Sir,
Evidence abound that unintended pregnancy is the most common indication for unsafe abortions, which constitute one of the leading causes of maternal mortality and morbidity in Sub-Saharan Africa and South central Asia.[1] In Nigeria, about one of three women in the reproductive age group has had an unsafe abortion with equal proportions in the Southern and Northern part of the country.[2] Emergency contraception (EC) has been found to be a reliable and inexpensive way of averting unintended pregnancies; its correct use could prevent as much as 75% of unplanned pregnancies.[3,4] Reports have shown that about a third of women who have utilized any modern method of contraception in Nigeria, obtained it through health professionals working in government public hospitals.[5] Nurses are the majority in this group and are usually the first point of contact with the health system. Hence, it is essential for them to have correct knowledge of EC. We identified the factors associated with nurses’ knowledge and attitude toward EC in Northern Nigeria through a multi-center cross-sectional study of 330 nurses in four tertiary health institutions in Northern Nigeria using a structured self-administered questionnaire.
Majority of the respondents were female nurses 262 (79%), married 232 (70%), Muslims 221 (67%), and of Hausa/Fulani ethnicity 198 (63%). Their ages ranged from 18 to 60 years with a mean ± standard deviation of 32 ± 7.9. Over half, i.e., 178 (54%) were <6 years postqualification. Three hundred (91%) nurses were aware of EC. Of these, just over half, i.e., 160 (53%) had adequate knowledge of EC, while 77 (26%), 31 (10%), and 30 (10%) incorrectly identified menstrogen, quinine, and ampicillin, respectively, as forms of EC. Knowledge was significantly associated with respondents’ religion (P < 0.05). Majority, i.e. 163 (68%) had negative attitude toward EC; this was also significantly associated with respondents’ religion and ethnicity (P < 0.05). Only 69 (29%) nurses would recommend EC to adolescents and school girls.
It is unacceptable that 9% of the nurses surveyed were unaware of EC in Northern Nigeria where a high prevalence of unintended pregnancy constitutes the main indication for induced abortions with attendant complications and mortality.[1] Notably, a 10th of those that were aware suggested that quinine and ampicillin are forms of EC whereas more than a quarter (26%) identified menstrogen as a form of EC. This finding is worrisome as menstrogen (a combination of ethyl estradiol and ethisterone) is used to induce menstruation, quinine is an antimalarial, and ampicillin is an antibiotic, all are not on the recommended list of EC agents. It is noteworthy that religion was significantly associated with knowledge and attitude toward recommending EC; participants that were Christians were more knowledgeable and also had positive attitude toward EC. The findings from this study point to a serious knowledge gap among nurses in Northern Nigeria concerning EC. There is an urgent need to provide comprehensive in-service training program to all nurses. Misconceptions regarding the use of nonrecommended agents for EC must be rectified.
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Conflicts of interest
There are no conflicts of interest.
References
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