A survey of knowledge of family planning (FP) methods among Kenyan medical doctors: secondary data analysis.

PIP: This survey, conducted between October 1989 and March 1990, to determine the knowledge, attitude, practice, and provision of family planning of a sample of 376 Kenyan medical doctors, reports on the aspects of knowledge of family planning (FP) methods. Kenyan medical doctors had low-to-average knowledge of the association between oral contraceptives (OCs) and the risk of various medical conditions and the mechanism of action of steroidal contraceptives. Their knowledge of the effectiveness of various program methods was average to high. There was a linear relationship between monthly income and knowledge of effectiveness of OCs, according to which physicians earning more had less knowledge than their colleagues who earned less (Z = 2.318, p = 0.02). A stepwise unconditional logistic regression model showed that two variables, department where most work is performed and sex, are significantly associated with better knowledge. Use of these operational variables for assessing medical doctors' knowledge of FP methods gave a better resolution of the extent and perhaps the quality of counseling and advice they provided to their FP clients. At the same time, the need for update courses in FP for medical doctors is unquestionable and long overdue.^ieng

A survey of attitude of Kenyan medical doctors on family planning (FP): secondary data analysis.

PIP: This was part of a survey conducted between November 1989 and March 1990 to determine the knowledge, attitude, practice, and provision of family planning (FP) by a sample of Kenyan medical doctors. This part of the survey reports on the attitude as assessed through several attitudinal variables. Medical doctors had an average-to-high (60-98%) positive attitude about the relationship between population/economic growth and the need for FP, the effectiveness of the FP campaign in Kenya, and the ideal family size being 0-4 children. However, the proportion of doctors who considered the ideal family size to be 0-2 children dropped to a mere 23%. In light of the 1993 Kenyan total fertility rate of 5.4, an ideal family size of 0-4 children would be a worthwhile ambition for Kenyans, the majority of whom are of low socioeconomic status. Important covariates were future fertility intentions (desire for children), doctors' place of work, and religion. It is very important that the FP campaign continue to promote small families in Kenya.^ieng

Unmet family planning demand: evidence from two sites in Kenya.

PIP: A study was undertaken in Kenya to assess 1) the family planning (FP) needs of women in the perinatal period, 2) whether these needs are recognized by staff, 3) the postpartum demand for FP information and services, and 4) the barriers to addressing client needs. Data were collected from interviews with 400 prenatal clients, 200 postpartum women, 400 child welfare clinic attenders, and 69 staff members. More than a third of the clients desired no more children. A further 22%, 33%, and 28% of the three client groups, respectively, wished to delay their next pregnancy for more than four years. Over 88% of the prenatal, 93% of the postpartum, and 84% of the child welfare clients wanted to use FP. The staff was generally aware of the women's desire for information, but they underestimated the need for information in the immediate postpartum period. Information from the child welfare mothers indicated that by six months postpartum 75% of the women are at risk of pregnancy, and, by 12 months, 83% are at high risk of pregnancy. Therefore, women need FP services by six months postpartum. Even though most of the postpartum women wanted to receive a method before discharge from the maternity ward, very few received any FP services during their stay. The clients felt uncomfortable raising the issue with the maternity staff, and the staff felt constrained by a lack of knowledge although they recognized the need and wanted to be able to provide adequate services. Based on this study, it is recommended that 1) FP services be available in all parts of a hospital; 2) maternity ward staff, in particular, be trained to provide FP services; 3) a team approach to FP services be developed; 4) staff be more pro-active in identifying potential clients; and 5) maternal/child health and FP services be fully integrated to provide FP services in a private setting for all clinic attenders.^ieng

The Situation Analysis Study of the family planning program in Kenya.

A new, relatively "quick and clean" operations research approach called a "situation analysis" was developed for examining the strengths and weaknesses of the family planning program of Kenya. Field research teams visited a stratified random sample of 99 of the Ministry of Health's approximately 775 service delivery points. Observation techniques and interviewing were used to collect information on program components and on the quality of care provided to new family planning clients during the observation day. As late as 1986, the Kenya program was rated "weak" and "poor" in the international literature. The Kenya Situation Analysis Study found a functioning, integrated maternal and child health/family planning program serving large numbers of clients, with an emphasis on oral contraceptives and Depo-Provera (and an underemphasis on permanent methods). Although a number of program problems were revealed by the study, overall, in terms of performance, a rating of "moderate" is suggested as more appropriate for Kenya's national family planning program today. In terms of the quality of care, a "moderate to moderate-high" rating is suggested.

PIP: In 1989, researchers conducted a situation analysis of 100 service delivery points (SDPs) in Kenya. They wanted to evaluate the usefulness of collecting and analyzing data on factors that influence the impact of family planning (FP). FP workers took a gynecological history and blood pressure on 96% of new clients and did a pelvic exam on 73%. 80 SDPs had Depo-Provera and foam tablets on hand and 85 had condoms. Even though the Ministry of Health had 8 varieties of oral contraceptives (OCs), not all SDPs had all types. 97 SDPs had the OC Microgynon, yet 24 had 10 cycles. 53 SDPs had at least 1 FP poster on the wall. 38 had charts or other educational aids. None provided educational material for the clients to take home with them. 32 SDPs had health talks and only 16 addressed FP. 1 on 1 client counseling made up somewhat for this lack of information (31% of clients interviewed reported the clinic as their 1st source of FP information). Yet the SDP workers often did not tell clients about contraindications, complications, and how to manage complications. Supervision was minimal. 87 SDPs kept records on FP clients. 81 SDPs had referred some women for FP services. Only 54% of the nurses and midwives attended the core 7 week training course in FP designed to certify them to deliver FP services. A mean of 9443 clients attended these SDPs each month. 71% used OCs, 19% Depo-Provera, 5% condoms, and 5% IUDs and foam. 94% of clients learned of 2+ methods at the SDPs, especially OCs and Depo-Provera. FP workers provided little information about sterilization. The researchers observed the quality of care indicators on an 1 client/clinic basis which probably biased the results in a positive direction. Nevertheless, FP workers did know how to provide acceptable good care. These results showed that the quality of FP in Kenya should be upgraded from weak and poor to moderate to moderately high.