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ORIGINAL ARTICLE
Year : 2016  |  Volume : 19  |  Issue : 2  |  Page : 182-188

Contraceptive knowledge and practice among senior secondary schools students in military barracks in Nigeria


1 Medical Department, Ministry of Defence Headquarters Abuja, School of Postgraduate Studies, University of Ibadan, Ibadan, Nigeria
2 Department of Preventive and Social Medicine, University College Hospital, Ibadan, Nigeria
3 Department of Community Medicine, Nnamdi Azikiwe University, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
4 Department of HIV Care; Department of Community Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria

Date of Acceptance01-Sep-2015
Date of Web Publication9-Feb-2016

Correspondence Address:
Dr. C C Nnebue
Department of HIV Care and Community Medicine, Nnamdi Azikiwe University, Nnamdi Azikiwe University Teaching Hospital, PMB 5025, Nnewi, Anambra State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1119-3077.175970

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   Abstract 

Background: Many adolescents lack adequate health education coupled with low contraceptive use. As a result of this, they may experience the negative health consequences of early, unprotected sexual activity as well as its social and economic implications.
Objective: To determine the level of knowledge of contraceptives and its use among senior secondary schools students in Ojo military barracks, Lagos.
Methodology: A cross-sectional study of 400 senior secondary schools students in Ojo military barracks, Lagos, selected using the multistage sampling technique was done. Data were collected using pretested, self-administered structured questionnaires. The data were analyzed using Statistical Package for Social Sciences version 17 (International Business Machine USA). Tests for statistical significance were carried out using Chi-square tests for proportions. P < 0.05 was considered significant.
Results: The response rate was 100%. Majority of them 391 (97.8%), were in the adolescent age group (10–19 years). The mean age was 15 ± 2.4 for males and 15 ± 2.2 for the females. Two hundred and seventy (67.5%) of them had correct knowledge of the use of condoms while 48 (31.1%) of the sexually active respondents have ever used any form of contraceptive with no statistically significant difference between the male and female respondents (P = 0.338). The most common barrier to contraceptive methods as reported by 131 (85.1%) of respondents was their being too embarrassed to source for the commodities.
Conclusions: There was a fairly high level of knowledge and relatively low use of contraceptives. We recommend that efforts should be intensified to promote the safe sexual practice and contraceptive use in this age group.

Keywords: Contraception, knowledge, Lagos, military barracks, practice, students


How to cite this article:
Chimah U C, Lawoyin T O, Ilika A L, Nnebue C C. Contraceptive knowledge and practice among senior secondary schools students in military barracks in Nigeria. Niger J Clin Pract 2016;19:182-8

How to cite this URL:
Chimah U C, Lawoyin T O, Ilika A L, Nnebue C C. Contraceptive knowledge and practice among senior secondary schools students in military barracks in Nigeria. Niger J Clin Pract [serial online] 2016 [cited 2019 Sep 21];19:182-8. Available from: http://www.njcponline.com/text.asp?2016/19/2/182/175970


   Introduction Top


The Nigerian National Demographic Health Survey, 2008 revealed that 16% of young women and 6% of young men aged 15–24 years, initiated sexual activity before age 15.[1] About half of young women (49%) and more than a quarter of young men (26%) aged 18–24 years had first sexual intercourse before the age of 18.[1] Despite risky sexual behaviors and increased sexual activities among adolescents; adequate health education is lacking, and contraceptive use remain low in both their first and last sexual encounters.[2],[3] In tandem with this is the high prevalence of reported experience of sexually transmitted diseases, reliance on unsafe abortion and many abortion-related complications.[4]

Every year about 16 million adolescents aged 15–19 give birth.[5] The health of young people all over the world, including Nigeria, represents a common future. Yet adolescent sexuality studies in Nigeria still report health and social outcomes such as unwanted pregnancies and attendant consequences such as maternal mortality and increasing the number of school dropouts.[6],[7],[8],[9] Complications from pregnancy and childbirth have also been reported as the leading cause of death in girls aged 15–19 years in low and middle-income countries (LMIC).[10] These outcomes could be stemmed by ensuring good knowledge of contraceptives and its use among these age group.

The negative effects of modernization among other factors reduce the influence that families have on effectively promoting a positive attitude and healthy sexual behavior among adolescents and youths.[11] These effects are further worsened by unstable family setups in the barracks, often as a result of a frequent job-related travel and transfers. Studies have shown that good knowledge, as well as correct and consistent use of contraceptives can go a long way in promoting sexual and reproductive health, thus averting these negative outcomes that result from poor knowledge and practice of contraception.[12],[13] Though there have been several studies on the reproductive health behavior of adolescents in the general population, no similar studies have been carried out in any barracks to determine the reproductive health status of young people who live and grow up here. With institutionalization in the barracks, it is important to create a supportive environment that would positively influence knowledge and behavior of adolescents and also help in increasing access to correct and complete information on reproductive health commodities. Furthermore, an intervention program in this kind of enclosed environment is likely to be very effective. It is against this backdrop that this survey will determine the level of knowledge of contraceptives and its use among senior secondary schools students in Ojo military barracks, Lagos.


   Methodology Top


Description of study area

Ojo military cantonment is one of the military barracks in Nigeria. It is located in Ojo local government area of Lagos state in south western Nigeria. The barracks have an estimated population of over 30,000 inhabitants comprising military personnel from various army units, their families, and dependents.

Three secondary schools are located within the same vicinity (about half to one kilometer away from each other). The schools include one army-owned co-educational school (Command Day Secondary school [CDSS]) and two Lagos state-owned schools, Cantonment Girls' secondary and Cantonment Boys' High schools.

The barracks have located in it, office blocks, a vocational center, two churches (one Catholic and one Protestant) and a mosque, a Medical Centre that offers curative services, immunization and family planning services to the military personnel, their families, and dependents.

Study design

A cross-sectional descriptive survey was done.

Study population

The study population comprises senior secondary schools (SS) students (SS1–3) of the three secondary schools. The three schools have a total population of 2903 senior students (SS1–3); a breakdown of this population is as follows: CDSS = 1512; Army Cantonment Boys' Senior Secondary School = 671; Army Cantonment Girls' Senior Secondary School = 720. Each class (SS1–2) is made up of between 5 and 7 arms in each of the three schools while SS3 classes have 3–4 arms. However, students residing outside the barracks and students whom none of the parents is a military personnel are excluded from this study. This group may not be influenced by enclosed environment as well as the way of life within the barracks.

Sample size determination

In a previous study in Nigeria, among the similar population, the level of sexual activity (P) was 52.0%.[14] Therefore, P = 0.52. The sample size was determined using the Leslie Fischer's formula for the calculation of sample size in populations > 10,000, n = z 2 pq/d 2,[15] where n = minimum sample size;P = proportion of sexually active; d = desired precision at 5%; z = a constant at 95% confidence interval z = (1.96). Substituting values:



Then a conversion was made using the formula for the calculation of minimum sample size in populations < 10,000:



nf = 340 students.

Anticipating a response rate of 90%, an adjustment of the sample size estimate to cover for nonresponse rate was made by dividing the sample size estimate with a factor f, i.e., n/f, where f is the estimated response rate.[15] Thus, the calculated sample size = 340/0.90 = 378 students. However, 400 questionnaires were distributed.

Sampling technique

A multistage sampling technique was used.

First, simple random sampling technique was used to select three arms from each of the classes (SS1–2) and 2 arms of the SS3 classes.

Second, stratified sampling technique was used to allot respondents according to relative school populations.

  • CDSS = 232 = 58.0%
  • Cantonment Girls' High school = 95 = 23.8%
  • Cantonment Boys' High school = 73 = 18.2%


Total minimum sample size = 400 = 100%.

Third, the class registers were used as the sampling frame. For the single-sex schools, simple random sampling technique was used to select eligible and consenting students until the required number allotted to the selected arms in each class (SS1–3) has been obtained. For CDSS (which is a co-educational school), the class registers were initially stratified by sex into males and females before proportionate sample of each sex was taken using simple random sampling technique was used to select eligible and consenting students until the required number allotted to the selected arms in each class (SS1–3) has been obtained.

Data collection technique

Data collection in this study was done using pretested, self-administered structured questionnaires developed from a review of relevant literature and interview of some adolescents. All questions were written in English language and pretested in similar schools in Navy Barracks Ojo. This was done, to check for its reliability and validity. Furthermore, determined were the appropriateness of format and wording of the questionnaire as well as the time needed to fill them. Thereafter, the instruments were reviewed by senior colleagues, necessary adjustments, and corrections were effected before administering the questionnaire to the study participants.

The questionnaire is divided into six sections (A-F) to obtain data on (a) the sociodemographic characteristics of the respondents; (b) respondents' knowledge of contraceptive uses and timing; (c) pattern of contraceptive use among respondents; (d) distribution of contraceptive awareness and types of contraceptive methods used by respondents; (e) respondents' sources of obtaining contraceptives; and (f) barriers to contraceptive use among the sexually active.

Data management and analysis

The data were scrutinized and entered into the computer. Data cleaning was done by carrying out the range and consistency checks. Data were analyzed in respect to the demographic characteristics of the respondents. Descriptive and analytical statistics of the data were carried out using Statistical Package for Social Sciences (SPSS) Windows version 17.0. Chicago, United States SPSS Inc.[16] Tests of statistical significance were carried out using Chi-square tests for proportions. P < 0.05 was considered significant. Descriptive data were presented as simple frequencies and percentages.

Ethical consideration

Written permission to carry out this study was sought and obtained from the barracks' commander and the principals of the three schools. Consent of the respondents was also solicited and obtained for the conduct and publication of this research study. All authors hereby declare that the study has been examined and approved by the University of Ibadan and University College Hospital ethics committee, Nigeria and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

The questionnaires were administered individually to the respondents in their respective classes.


   Results Top


A total of 400 respondents participated in the study. This was made up of representative samples from the co-educational school and the two single-sex schools. The response rate was 100%. [Table 1] shows the sociodemographic distribution of the respondents. The majority of the students 391 (97.8%) were in the adolescent age group (10–19 years), only 9 (2.2%) respondents were in the age range of 20–24 years; all the respondents above 19 years were from the girls' school. The mean age of the respondents was 15 ± 2.4 for males and 15 ± 2.2 for females. There were more males 221 (55.3%) than females 179 (44.7%). Christianity and Islam were the predominant religion with Christians making 249 (62.3%) and Moslems 151 (37.7%).
Table 1: Distribution of respondents' sociodemographic characteristics

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[Table 2] shows respondents' knowledge of contraceptive uses and timing. Majority 270 (67.5%) of the respondents had correct knowledge of the use of condoms. For the other types of contraceptive, both knowledge of the use and the timing was poor. However, there was no statistically significant difference in knowledge of contraceptive uses and timing between the male and female respondents (χ2 = 1.614, df = 3, P = 0.204).
Table 2: Distribution of respondents with correct knowledge about contraceptives

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[Table 3] shows a pattern of contraceptive use among respondents. Less than one-third, 48 (31.1%) of the sexually active respondents have ever used any form of the contraceptive method, more males 28 (34.6%) than females 20 (27.4%). However, there was no statistically significant difference in this practice between the male and female respondents (χ2 = 0.919, df = 1, P = 0.338). Only 10 (6.5%) of these respondents used some contraceptive during their first sexual intercourse. However, there was no statistically significant difference in this practice between the male and female respondents (χ2 = 0.236, df = 1, P = 0.627). 13 (20.3%) of the sexually active respondents used contraceptive in the last 3 months and there was no statistically significant difference in this practice between the male and female respondents (χ2 = 0.235, df = 1, P = 0.627). 19 (12.3%) sexually active respondents are regular users of contraceptives while 28 (18.2%) were occasional users.
Table 3: Pattern of contraceptive use among respondents

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[Table 4] shows the distribution of contraceptive awareness and types of contraceptive methods used by respondents. 324 (81.0%) were aware of condoms while 142 (35.5%) had heard of oral pills and 78 (19.5%) mentioned abstinence. In addition, 51 (12.8%) mentioned other nonorthodox methods such as hot drinks, potash, as contraceptives. The most popular method of contraceptive methods among the respondents was condoms 16 (33.3%), followed by oral pills 10 (20.8%). A good percentage of them used unreliable methods such as withdrawal 7 (14.9%) and safe periods 7 (14.6%), also 8 (16.7%) used unorthodox methods.
Table 4: Distribution of contraceptive awareness and types of contraceptive methods used by respondents

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[Table 5] shows sources of obtaining contraceptives by respondents. The most popular source of obtaining contraceptive methods by the respondents was the patent medicine stores followed by boy/girlfriends. It is pertinent to note that parents and family planning clinics played no part at all in providing contraceptive services to the students.
Table 5: Respondents sources of obtaining contraceptives

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[Table 6] shows barriers that respondents encountered in sourcing for and using contraceptives. These include: Being too embarrassed to source for contraceptive methods. 131 (85.1%), lack of fund to purchase contraceptive methods required 123 (79.9%), fear of side effects of contraceptives 86 (55.8%), fear of adults disapproval 73 (47.4%), lack of knowledge on how these contraceptives work, 55 (35.7%), and other reasons such as the spontaneity of having sex were cited by 15 (9.7%) respondents.
Table 6: Barriers to contraceptive use among the sexually active

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   Discussion Top


Majority of the respondents (97.8%) were aged between 10 and 19 years. This falls within the adolescent age group.[17] Studies have shown that adolescents and youths constitute a high-risk group for unwanted pregnancy and sexually transmitted infections (STIs) including HIV/AIDS. These are conditions that could be averted by good contraceptive knowledge and practice. The studies posited that these occurrences could be because these adolescents are in the transition period to adulthood and are likely to experiment including sexual experimentation and their involvement in the unprotected sexual activity is also most prevalent.[2],[17],[18] They tend to have wrong self-perception of infertility, and their contraceptive practice is usually very poor.

In this study, respondents' awareness of contraceptives was high. The most commonly known contraceptive method was condoms (81%) followed by pills (19.5%). This pattern is consistent with the findings in Nnewi, Nigeria.[2] This finding is also similar to the finding by Blanc and Way, which recorded 73.9% awareness overall.[19] However, participants in a qualitative study by Otoide et al. among adolescents in Benin, Nigeria often did not mention the condom as a contraceptive method.[4] When they were asked why, the major reason for this observation was that they thought of the condom more as a means of preventing infections than as a way of preventing pregnancy. The high awareness of condoms and pills as reported in this survey is likely to be due to continuous widespread information from the mass media on the effectiveness of condoms in the prevention of STI's including HIV and teenage pregnancy sponsored mostly by donor agencies and marketers of this commodity. This finding is consistent with reports from some studies though little or no variations in sources of information exist.[1],[2] This is because information from the media may not be from experts and could, therefore, be vague and lack depth.

Students' knowledge of the use of condoms was fairly high (67.5%) while the knowledge of the uses and timing for contraceptive methods was generally poor. This finding is contrary to that of Agyei in Uganda and Boohene in Zimbabwe both of which recorded very high knowledge level of contraceptives use among young people.[20],[21] The above result, suggests that these respondents have a lack of basic factual information (particularly from reliable sources) on contraceptive devices. This lack of reliable information might have influenced their use of contraceptives while simple measures such as mobile phones and social media if censored by appropriate authorities, have been suggested as promising means of increasing contraceptive use among adolescents.[22] The result of this study showed that less than one-third of the sexually active respondents have ever used any form of a contraceptive method. This finding is similar to that by Omo-Aghoja et al., that contraceptive usage remain poor despite the high level of awareness.[23] Less than 10% of these respondents used some contraceptive during their first sexual intercourse while about one in every five of the sexually active respondents used contraceptive in the last 3 months. This finding has lower figures when compared to the Nnewi study, where contraceptive use among the sexually active respondents was 29.2% at their first sexual exposure but rose to 75% at their last sexual exposure preceding the survey.[2] However, this level is higher than the finding from 1992 Nigerian National Demographic and Health Survey, which showed that contraceptive use among sexually active unmarried youths was generally low in Sub-Saharan Africa, ranging from 25% in Zimbabwe to 1% in Nigeria.[24] This shows that an appreciable progress has not been made in ensuring contraceptive use by this group of individuals.

Majority of the sexually active respondents that used contraceptives obtained this from drug stores (mostly patent medicine stores). This finding is consistent with the report that adolescents in many places are unwilling to visit facilities providing contraception because they view them as unfriendly.[22] The result also confirmed previous research findings that adolescents were the most neglected segment of the population because little attention is paid to their reproductive health needs and that in most cases, they are not always attended to in government hospitals or clinics.[25] In addition, the negative societal and health personnel attitude to young people visiting family planning clinic is a major negative influence on adolescents' utilization of contraceptives. This area is of deep concern that requires urgent attention. The government should institute adolescent friendly centers where this age group can access contraceptives and other reproductive health commodities with ease. The World Health Organization's Guidelines on adolescent pregnancy call for making health services adolescent friendly to make it easier for adolescents to obtain the contraceptive methods they need.[5] In making health services adolescent friendly, it is important to build on what already exists-modifying general health facilities and building the competencies and attitudes of existing health service providers.

Regarding barriers encountered by sexually active respondents in obtaining/use of contraceptive methods, majority of the respondents said they feel too embarrassed to source for contraceptive. This agrees with findings from several published studies.[26],[27] It is, however, at variance with reports from a previous study where adolescents did not feel that having to obtain contraceptives was a major hindrance to using. Other barriers reported by respondents include Lack of fund, fear of side effects, and fear of adult disapproval and lack of correct knowledge about functions of contraceptives. This corroborates the finding that all adolescents in LMIC-especially unmarried ones face a number of barriers in obtaining contraception and in using them correctly and consistently.[22]

It is pertinent to note that students had a lot of misconceptions about effective contraceptive methods; they practiced ineffective methods such as withdrawal methods and various unorthodox methods of contraception, which are not likely to be effective or might even be harmful as the case maybe. It has been reported that youths generally felt that the services offered by patent medicine dealers were sufficient to meet their contraceptive needs.,[4] It was adduced that these dealers are located on street corners. Hence such a finding is not a surprise, as they provide confidential services. This may also explain adolescents' knowledge and use of modern antibiotics and other medications as contraceptives, as these likely were recommended by and procured from patent medicine dealers. Previous studies have also shown that patent medicine dealers often are not trained and have diverse educational backgrounds, with a significant number of them not literae.[4],[28]

Limitations of the study

This study is based on self-reported behaviors, and the data is, therefore, subject to reporting errors of unknown magnitude and direction. Another limitation was the inability of a number of respondents to read and understand the questions; to minimize this research assistants were mandated to read and interpret aspects of the questionnaire as the need arose; this was also time-consuming.


   Conclusions Top


Findings from this study have shown that though there was a high level of contraceptive awareness, and fairly high level of knowledge, the level of use by the study respondents was relatively low coupled with contraceptive barriers. Based on the findings of this study, we recommend that efforts should be intensified to promote safe sexual practice including effective contraceptive use among this age group.

Acknowledgments

This work was part of a dissertation submitted to the School of Postgraduate Studies, University of Ibadan, Nigeria in part fulfillment of the requirements for the award of the Master of Public Health in Community Medicine.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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