% CI: 4%, 7%). The highest proportion reported (72%; 302 95% CI: 53%, 86%) was from HCWs in Cape Town and Umtata, South Africa ( Gutin SA. Et. al., 2011). Similarly, a study in Kenyan by Tumlinson K. (2015), showed that, women are usually at least 20 years of age before inserting an IUD.

7. Methods Study Setting : The study will be conducted at Kawempe referral hospital, formerly known as KCCA health centre-IV, a government premier Obstetrics and Gynaecological facility, that was renovated, restructured and expanded in 2014, located in Kawempe village, Kawempe Division of Kampala City. Study Design : An analytical Cross-sectional study design – using quantitative methods of data collection. Study Population : Study participants will be selected from women ages 15-49, attending the different departments of Kawempe referral hospital. Sample size determination : The sample size shall be statistically determined using the Taro Yamane formula; n = n/1+N (d). Sampling Method : Convenience sampling technique will be used to select the sample of 80 participants, with each woman meeting the inclusion criteria and voluntarily willing to consent to participate after explanation of the study purpose recruited. Inclusion and Exclusion criteria : All women ages 15-49, attending the different departments of Kawempe referral hospital, who will be available and voluntarily consent to participate in the study.

8. Methods Cont … Definition of variables : Independent variables (knowledge, Attitudes, and Perceptions). Dependent variable (Use of IUDs). Data collection instrument : The data collection instrument for this research, will be a well-structured researcher developed questionnaire. - Developed based on the research objectives and shall consist of four sections (A, B, C and D). - To be used in tandem with the Likert scale - as it provides an ordered manner to enable respondents to select one option that best represents their point of view. Data Quality Control : The following quality control protocols will be undertaken to ensure reliability of results to be obtained; i . Conducting a pilot study. ii. Use of clear selection criteria so as to attain accurate results and eliminate bias. The expertise of the research supervisor will be sought in order to ensure that the correct variables will be included in the study tool.

9. Methods Cont … Data Collection Procedure : Ethical approval will be obtained from the Research and Ethics Committee of Victoria University. - Acquire an introductory letter to be presented to the administration and/or the Research and Ethics Committee or in lieu of which, the administration at Kawempe referral hospital to seek for permission to conduct the study. - The respondents will be met at the hospital and researcher will ask each respondent, questions from the questionnaire to obtain data about the study variables and their responses will be filled in the questionnaire. Data Management : Data obtained will be stored in a file folder under lock and key, where it will only be accessible to the investigator. This will be aimed at preventing any losses and/or manipulation of the data. Data Analysis & Presentation : Data will be organized and tallied manually by hand then entered and cleaned using Epidata. Analysis will then be carried out using Statistical Package for Social Sciences (SPSS®) for Windows. Means and standard deviations (SD) will be calculated for normally distributed continuous data, while proportions and frequencies will be used for categorical variables. The influence of knowledge and attitude towards the use of IUD will be determined using bivariate analysis. Ethical Consideration : Approval of the study, informed consent, confidentiality, privacy, anonymity and rights to withdraw from the study.

10. Methods Cont … Study Limitations : The knowledge and perception of IUD use among women attending Kawempe referral hospital will be assessed on a self-reported basis. This may increase the risk of biased responses, as some respondents may not genuinely answer the questions in fear of exposing their ignorance of lack of IUD knowledge to the researcher/ research assistants. Dissemination of study findings : Two copies of the research report will be submitted to Victoria University, as a requirement for the partial fulfillment of the requirements for the award of a Degree of Bachelor of Nursing Sciences of Victoria University. A copy of the report will also be submitted to the management and administration at Kawempe National Referral hospital. A plan for publication of findings in research journals will also be made.

11. References Gbagbo FY, Kayi EA (2018). Use and discontinuation of intrauterine contraceptive device in the Greater Accra Region of Ghana. Contracept Reprod Med. Stoddard A, McNicholas C, Peipert JF (2011). Efficacy and Safety of Long-Acting Reversible Contraception. Drugs.;71:969–980.   MOHCDGEC [Tanzania Mainland], MOH [Zanzibar], NBS, OCGS and I. Tanzania Demographic Health Survey (2016). Demogr Heal Surv.;2:207. Nagamala J, Muthulakshmi P, Kayalvizhi M. (2018). A Study to Assess the Knowledge, Practice and Attitude on Temporary and Permanent Contraceptive Methods among Primi and Multi Mothers in Selected Areas in Coimbatore. Heal Sci J.;12(03):1–5. Uganda Demographic and Health Survey (UDHS) (2022). Vakilian K, Molavi S, Zamani AR, Goodarzi M. (2018). Effect of motivational interviewing on using intrauterine device in women at high risk for pregnancy. Open Access Maced J Med Sci.;6(7):1305–9.

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