international journal of innovative pharmaceutical ...undergraduate female regular students on rh...

RESEARCH ARTICLE Diriba et.al / IJIPSR / 3 (7), 2015, 775-793

Department of Pharmacy ISSN (online) 2347-2154

Available online: www.ijipsr.com July Issue 775

ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE

OF FEMALE STUDENTS TOWARDS RH DISEASE

(SHOTELAY): IN CASE OF AMBO UNIVERSITY

1Diriba Alemayehu Gadisa,

2Alemayehu Megersa

1Assistant lecturer, Pharmacology unit, Department of Pharmacy, College of medicine and health

science, Ambo University, ETHIOPIA 2Pharmacy department, College of medicine and health sciences, Ambo University, ETHIOPIA

Corresponding Author

Diriba Alemayehu Gadisa

Assistant lecturer, Pharmacology unit,

College of medicine and health science, Ambo University, ETHIOPIA

E-mail: [email protected]

Phone: +251915958190

International Journal of Innovative

Pharmaceutical Sciences and Research www.ijipsr.com

Abstract The objective of this study is to assess the Knowledge, Attitude and Practice of Ambo University (AU)

undergraduate female regular students on Rh disease (shotelay). Cross sectional facility based

quantitative study method was employed among Ambo University regular undergraduate female

students from April 5-15, 2015.Data collected from students by using structured questionnaire were

analyzed by using both manual and SPSS software. Then the result was presented using table, graphs

and charts. There were 328 study participants. The response rate was 91.77% with mean age of 21.31

year which ranges from 18 to 33years. The knowledge level of study participant was 23.58%. Being

health students have significant association [p-value = 0.005, CI = 1.69, 18.69); AOR = 5.624] with

knowledge level of respondents. From those who knews Rh disease only 40 (13.29%) had positive

attitude. There were Pearson correlation between knowledge and attitude(r=0.462) and there was also

correlation between knowledge and practice(r=0.713). The level of knowledge, attitude and practice of

Ambo University undergraduate female students toward Rh disease locally called „shotelay‟ was not

much enough to overcome the incompatibility of Rh and its complication during and after pregnancy. So

that, information should be provided to child bearing age women‟s to create awareness since it is

possible to prevent the problem by creating good awareness.

Keywords: Knowledge, Attitude, Practice, Rh-disease, Ambo, University, Female student.




INTRODUCTION

Human blood is classified according to two main systems: the ABO system and the Rhesus (Rh)

system. The Rh system consists of several related proteins, the most important of which is called

the Rhesus D (RhD) antigen. People who have this antigen on their red blood cells are said to be

RhD positive, whereas those who do not are said to be RhD negative [1].

The Rh disease, which is caused by Rh positive foetus carried by Rh negative mother, leads to

typical patterns of perinatal mortality with an increase of mortality with parity and mortality

clustered in families [2].The development of D antibodies results from feto maternal sensitization.

Potentially sensitizing events include; abortion, ectopic pregnancy and miscarriage. Sensitization

is unlikely to affect the first pregnancy but may result in hemolytic disease of fetus and neonates

(HDFN) during subsequent RhD-positive pregnancy [3]. This hemolysis can cause fetal and

neonatal anaemia and increased bilirubin levels in the newborn. In severe cases, this may lead to

fetal death due to severe anaemia resulting in heart failure and hydrops fetalis. The newborn is at

risk for induced prematurity, anaemia, cholestasis and hyperbilirubinemia. Severe

hyperbilirubinemia may lead to neurological sequele due to deposition of unconjugated bilirubin

in brain tissue (kernicterus) if not recognized and adequately treated [4].

Over 50 red blood cell antigens can cause HDFN, however only Rh D, Kell (K1) and Rh c

alloimmunization are frequently associated with severe fetal disease. Fetal hydrops consists of

abnormal fluid accumulation in fetal compartments, including ascites, pleural effusion, pericardial

effusion, and skin oedema [5].

So, the knowledge, attitude and practice of child bearing age women‟s plays great role in

controlling the progression and to overcome such problem in the community. Very little is known

about the extent of knowledge, attitude and practice of child bearing aged women toward Rh

disease. There has been limited number of studies conducted in Ethiopia regarding Rh disease [6].

The incidence of RhD incompatibility varies according to race and ethnic background.

Approximately 15% of the Caucasian population is RhD negative. In most other populations

however, the incidence of an RhD negative phenotype is significantly lower, in African-

Americans the incidence is 5–8%, in Asians and Native Americans 1–2%. In the Caucasian

population, an RhD negative woman has an 85% probability that her partner will be RhD positive,

in 60% heterozygous and in 40% homozygous at locus RhD. In approximately 10% of all

pregnancies, the situation arises where an RhD negative mother will have an RhD positive child




and approximately 60% of RhD negative women will have an RhD positive child in their first

pregnancy [7].

The RhD-negative phenotype is low among Africans; 4.44% in Nigeria, 3.9% in Kenya, 4.06% in

Guinea and 2.4% in Cameroon and significantly lower compared to prevalence observed among

Caucasians [3, 8, 9, 10]. But the incidence of Rhesus D hemolytic disease resulting from feto

maternal haemorrhage (FMH) occurring in Rhesus negative women who carry a Rhesus positive

foetus continue to be high. In most countries of SSA, there are challenges associated with the

management of sensitizing events (abortion, ectopic pregnancy and miscarriage) associated with

Rh negative women [3].

Results of research conducted at Mekelle shows that 91.2% (5458/5987) women were positive for

rhesus D antigen while the remaining 8.8% (529/5987) women were negative for the antigen

[11].While the results from Silte shows the percentage of Rh (D) positive subjects 91.16%,

93.19%, 91.84% in Sodo, Silte and Meskan ethnic groups, respectively and Rh negative subjects

was 8.84%, 6.81%, 8.16% in Sodo, Silte and Meskan ethnic groups, respectively [12]. The other

results from researches conducted at Dilla university shows that the most prevalent blood group

was positive blood type (90.78 %), followed by negative blood type (9.21%), in the students from

Amhara region. Similarly, in the SNNP state of students was positive blood type (87.32 %)

followed by negative blood type (12.68 %). On the other hand, the highest blood type in the

Oromia state of students was positive type (91.50 %) followed by (8.50 %) Rh negative [13].

In 2010, an estimated 373,300 babies were affected with Rh haemolytic disease worldwide. The

global estimated prevalence for Rh disease was 276/100,000 live births. Prevalence for specific

regions such as Southeast Asia/Pacific countries, Latin America, North Africa/the Middle East,

South Asia, sub-Saharan Africa, and Eastern Europe/Central Asia is estimated at 57, 252, 278,

385, 386, and 529/100,000 live births, respectively. These data are in contrast to Rh disease

prevalence of 2.5/100,000 live births in countries that have well-established health-care

infrastructure that includes coordinated perinatal–neonatal care for virtually all pregnancies [14].

Each year greater than 42 million pregnancies are terminated due to various reasons. Of this 22

million occur in countries where abortion is legalized and in safe ways. The rest 20 million occur

mostly in the developing countries where abortion is not legalized and in unsafe ways. The reason

for this can be increased number of unplanned pregnancies some of which are terminated by

inducing abortion. In addition to this there is increased probability of women to seek for




traditional abortion practices which are performed by untrained professionals in a place that does

not meet the minimal medical standards or both and decrease the chance of gaining access to post

abortion care, so that there will be a high incidence of complications [15].

In Ethiopia, unwanted pregnancy is a big problem; more than 60% of the pregnancies in

adolescents are unwanted resulting from unprotected sexual intercourse which is an alarming

figure, and most of these pregnancies particularly in adolescents end up with unsafe abortion.

Despite the effort made by the health authority in Ethiopia to prevent unwanted pregnancies,

unsafe abortion among youths of age less than24 years and the number of youths requesting

termination of pregnancy is increasing annually [16,17].

In a survey of 200 pregnant women (mean age 24 years) attending a traditional birth home (TBH)

in Abeokuta, Nigeria, 19 (9.5%) were found to be rhesus negative delivered at the TBH without

being given the post-partum injection of anti-D-gama globulin within 72 hr of delivery, thereby

having their systems likely sensitized (if baby is rhesus positive) against subsequent pregnancies

involving Rhesus positive foetuses. One woman who has had an induced abortion and was

carrying a second pregnancy lost the pregnancy in the course of this study. The knowledge of

these women (who were mostly without formal education) on their haematological status is nil

[18].

Without prophylaxis an Rh (D)-negative mother with an Rh (D)-positive fetus has a 12% to 16%

risk of sensitization. Routine use of postpartum anti-D immunoglobulin (Ig) prophylaxis in

eligible women, i.e., Rh (D)-negative women without prior sensitization, decreases the

sensitization rate to 1.6% to 1.9%. Therefore, the remaining 2% of patients with sensitization,

despite postpartum anti-D Ig prophylaxis, are believed to become sensitized during the antenatal

period prior to delivery. Many studies have demonstrated that an additional ante- partum dose of

anti-D Ig in the third trimester can further decrease alloimmunization rates 10-fold, resulting in

overall rates as low as 0.1% to 0.2%. Clinical practice guidelines in Canada and the United States

recommend routine prophylaxis for eligible women, with anti-D Ig given as a single or double

dose in the third trimester and within the first 72 hours postpartum. Even with these guidelines in

place, maternal alloimmunization still occurs in up to 6.8/1000 live births [19].

In Karachi, Pakistan a total of 350 females were interviewed and checked for blood group and

8.3% were found to be Rh negative. Only 2% women had knowledge about complications related

to negative blood group during and after pregnancy. Majorities (94.3%) were not aware that what

precautions should be taken if a mother's blood group is Rh negative [20].




According to researches done at University of Kufa, Najaf, Iraq, it was found that only 8

neonate‟s (28.6%) mothers already knew their own and their husbands blood Rh type in the first

group of study population selected by the researcher. In the second group 61 neonate‟s (66.3%)

mothers knew their own and their husbands blood Rh type while 20 neonates‟ (71.4%) in first and

31 neonates‟ (33.7%) in second group mothers didn‟t know the Rh blood type of their own and

their husbands [21].

STATEMENT OF THE PROPLEM

In Ethiopia, unwanted pregnancy is a big problem; more than 60% of the pregnancies in

adolescents are unwanted resulting from unprotected sexual intercourse which is an alarming

figure, and most of these pregnancies particularly in adolescents end up with unsafe abortion.

Despite the effort made by the health authority in Ethiopia to prevent unwanted pregnancies,

unsafe abortion among youths of age less than 24 years and the number of youths requesting

termination of pregnancy is increasing annually [16,17].

Rh disease or Rh haemolytic disease is defined by maternal fetal Rh (D) antigen incompatibility

and the consequences associated with maternal sensitization. Severe haemolytic disease manifests

as progressive anemia and hypoalbuminemia, leading to edema and heart failure, resulting in

stillbirths or early neonatal deaths. Surviving infants can present with severe jaundice, anemia,

and death from kernicterus or brain damage resulting from excessive hyperbilirubinemia (EHB).

These complications can be treated with timely exchange via blood transfusions. In most high-

income countries, Rh disease has been eradicated by coordinated obstetrical and neonatal care.

But, in most countries in Sub-Saharan Africa (SSA), like Ethiopia there are challenges associated

with the management of sensitizing events (abortion, ectopic pregnancy and miscarriage)

associated with Rh negative women [3] and also very little is known about the extent of

knowledge, attitude and practice of child bearing aged women toward Rh disease. There has been

limited number of studies conducted in Ethiopia regarding Rh disease [6]. That is why the study

focuses on determining KAPs of AU undergraduate female students on Rh disease.

SIGNIFICANCE OF THE STUDY

Risky sexual behaviours like unprotected sex, no or inconsistent use of condoms and drug abuse

are extremely detrimental to the health of adolescents putting them at high risk to unintended

pregnancy. This Results in abortion which is one of the risk factors that sensitize the mother if

there is contact between mother‟s and the fetal blood. This sensitization occurs if mother is RhD




negative and the foetes is RhD positive. It is reasonably possible to think that university students

are educated, inspired, able to practice upon the information they receive and as a result, they are

among a low risk population. On the other hand incidence and the complication rate of Rh

incompatibility varies in different parts of the world and the low incidence of Rh negativity often

leads to the neglect of rhesus incompatibility in many parts of world. Knowledge is very

important for acquiring optimum health. Attitude formation is not essentially a function of the

amount of information one receives but a function of how that information was acquired.

Moreover, increasing knowledge of RhD incompatibility can be a powerful means of fostering

positive attitudes and building safe practices among population. Hence, a clear understanding

about knowledge, attitude and practices (KAPs) among any population is very important for

planning to control or prevent the Rh disease. So, it is prudent to conduct this study among AU

students in order to ascertain their knowledge, attitude and practices (KAPs) regarding Rh

disease. Thus, this study intends to examine students‟ knowledge, attitude, and practices on

preventive measures against Rh disease among students of Ambo University.

OBJECTIVE OF THE STUDY

General objective:

To assess the Knowledge, Attitude and Practice of Ambo University undergraduate regular

female students on Rhesus disease (shotelay).

Specific objective:

To identify knowledge of the students about Rh disease

To assess the attitude of students towards Rh disease

To assess the contribution of the students towards Rh disease control and prevention practice.

To find out factors associated with KAPs toward Rh disease

METHODOLOGY

Study area

Ambo is found 125km from Addis Ababa in West Shewa, Oromia region. Ambo University is

one of the pioneer Universities in Ethiopia offering multidisciplinary fields of study in post

graduate, under graduate and continuous education program. It has 3 campuses including the

main campus. The regular students who learn in Ambo University are 11096 in which the number

of male students is 7413.

There is 10 faculties and 45 departments under the university in academic year of 2007 EC.




Study period

The study was conducted from April, 8 – May, 30, 2015, in Ambo University main campus.

Study design

An institutional based cross-sectional study design was employed.

Source population

All regular female students of Ambo University were source population.

Study population: All undergraduate regular female students of Ambo University main campus

selected randomly were study population.

Study unit: The study units are the individual female students who fulfill inclusion criteria.

Inclusion criteria: Regular students of the academic year 2015 in main campus

Exclusion criteria:-

Distance and continuous students were excluded

All students who were critically ill during data collection were excluded.

Technology students were excluded

Students of Woliso campus

Females of age less than 18 and greater than 49

Students on attachment during data collection

Sample size determination and sampling techniques

Sample size determination

With an assumption the proportion of adequate knowledge as 50% among Ambo University

female students at confidence level of 95% and marginal error of 5% and using a single

population proportion formula:

= (1.96)2 x 0.50(1-0.50)/ (0.05)

2 = 384

N = sample size;

Z = value corresponding to a given confidence level;

p = percentage of the primary indicator, expressed as a decimal

c = standard error, expressed as a decimal

Because the sample was taken from a relatively small population n<10,000 the required minimum

sample was obtained as follow

Sample size=n / (1+(n/N))




384 / (1+ (384/1692)) =312.958 ≈ 313

By considering 5% non response rate the total sample size was 328.

Sampling technique: The study participants were selected by simple random sampling technique

by proportionally allocating to each faculty.

Fig. 1: Schematic presentation of the sampling procedure Ambo University main campus

Undergraduate Regular Students, Ambo, Ethiopia, 2015

Data Collection Procedures

The data collection tools was adapted from different relevant literatures published sources and

modified to the local context. Data collection was self- administered questionnaire with combined

closed and open-ended questions. It was prepared in English language. The facilitator was

principal investigator and he announced about the study.

Study Variable

Dependent Variable

Knowledge, attitude and practice (KAP) of Rh disease.

Independent Variable

Socio-demographic characteristic: Age, marital status, religion, years of study and residence.

Data collector and quality management

The pretest was performed on 5% of participants who were taken from Ambo University Awaro

campus in order to modify the questionnaire if there is ambiguity and vagueness of words

including medical terms that are difficult to understand for students who are not in health




department as well as to keep logical order of the questions. Data collection facilitator was

principal investigator and for data quality management the collected data was sorted as

completely filled or incompletely filled then the 27 incompletely filled questionnaires was

discarded and only completely filled questionnaire was used.

Data processing and analysis

After data collection, each questionnaire was checked for completeness, edited, cleaned missed

values and missed variables and data was analyzed manually by using scientific calculator as well

as using SPSS software to provide frequencies and percentages for categorical variables and

means and standard deviations for numerical variables. Correlation was done to factors correlated

with KAP of Rh disease and the result was presented using tables, figures and charts.

Operational Definitions and Terms

Knowledge: Knowledge is a set of understandings, knowledge and of “science.” It is also one‟s

capacity for imagining, one‟s way of perceiving. Knowledge of a health behaviour considered to

be beneficial, however, does not automatically mean that this behaviour will be followed.

Attitude: Attitude is a way of being, a position. These are leanings or “tendencies to….” This is

an intermediate variable between the situation and the response to this situation. It helps explain

that among the possible practices for a subject submitted to a stimulus, that subject adopts one

practice and not another. Attitudes are not directly observable as are practices, thus it is a good

idea to assess them

Practice: Practices or behaviours are the observable actions of an individual in response to a

stimulus. This is something that deals with the concrete, with actions.

Abortion: the act of inducing the cessation of pregnancy or fetal development

Miscarriage: spontaneous natural termination of a pregnancy; the fatal explution of a foetus from

the womb before term.

Good knowledge: respondents who answer more than 65% of the questions asked to assess their

knowledge.

Poor knowledge: respondents who answer less than or equal to 65% of the questions asked to

assess their knowledge.

Positive attitude: when the respondents answer more than 60% of questions of attitude.

Poor attitude: when the respondents answers less than or equal to 60% questions of attitude.

Ethical Consideration: Ethical clearance letter was initially obtained from Ambo University

research Ethical Committee. Then written consent was secured from student dean office which




was provided to registrar office to get permission. Further, principal investigator was briefed

about the study by the data collector by stating the main objective and any unclear points related

to the study was explained, after which the interview was began. Moreover, to ensure

confidentiality the name of respondents was not written on the consent form. Telling that their

participation in the study is very important, every student to be interviewed was informed that

they have a full right to discontinue the interview at any time.

RESULT AND DISCUSSION

Socio-demographic status of the participants

The complete response rate was 91.77% (301/328) with mean age of 21.31 year which ranges

from 18 to 33years. Concerning ethnicity, majority of the respondents 193(64.10%) were Oromo

followed by Amhara which account, 54 (17.90%). Regarding religion 127(42.20%) of the

respondents were protestant followed by Orthodox which account 119(39.50%). Almost all of the

respondents 263(87.40%) were single and only 2(0.70%) divorced/widowed. From the total 8

faculties the proportion of agriculture and veterinary science students accounts 57(18.90%) which

is similar proportion for Natural and computational science students. Out of total 301

respondents‟ students from school of law accounts only 10(3.30%). Majority of the respondents

were from second year students which accounts 113(37.90%).

Table 1: Age frequency distribution of 301 undergraduate regular female students of Ambo

University main campus West Shewa, Ambo, Ethiopia April, 2015Gc. (N=301)

Age 18 19 20 21 22 23 24 25 26 27 28 29 30 33

Frequency 7 28 106 57 37 25 12 14 7 3 1 1 2 1

Percent (%) 2.3 9.3 35.2 18.9 12.3 8.3 4 4.7 2.3 1 0.3 0.3 0.7 0.3

Table 2: Demographic Information of Respondents

Variable Category Frequency(N) Percentage (%)

Ethnicity

Oromo 193 64.20

Amhara 54 17.90

Tigre 29 9.60

SNNP 25 8.30

Residence Urban 171 56.80

Rural 130 43.20

Marital status

Single 263 87.50

Married 36 120

Divorced/widowed 2 0.30

Religion

Protestant 124 41.20

Orthodox 119 39.50




Muslim 27 9.00

Catholic 18 6.00

Wakefata 9 3.00

Adventist 4 1.30

Faculty

Agriculture 57 18.90

Natural & computational science 57 18.90

Social science &humanity 51 16.90

Health 50 16.60

FBE 29 9.60

Cooperative &dev‟t study 24 8.00

Education &professional dev‟t 23 7.60

Law 10 3.30

Academic year

1styear 67 22.30

2nd

year 114 37.90

3rd

year 97 32.20

4th

year 23 7.60

Respondents source of information regarding the Rh disease

Out of total respondents 189(62.80%) did not know the Rh disease before while 43(14.3%),

24(8.00%), 93(6.30%) did know the Rh disease with source from school, health institution, mass

media, respectively.

Fig. 2: Distribution of primary sources of information of Rh disease (shotelay) of Ambo

University main campus regular undergraduate female students, 2015 GC

Knowledge of the participants about Rh disease (shotelay)

According to this study result only 112(37.20%) respondents from total of 301 knows about Rh

disease (shotelay) before. Out this 61(54.46%) students were from urban area. Among those who




knew the disease 43(38.40%) of them get information from school teachers. Sixty one (54.50%)

female students know the complications that result when Rh- mother become pregnant of Rh+

child. The overall knowledge level of respondents was 23.58%.

Fig. 3: The difference between urban and rural female students on the answer of question

which says, do you know Rh disease (shotelay), N = 301

Table 3: Answers of Questions Assessing Knowledge of Respondents

(N=112, who knew Rh disease.)

Variable

Category (frequency, percent)

Yes/correctly

answered*

No/incorrectly

answered*

Do you know complications result when Rh

negative mother become pregnant of Rh

positive foetus?

61(54.46%) 51(45.54%)

Do you know what precautions to be taken if a

mother Rh is negative? 69(61.6%) 43(38.4%)

Who can be affected with shotelay? 62(55.4%) 50(44.6%)

Can Rh disease (shotelay) be prevented 73(65.2%) 39(34.8%)

How can Rh be prevented? 66(59%) 46(41%)

* indicates for those question having multiple choice

Table 4: The overall knowledge level of participants, N = 301

Good knowledge (those who answered ≥4 out of

six, ≥65%)

Poor knowledge (those who answered <4

out of six, <65%)

71(23.58%) 230(76.42%)

Being health students have significant association [p-value = 0.005, CI = (1.69, 18.69);

AOR = 5.624] with knowledge level of respondents when compared with other variables like

residence, religion, ethnicity, marital status and academic year. Majority of study participants 230

(76.42%) had poor knowledge about Rh disease.

61

110

51

79

112

189

0

20

40

60

80

100

120

140

160

180

200

KNOW ABOUT RH

DO NOT KNOW ABOUT RH

URBAN

RURAL

TOTAL




The prevalence of knowledge in the previous study which was conducted in korangi, Karachi was

very poor and 19.00% females had knowledge about their blood group and only 4.00% female

knew their husband‟s blood group among participants of the study [20]. The current study showed

that knowledge level of the participants is 23.58% which shows that there a little more knowledge

among Ambo University female students when compared to the research‟s conducted in Karachi.

But this does not mean the knowledge is enough to prevent Rh incompatibility and its

complications during pregnancy and after child birth.

There were a gap between these study and the previous studies on educational level of

participants because the previous research were conducted in the community but the current one

was conducted among University students. Most of people agree that University students are

closer to information as compared to the other segment of the community. Thus, they might be

more aware and motivated to prevent Rh disease as compared to the previous study showing

significant association between Rh disease practice and knowledge about Rh disease.

To prevent hemolytic disease of the newborn, sufficient knowledge on blood group and Rh typing

prior to delivery can help to reduce the burden. Rh incompatibility usually happens in the second

and subsequent pregnancies.

This study shows that knowledge regarding blood group, Rh negative incompatibility and its

complications during pregnancy and after child birth was very poor. Mass media campaigns and

awareness drives need to be done in the public and in the reproductive age women and pregnant

cases to make them aware of the importance of blood grouping and its complications in Rh

negative mothers.

Attitude of the study participants towards Rh disease (shotelay)

This study revealed that from the total respondents only 42 (14.00%) had positive attitude towards

Rh disease (shotelay) among Ambo University main campus regular under graduate female

students. Out of total respondents, 22 (7.31%) female students perceive that the Rh disease were

punishment from God; when they were asked for the reason of absence from health center.

Twenty five study participants (8.30%s) do not have any reaction toward ‟‟shotelay.‟‟

Table 5: The overall attitude level of respondents towards Rh disease. N = 301

Positive attitude (those who answered >3

positive attitude question out of five; >60%)

Poor attitude (those who answered ≤3attitude

question out of five; ≤60%)

40(13.29%) 261(86.71%)




Out of 301 total respondents, 141(46.83%), 82(27.11%) and 40(13.38%) have negative reaction

towards those having Rh disease respectively.

Fig.4: Answer to question which says what would be your reaction if you face Rh disease

(shotelay), N = 301

From the total 301 respondents, 26(8.64%) from urban and 14(4.65%) from rural have positive

attitudes while 145(48.17%) from the urban and 116(38.54%) from rural have poor attitudes

towards the Rh disease.

Table 6: Comparative of Rural and Urban distribution frequency of attitude toward

Rh disease

Attitude

Residence

Urban Rural Total

positive 26(8.64%) 14(4.65%) 40(13.29%)

Negative 145(48.17%) 116(38.54%) 261(86.71%)

Residence of the participant (p=0.033,CI [1.079, 6.152],AOR=2.576)have significant association

with attitude of participants on Rh disease. Urban resident respondents have greater positive

attitudes than rural resident participants towards the Rh disease.

This study shows that the attitude of Ambo University regular undergraduate female students

toward Rh disease is more negative 261/301 (86.71%). According to this figure creating

awareness is one of the point that needs special attention to create good attitude. Out of 171 urban

students 26(8.64%) of them had good attitude towards Rh disease. This might be due to exposure

to mass media, and other sources of information than students from rural. Distance from health

facility centers may also have contribution on attitude of participants. So, rural area is the area

which needs more focus when compared to urban area.

46.83%

27.11%

5.99%

6.69%

13.38%

SADNESS

FEAR

SURPRISE

SHAME

EMBARRASSMENT




Practice of the study participants on Rh disease (shotelay)

All the participants (100%) were willing to get information about Rh disease. From total

respondents that participate in the study 42(14.00%) of them were became pregnant in their life

and out of this 17/42 (40.47%) females underwent abortion of which only 2(2/17) used anti-D

because they were Rh negative. The abortion of 12 study participants took place at health

institution out of 17 individuals who underwent abortion while five of them (5/17) did not

undergo abortion at health institution. Nine female out of those who became pregnant in their life

(21.43%) students had checkup for their husband‟s Rh blood group.

Table 7: Practice of respondents toward Rh disease

Total participants who ever become pregnant, N = 42

Terms Frequency

Rh- 9

Rh+ 8

Do not know their Rh type 25

Know their husbands Rh type 9

Abortion 17

terms frequency

Rh- 2

Rh+ 4

Do not know their Rh type 11

Abortion at health

institution 12

Abortion out of health

institution 5

2 Rh positive

3 do not know their Rh blood type

According to the above results almost all of the participants of the study have poor practices

toward preventing and controlling the Rh disease in their community. As indicated above many

of them 25/42(59.52%) did not know their blood type and they did not check for their husband‟s

blood type even though they were pregnant which is lower than the study done in University of

Kufa, Najaf, Iraq, which was found that 8 neonate‟s (28.6%) mothers already knew their own and

their husbands blood Rh type in the first group of study population selected by the researcher

[21].

Moreover, significant number of respondents who ever became pregnant in their life did not

undergo abortion safely since it took place out of the health institution. This accounts for

5/301(1.66%) and which is lower when compared it with the study done in Nigeria, 19

(9.5%)[18].In addition to this there is increased probability of women to seek for traditional

abortion practices which are performed by untrained professionals in a place that does not meet




the minimal medical standards or both and decrease the chance of gaining access to post abortion

care, so that there will be a high incidence of complications [15]. This might be due to many

reasons such as because most of them do not have enough knowledge about shotelay in the recent

study, and low incidence of Rh disease in the world wide [3, 7-14]. Among the total study

participants, only 16(5.31%) students who became pregnant in their life knew the Rh disease

(shotelay). There is significant association between practice and knowledge. Generally, to

decrease the burden of Rh disease (shotelay) in the community awareness should be created to

bring good and appropriate practices toward controlling this burden.

Correlation between Knowledge, Attitude and Practice

There were Pearson correlation between knowledge and attitude(r=0.462) and there was strong

correlation between knowledge and practice (r=0.713).As the knowledge level of respondent

increase there was direct positive increase in positive attitude of participants as well as in good

practices in controlling and preventing Rh disease.

Limitation of the Study

Limitation of the study was Lack of similar studies locally and globally to compare the

finding.

The study was conducted in one university which cannot be generalized for general

population.

CONCLUSION

Generally the knowledge level of the students regarding Rh disease in Ambo University main

campus regular female student were low which was 23.58%. The majority of the study participant

did not know the Rh incompatibility and its complication during and after pregnancy.

Only 40(13.28%) of the study participants had good or positive attitude towards Rh disease while

25 (8.30%) had no any feeling toward ‟‟shotelay‟‟ and factors associated with attitude of study

respondents were knowledge of the participants. And also many respondents had poor practice in

preventing the Rh disease.

RECOMMENDATION

Based on the findings, the following recommendations were forwarded: Policy makers and health

planers should design programs and plans to increase the knowledge, favorable attitude and

practice of Rh disease (shotelay) among University students and community as well.




It would be better to give greater emphases to address KAP towards Rh disease (shotelay)

by using mass media and school health education in more comprehensive manner because

Rh disease is one of the disease that can be prevented if good awareness is created among

community.

Government should increase or create awareness among the community at all through the

health care package especially through Health Extension Workers.

Further researches both quantitative and qualitative study methods on large scale of different

Universities as well as in community are recommended for researchers.

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