Printer Friendly

Knowledge of combined oral contraceptives among young females in Riyadh.

INTRODUCTION

High fertility level is a major concern, and regulation of fertility plays an important role in improving both maternal and child health. [1] The Saudi community has seen a recent change in the sociodemographic pattern related to women's education and career. These changes have played a role in tendencies toward fertility regulation behaviors such as birth spacing and the use of contraceptives. [2] Oral contraceptive pills are considered effective, with a low pregnancy rate theoretically if taken consistently and correctly, but with higher actual pregnancy rates due to inconsistent or incorrect use. [3] Oral contraceptives are hormonal preparation pills that may contain progestin alone or combination of both hormones estrogen and progestin. The combined pill has both contraceptive and noncontraceptive benefits such as reductions in dysmenorrhea, acne, ovarian cancer, and endometrial cancer. [3,4] As much as combined oral contraceptives (COCs) can be beneficial, they carry a number of risks. These include increased chance of developing venous thromboembolism, myocardial infarction, stroke, breast cancer, and cervical cancer. [5] COCs are absolutely contraindicated in case of thromboembolic disorders, cerebrovascular or coronary artery disease, estrogen-dependent neoplasia, undiagnosed abnormal genital bleeding, or history of liver tumors. [6] Side effects from COCs include breakthrough bleeding, weight gain, mood changes, breast tenderness, headaches, and nausea. [5,7] The purpose of this study was to assess the knowledge of COCs among young females in Riyadh, which in turn can help planning strategies for improvement.

MATERIALS AND METHODS Subjects and Setting

In this cross-sectional study, a structured online questionnaire was electronically disseminated; utilizing social media, among young females aged 18-40 living in Riyadh who were willing to participate in the survey. Demographic data, as well as responses to the questionnaire assessing five domains (type, risk, side effects, contraindications, and use of COCs), were collected and then analyzed. The questionnaire was initially developed in English, translated to Arabic, made available online (https://www.surveymonkey.com/r/ contraception_Riyadh) during the month of September 2016 and invitations to participate in the survey were sent through social media.

Sample Size and Data Analysis

Assuming a margin of error of 5%, population proportion of 50% and confidence interval of 95%, a sample size of 384 was targeted in this study. [8] 426 complete responses were collected during the survey period and were all included in the analysis. A descriptive analysis was used to present the data and frequency (%) was used for categorical variables.

RESULTS

During the month of September 2016, 426 females living in Riyadh completed our survey. Of those, 67.1% were aged between 18 and 30 years old, while 32.9% were between 31 and 40 years old. 64% of respondents were married and about 60% were current or previous users of contraceptive pills. Our sample was well educated with 81.46% of them holding a university degree, whereas the majority of them (85.92%) had a monthly income of <15000SR (Table 1).

The scoring system used and scores for individual questions in the survey are detailed in Tables 2 and 3. Our sample scored well below average for all of the five domains in the questionnaire, and poor/very poor knowledge level was noted across all domains of the questionnaire (Figure 1 and Table 3).

DISCUSSION

Sixty four percent of couples worldwide are using some form of contraception. The percentage varies across different countries and regions and is lower in the least developed countries. [9] Studies conducted in Saudi Arabia showed variable levels of use of contraception in different geographic areas. For example, low levels of use of contraceptives were observed in Abha and Qassim (27% and 44%, respectively), while high levels of contraceptives use among Saudi females were observed in Al-Khobar with a rate of 74.8%. [10,11] In Riyadh, Mahboub et al. found that 86.6% of Saudi women have ever used contraception, and the most commonly used method was contraceptive pills (64.9%). [12] Working status of women as well as husband approval were found to be significant factors affecting women's attitude toward the use of contraception. [12] Al-Sheeha also concluded that being a working woman as well as education level were important determinants of using contraceptives (odds ratio 2.6 and 2.1, respectively). [2]

Five domains were used in our questionnaire in assessing the level of knowledge on COCs among women in Riyadh, namely, type of available oral contraceptives, risks of using COCs, side effects, appropriate use, and contraindications (Table 3). Our study population consisted of 426 females aged 18-40. Most of them were married (64.08%), well-educated (81.46%) and have used or currently using OCPs (59.39%). However, overall mean scores were low (<2.5), indicating poor level of knowledge and awareness in all of the five domains. The study sample scored highest in side effect domain (2.4), and lowest in risk domain (1.2) (Figure 1).

Possible reasons for the poor score include limited information given by physicians at the time of prescribing COCs as well as the fact that some women initiate COCs over the counter without a physician consultation. Only 1.4% of our sample had low education (below high school), while over 81% of them had a university degree but still scored below average in the questionnaire, which makes "level of education" a less likely contributing factor, although a direct relationship was not examined in our study. In contrast, Al-Shamrani et al. found that higher levels of education were associated with better knowledge of contraceptive pills among Saudi women (P < 0.001). [13]

Our results are comparable to Al-Sheeha who conducted a study in Al-Qassim, examining the perception regarding the use of different types of contraceptives among Saudi women attending primary care clinics in 2010. Participants had low knowledge level regarding the variety of contraceptive methods. [2] Similar findings were also reported by Al-Mansour et al. in their study of contraceptive use among 388 women in Al-Khobar. [14] The majority of women in their study (68.3%) had poor knowledge on contraceptives. [14] In addition, in Jeddah, Iftikhar and Aba Al Khail studied 357 women and also found that women in their study group had poor level of knowledge on OCPs. [15]

Physicians have a central role in explaining available types of contraceptive pills, screening for contraindications, explaining risks, and potential side effects as well as advising on appropriate use of contraceptives to women seeking contraception. Oral contraceptives should not be dispensed over the counter without a valid prescription. Moreover, educational campaigns can assist in improving women's knowledge on the topic.

Our study was cross-sectional, which was relatively easy to conduct as well as helpful in generating and supporting a hypothesis for poor knowledge of COCs among young women in Riyadh. Limitations of our study include recall bias among respondents as well as using social media, which could have potentially created "closed loop responses" and therefore, may have affected our sample representation. Moreover, correlation between poor knowledge and other parameters was not specifically examined in our study.

CONCLUSION

This survey clearly indicated a poor level of knowledge on COCs among females in Riyadh. Increasing awareness through health education campaigns as well as family planning clinics with a focus of contraceptive counseling is recommended.

REFERENCES

[1.] Abdel-Fattah M, Hifnawy T, El Said TI, Moharam MM, Mahmoud MA. Determinants of birth spacing among Saudi women. J Family Community Med. 2007;14(3):103-11.

[2.] Al Sheeha M. Awareness and use of contraceptives among Saudi women attending primary care centers in Al-Qassim, Saudi Arabia. Int J Health Sci (Qassim). 2010;4(1):11-21.

[3.] Kauntiz A. Contraception Counseling and Selection; 2016. Available from: http://www.uptodate.com/contents/ contraceptive-counseling-and-selection. [Last accessed on 2016 Aug 20].

[4.] Martin K, Barbieri R. Overview of the Use of Estrogen-Progestin Contraceptives; 2011. Available from: http://www. uptodate.com/contents/overview-of-the-use-of-estrogenprogestin-contraceptives. [Last accessed on 2016 Aug 20].

[5.] Patient. Combined Oral Contraceptive Pill (First Prescription); 2016. Available from: http://www.patient.info/doctor/ combined-oral-contraceptive-pill-first-prescription. [Last accessed on 2016 Aug 20].

[6.] Human Reproduction Seminars: Combination Oral Contraceptives, Prescribing Oral Contraceptives; 2016. Available from: http://www.library.med.utah.edu/kw/human_reprod/ seminars/seminar1A4.html. [Last accessed on 2016 Aug 20].

[7.] Barr N. Managing Adverse Effects of Hormonal Contraceptives; 2010. Available from: http://www.aafp.org/afp/2010/1215/ p1499.html. [Last accessed on 2016 Aug 20].

[8.] Lwanga SK, Lemeshow S. Sample Size Determination in Health Studies: A Practical Manual. Geneva: World Health Organization (WHO); 1991. Available from: http://www.whqlibdoc.who.int/ publications/9241544058_%28p1-p22%29.pdf. [Last accessed on 2016 Aug 12].

[9.] United Nations. Trends in Contraceptive Use Worldwide; 2015. Available from: http://www.un.org/en/ development/desa/population/publications/pdf/family/ trendsContraceptiveUse2015Report.pdf. [Last accessed on 2016 Aug 20].

[10.] Farheen A. Ever use of contraceptives among women attending primary health care centers at Abha, Saudi Arabia. IJCRR. 2013;5(10):26-32.

[11.] Al-Turki HA. Contraception: Attitudes and experiences of Saudi Arabian women. Health Care Women Int. 2011;32(2):134-9.

[12.] Mahboub S, Abdelkader S, Al-Muhanna A, Al-Muhanna A, Al-Musallam F, Al-Ghannam J, et al. Attitude towards contraceptives use among Saudi women. Int J Healthc Sci. 2014;2(2):331-9.

[13.] Al-Shamrani A, Tayeb S, Alsaggaf A, Alafif M. Oral contraceptive pill use among Saudi women. Hamdan Med J. 2015;8[Online]. DOI: 10.7707/hmj.595.

[14.] Al-Mansour R, Sabra A, Hafez A. Contraception: Knowledge, attitude and practice with special emphasis on contraceptive pills among Saudi women at Al-Khobar city, Eastern Saudi Arabia. Egypt J Community Med. 2012;30(2):1-13.

[15.] Iftikhar R, Aba Al Khail BA. Knowledge about missed contraceptive pills among married women at King Abdulaziz university hospital. Patient Prefer Adherence. 2015;9:401-11.

Thamer Alsulaiman (1), Meshail Alamer (2), Ghadah Alrajeh (2), Qamar Khojah (2), Shorouq Alrumaihi (2), Ohoud Almutairi (2)

(1) Department of Family Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia, (2) College of Medicine, King Saud University for Health Sciences, Riyadh, Saudi Arabia

Correspondence to: Thamer Alsulaiman, E-mail: alsth829@hotmail.com

Received: November 15, 2016; Accepted: December 06, 2016

DOI: 10.5455/ijmsph.2017.1266406122016

Caption: Figure 1: Overall mean scores per domain.
Table 1: Baseline characteristics of female responders
(n = 426)

Parameter                                          Percentage

Age
  18-30                                               67.1
  31-40                                               32.9
Marital status
  Married                                            64.08
  Single                                             35.92
Highest education
  University degree                                  81.46
  High school degree                                 17.14
  Below high school                                   1.4
Income
  Above 15000SR                                      14.08
  8000-15000SR                                       34.27
  Below 8000                                         51.64
Current or previous user of oral contraceptives
  Yes                                                59.39
  No                                                 40.61

Table 2: Scoring system used for rating respondents'
answers

Percentage of correct               Equivalent   Description
answers per question (%)              score

[greater than or equal to]90-100        5        Excellent knowledge
[greater than or equal to]70-89         4        Good knowledge
[greater than or equal to]50-69         3        Average knowledge
[greater than or equal to]30-49         2        Poor knowledge
<30                                     1        Very poor knowledge

Table 3: Scores for individual questions in the questionnaire (n=426)

Domain              Question                   Percentage    Equivalent
                                               of correct      score
                                               answers (%)

Type                All COCs are made of the      32.86          2
                    same hormone

                    All COCs work in the          42.96          2
                    same way

                    Some COCs have one            46.95          2
                    hormone while others
                    have two

                    Hormone concentration         71.13          4
                    varies between COCs

                    My doctor can adjust the      54.46          3
                    strength of hormones of
                    COCs if I develop side
                    effects

                    COCs are the most             28.87          1
                    prescribed type of oral
                    contraceptives to Saudi
                    women

Risks               COCs can cause breast         22.07          1
                    cancer

                    COCs can cause cervical       18.31          1
                    cancer

                    COCs can cause clotting       38.03          2
                    in legs and lungs

                    COCs can cause ovarian        12.68          1
                    cancer

                    COCs can cause                11.50          1
                    osteoporosis

Side effects        COCs can cause weight         64.79          3
                    gain

                    COCs can cause                38.5           2
                    hypertension

                    COCs can cause                20.19          1
                    infertility

                    COCs can cause                65.96          3
                    depression

                    COCs can affect               59.15          3
                    lactation during
                    breastfeeding

Use                 I should immediately          6.57           1
                    stop COCs if I develop
                    any side effects

                    COCs work by killing          36.62          2
                    sperms

                    COCs work by preventing       47.89          2
                    ovulation

                    COCs prevent sexually         44.37          2
                    transmitted infections

                    Best day to start COCs        16.67          1
                    when using for the first
                    time is during the first
                    day of period

                    COCs can be used to           40.61          2
                    treat acne and heavy
                    menstrual bleeding

                    Using antibiotics while       60.33          3
                    on COCs can reduce their
                    efficacy and lead to
                    pregnancy

                    Vomiting and diarrhea         24.88          1
                    can reduce COCs efficacy
                    and lead to pregnancy

                    I have to use the              27            1
                    hormone pills for 21
                    days followed by sugar
                    pills for 7 days and
                    then start a new pack

                    During the sugar pill         19.72          1
                    week, I must wait for my
                    period to finish before
                    starting hormone pills

                    I am aware of the 7-day       21.13          1
                    rule

Contraindications   I can immediately start       41.31          2
                    COCs after giving birth

                    I must wait at least 6        42.49          2
                    weeks after giving birth
                    before starting COCs

                    I must stop COCs if I         50.94          3
                    develop migraine with
                    aura

                    Smoking while taking          36.85          2
                    COCs increases the risk
                    of heart attacks

                    I shouldn't use COCs if       40.85          2
                    I have severe
                    hypertension

                    I shouldn't use COCs if       24.18          1
                    I have morbid obesity

Domain              Question                   Mean score
                                               for domain

Type                All COCs are made of the      2.3
                    same hormone

                    All COCs work in the
                    same way

                    Some COCs have one
                    hormone while others
                    have two

                    Hormone concentration
                    varies between COCs

                    My doctor can adjust the
                    strength of hormones of
                    COCs if I develop side
                    effects

                    COCs are the most
                    prescribed type of oral
                    contraceptives to Saudi
                    women

Risks               COCs can cause breast         1.2
                    cancer

                    COCs can cause cervical
                    cancer

                    COCs can cause clotting
                    in legs and lungs

                    COCs can cause ovarian
                    cancer

                    COCs can cause
                    osteoporosis

Side effects        COCs can cause weight         2.4
                    gain

                    COCs can cause
                    hypertension

                    COCs can cause
                    infertility

                    COCs can cause
                    depression

                    COCs can affect
                    lactation during
                    breastfeeding

Use                 I should immediately          1.5
                    stop COCs if I develop
                    any side effects

                    COCs work by killing
                    sperms

                    COCs work by preventing
                    ovulation

                    COCs prevent sexually
                    transmitted infections

                    Best day to start COCs
                    when using for the first
                    time is during the first
                    day of period

                    COCs can be used to
                    treat acne and heavy
                    menstrual bleeding

                    Using antibiotics while
                    on COCs can reduce their
                    efficacy and lead to
                    pregnancy

                    Vomiting and diarrhea
                    can reduce COCs efficacy
                    and lead to pregnancy

                    I have to use the
                    hormone pills for 21
                    days followed by sugar
                    pills for 7 days and
                    then start a new pack

                    During the sugar pill
                    week, I must wait for my
                    period to finish before
                    starting hormone pills

                    I am aware of the 7-day
                    rule

Contraindications   I can immediately start        2
                    COCs after giving birth

                    I must wait at least 6
                    weeks after giving birth
                    before starting COCs

                    I must stop COCs if I
                    develop migraine with
                    aura

                    Smoking while taking
                    COCs increases the risk
                    of heart attacks

                    I shouldn't use COCs if
                    I have severe
                    hypertension

                    I shouldn't use COCs if
                    I have morbid obesity

COCs: Combined oral contraceptives
COPYRIGHT 2017 Association of Physiologists, Pharmacists and Pharmacologists
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2017 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:Research Article
Author:Alsulaiman, Thamer; Alamer, Meshail; Alrajeh, Ghadah; Khojah, Qamar; Alrumaihi, Shorouq; Almutairi,
Publication:International Journal of Medical Science and Public Health
Article Type:Report
Geographic Code:7SAUD
Date:Apr 1, 2017
Words:2542
Previous Article:Effect of oral clonidine as premedication on hemodynamic changes during laparoscopic cholecystectomy.
Next Article:Prevalence of hepatitis C virus infection and response to hepatitis B vaccination among Egyptian school children.
Topics:

Terms of use | Privacy policy | Copyright © 2019 Farlex, Inc. | Feedback | For webmasters