الفهرس 
الملخص العربيOnly 14 pages are availabe for public view
 |  | from | 240 |  |  |
| | | from | 240 | | |
Abstract
During the last 25 years, Egypt has made an impressive progress towards its population policy goals. But despite this progress, still acute disparities in contraceptive prevalence rate (CPR) do exist in some areas.
According to EDHS, 2005, Assiut – one of Upper Egypt governorates - showed the second lowest level of contraceptive use rates all over Egypt. And although the DHS estimates the CPR in all the governorates of Egypt, but it doesn’t differentiate between CPR in the mother villages and in the remote rural areas “satellites”. Among the suggested reasons for the low CPR is the low accessibility problem. So, in 1997, the Egyptian MOHP launched the “Mobile clinic project” which aimed at providing reproductive health services to women living in remote rural areas (satellites; Ezab & Nogou) in Egypt. The present study aimed at determining the CPR and unmet need in these satellites and to assess the role of mobile clinic in these areas.
Two study samples were selected
The first sample is composed of 474 currently married women (15-49 years) who were living in the satellites of rural Assiut governorate.
The second sample is composed of 216 currently married women (15-49 years) who were living in the mother villages of rural Assiut governorate.
Data collection was carried out via interviewing of study samples using a semi-structured questionnaire.
I- Socio-demographic and reproductive characters
There was no significant difference between women who were living in the satellites and those who were living in the mother villages concerning mean age, level of education of the study participants or their husbands, mean age at marriage or mean age at first pregnancy. However, work status of the participants showed a statistical significant difference as women who were living in the satellites were more likely to work without being paid compared to women living in the mother villages (31.4% and 6.5% respectively).
Concerning the living arrangements, 66.2% of those who were living in the satellites belonged to extended families compared to 75.5% of those who were living in the mother villages.
In the satellites, the mean number of living children was 3.8 ± 2.1, while the mean number of living children in the mother villages was 3.9 ± 1.9. Moreover, there was no statistical significant difference in the future fertility intentions between the two samples of women as nearly two thirds of the study participants (61.8% of those who were living in the satellites and 69.9% in the mother villages) reported that they do not intend to have another child in the future.
II- Accessibility to health services and health seeking behavior
Accessibility to health services is more apparent among mother villages’ residents than among satellites’ residents with a significant statistical difference. Satellites’ residents lie at a longer distance and time from the nearest health facility than mother villages’ residents. In addition, 73.6% of those who were living at the satellites reported that the transportation means were available all the day compared to 90.9% of those who were living at the mother villages.
The private sector was the main source of obtaining health care for abortion and for antenatal period among women of both samples (those who reside in the satellites or mother villages), while the public sector was the main source of obtaining contraceptive methods among participants of both groups.
III- Received antenatal care
There was no statistical significant difference between women who were residing at the satellites and those who were living at the mother villages concerning their current pregnancy status. Most of the study participants who were living at the satellites (90.9%) or mother villages (88.4%) were not pregnant at the time of the interview.
Among those who were currently pregnant, 62.8% and 64.0% of those women who were living in the satellites and mother villages respectively sought antenatal care in their current pregnancy. Among them, 51.9% compared to 50.0% of those who were living in the satellites and mother villages respectively reported seeking antenatal care 4 times or more. The most common measures taken for women included blood pressure examination, urine and blood samples, weight examination and ultrasound examination.
IV- Contraceptive methods knowledge and practice
There was a gap between knowledge of study participants about contraceptive methods and their use of the methods. Nearly all the study participants who were living in the satellites or in the mother villages had heard about contraceptive methods (99.6% and 100.0% respectively). However, The CPR was 42.6% among those who were living in the satellites compared to 44.5% among women living at the mother villages. There was no observed statistical significant difference among those who were living in the satellites or mother villages concerning their knowledge about contraception and contraceptive methods or their CPR.
Although the public sector was the main source of supply for the current contraceptive method, but mobile clinic was reported as a source in 5.5% of those who were living at the satellites. Having a blood pressure measured, a pelvic, abdominal and breast examination were more reported among women who sought medical advice for the contraceptive method from the private sector than among those who went to the public sector with a significant statistical difference. However, Being told by the heath care provider where to go in case of emergency and to come back for a follow up visit were more reported among women who sought medical advice for contraceptive methods from the public sector than from the private sector with a significant statistical difference.
Among those who were currently not using contraceptives, the perception that being a breast feeding woman or recently delivered make them non vulnerable for not being pregnant was the most common mentioned reason (26.0%). Moreover, the desire to have more children, the perception of being unable to get pregnant due to start of menopause, the fear from the contraceptive side effects and husband refusal were among the other mentioned causes. Discussion of contraceptive use with the husband and his approval is very important factor among current contraceptive users.
Among those who are currently using contraception – the decision of using contraception was a joint decision between both the husband and the wife among the majority of the participants, while the decision of non using a contraceptive method was reported among more than half of the participants.
The main determinant factors of contraceptive method use among the study participants were: age, religion and husband approval of family planning use by his wife. In the satellites, the main determinant factors were: husband approval of family planning use by his wife, number of female live births, religion and age while the main determinant factor in the mother villages was the age of the study participants.
V- Unmet need for contraception
As regards to the unmet need for contraception, 28.2% of the study participants had unmet need for contraception; 21.2% for limiting and 7.0% for spacing. Those who had met need for contraception comprised 38.6% of the study participants. The unmet need for contraception was higher among women living in the mother villages (33.3%) than among women living in the satellites (25.7%) with a statistical significance difference.
The determinants of unmet need for contraception among the study participants living in the satellites were: husband disapproval of contraceptive method use by his wife, women residence being ever visited by a mobile clinic and age of the study participants. On the other hand, among those who were living in the mother villages, the determinants of unmet need for contraception were: husband disapproval about contraceptive method use by his wife and age of the study participants.
VI- Knowledge about mobile clinics among satellites’ residents
Most of the study participants who were living in the satellites (93.9%) have heard about mobile clinics. seeing the mobile clinic when it came nearby the women’s houses was the most frequently mentioned source of knowledge by women living in the satellites (50.1%), followed by friends and neighbors; 24.0% and 29.4% respectively.
Although the majority of satellites’ residents were aware about the mobile clinic, but the pattern of knowledge concerning the regularity of mobile clinic visits, knowing the time and parking place of the next visit of the mobile clinic to women residences and the services offered by these clinics showed much variability between women.
Only 26.2% reported that the mobile clinic visit their places regularly while 39.0% reported that the mobile clinic visited their places in an irregular way. However, 19.0% of those women residing at the satellites reported that their places had never been visited by a mobile clinic. Concerning knowledge about the time and parking place of the mobile clinic, 22.3% of those who were living in the satellites reported that they heard about the mobile clinic and know the time and place of its next visit. On the contrary, more than one third of the satellites’ residents (42.5%) reported that they know neither the time nor the place of the next visit of the mobile clinic to their places.
VII- Mobile clinic service utilization among the study participants
Among those who were living in the satellites and heard about the mobile clinics, only 14.4% and 6.3% had ever visited the mobile clinic or had visited the mobile clinic at least once during the last year prior to the interview survey. Getting or following up a family planning method was the main reason for visiting the mobile clinic.
Among those who never visited the mobile clinics, the need for services other than family planning services (36.0%) which perceived as the main services offered by these clinics, the ignorance of women about the parking place or visiting schedule of mobile clinic and the perception that the mobile clinic leave the satellites quickly (17.7%), the preference of a private doctor (17.4%) due to the perception of the low quality of mobile clinic free services were the main reported reasons for not visiting the clinic. In addition, social pressures played a role in preventing women from visiting a mobile clinic, namely the feeling of lack of privacy in entering or exiting the clinics, since the mobile clinics are usually parked in visible spots where other villagers can see women while visiting the clinic which discloses their privacy. Also, refusal of the husband and his family and restriction of women mobility in going outside the houses were among the mentioned reasons.
The mobile clinic role in health education concerning information about child care, female genital mutilation and changes in the menopausal period was very limited either in the satellites or in the mother villages.
VIII- Client satisfaction and dissatisfaction about mobile clinic services
Concerning their opinion about the quality of services offered at the mobile clinic, 19.6% of the clients who visited the mobile clinic were dissatisfied with its services. Moreover, although the majority of the mobile clinic clients were satisfied with its services (73.5%), but only 40.2% of those who ever visited the mobile clinic advised their neighbors or relatives to seek medical care at the clinic.
The most common reported reason of client satisfaction with the mobile clinic services was the good way the clinic staff treated them; (64.0%). Other causes of satisfaction were: the presence of a female doctor (32.0%), the cleanliness of the clinic (30.7%), the free of charge services (26.7%) and the availability of all family planning methods (21.3%). Also physical accessibility to the clinic (17.4%) was among the mentioned reasons of satisfaction.
On the other hand, reported reasons of dissatisfaction were: perceived careless way of doctor examination (45%), insertion of the IUD without prior enough counseling with the client (20%, n=4) and even obtaining no examination at all at the clinic (20%, n=4).
IX- Determinants of mobile clinic visit
The most important determinant factors of ever visiting the mobile clinics among women who were living in the satellites were: knowing the parking place of the mobile clinic, number of female live births, place of women residence being ever visited by the mobile clinic, ever discussed family planning with the husband, ever using a contraceptive method in the last 5 years prior to the interview and the presence of available transportation mean all the day.
The CPR was 42.6% at the satellites and 44.5% at the mother villages with no significant statistical difference among women living in the satellites or mother villages. The most common used methods were: IUDs, pills and injectables whether among women living in the satellites or mother villages. The unmet need for contraception among satellites’ residents was 25.7% while it was 33.3% among mother villages’ residents. The public sector was the main source of obtaining contraceptive methods. While the mobile clinics were the main source of obtaining contraceptive methods in 5.5% only of satellites’ residents.
There was a wide gap between knowledge about the mobile clinic and utilization of its services among women living in the satellites. Although mobile clinic clients were satisfied with its offered services, but still a larger percentage of women had never visited the mobile clinic in their whole lives. Misconceptions about the services offered by the mobile clinic, preference of a private physician, social stigma, husband approval and lack of information about the time of visit and place of mobile clinic parking were the main reasons for its low utilization among women living in the satellites.
So, the study recommends that:
An awareness meeting needed to be held and directed to women living in satellite villages to inform them and their family members that mobile clinics offer a range of health services other than family planning, and even though offered for free, the services are of good quality.
Also, the announcement plan of the clinic needed to be reviewed concerning time of visit and place of parking in these satellites. Further studies addressing the cost-effectiveness of the clinic are needed.
An awareness media campaign needs to be carried out to remove the social obstacles and misconceptions about family planning methods.
Intensive training to health personnel (medical and paramedical) should help to increase more awareness of the significance of rumors and their discussion with women so that the negative influence of wrong information is minimized.
Moreover, further researches on cost effectiveness of mobile clinics to ensure efficient use of available resources.