Level of knowledge, attitude, and practice regarding emergency contraception pills among female undergraduate students at KCMUCo in the Moshi Municipality, Kilimanjaro, Tanzania

Abstract

Background

Globally, unplanned pregnancies and unsafe abortions are prevalent among young and unmarried women aged 18

years and above. Existing evidence shows widespread use of emergency contraception pills (ECP) may significantly

reduce induced abortion-related morbidity and mortality. This study aimed to determine the level of knowledge,

attitudes, and practice regarding ECP among female undergraduate students aged 15 years and above at a Medical

University in Moshi Municipality in the Kilimanjaro region, Tanzania.

Methods

Using a descriptive cross-sectional study design with multistage random sampling, semi-structured questionnaire

data were collected among 314 female students at Kilimanjaro Christian Medical University College (KCMUCo) from

July 2024 to August 2024.

Results

Three hundred and fourteen (314) participants were enrolled (response rate 100%). The median age was 22 years

(Interquartile range (IQR)= 2 years), the majority, 302 (96.2%) were in the age group of 15-25 years old, 309, (98.4%),

were unmarried, 218, (69.4%)were Christians,169(53.8%) were enrolled in the Doctor of Medicine program, 44%

(n=138/314), had had a sexual experience, and 60% (83/138) had their sexual debut between 14-19 years old. The

majority, 87.9% (276/314), had heard about ECP, and 72% (198/276) mentioned the internet as the main source of

information on ECP. More than half of participants, 58.8 %(n=168/287), had a high level of knowledge of ECP. More

than half of participants, 54.4% (n=156/287), had positive attitudes towards ECP. 62%(85/138), had used ECP in the

past, and predictors associated with ECP practices at multivariate analysis include social acceptability for female

students to use ECP (Adjusted odds ratio (AOR) = 2.10 [95 % Confidence interval (CI) 1.00-4.31; P= 0.05], intention

to use ECP in the future (AOR=3.01[2.30-8.64]; P=0.000), adequate knowledge of ECP (AOR=6.70[2.80-16.0];

P=0.000), fear of side effects as a barrier to ECP use (AOR=0.23[0.11-0.48]; P= 0.05), and the belief that ECP can

prevent STD (AOR = 0.32[0.12-0.85]; P=0.02).

Conclusion

Female graduate students had a high level of knowledge, and a positive attitude towards ECP, with the internet as

the main source of information. Adequate level of knowledge, social acceptability of female students to use ECP,

and intention to use ECP in the future are positively associated with ECP practices. Participants who reported fear

of side effects of ECP, and the belief that ECP can prevent STDs, are less likely to use ECP. Despite a high level of

knowledge and positive attitude towards ECP, reinforcing the respondent’s knowledge of specific details of ECP

such as mechanism, efficacy, and typology may be beneficial for improving ECP practices among female

undergraduate students at KCMUCo in Moshi Municipality.