Health Professionals' Knowledge of Female Genital Mutilation
Health Professionals' Knowledge of Female Genital Mutilation
To achieve the proposed objective, a cross-sectional descriptive study was designed to examine the KAP of Gambian HCPs regarding FGM/C. A multiethnic approach was chosen because this practice is closely linked to ethnic identity. The survey was conducted in 2009. Following a pilot study carried out in Banjul and the West Coast Region, implementation of the survey took place in rural settings throughout four regions: North Bank Region, Lower River Region, Central River Region, and Upper River Region.
The questionnaires were administered, face to face, by 40 medical students of the Community-based Medical Programme, under the Cuban Medical Mission in The Gambia. This research was conceived as part of their practicum in the Biostatistics course. The medical students attended 1 week of training on FGM/C and social research skills (including data collection, entry and analysis, as well as proposal development) by a team consisting of a medical anthropologist, a biostatistician, and a medical doctor. The organisation and supervision of the fieldwork were performed by members of the Regional Health Teams, under the authority of the Ministry of Health and Social Welfare. Their committed collaboration was fundamental to the implementation of this research.
The involvement of native interviewers was important for this study. This contributed to reduce the distance between interviewers and interviewees because they were both living in rural areas and shared the same culture. The interviews were conducted in English and/or local languages, as agreed between the interviewer and the interviewee. The involvement of native interviewers promoted the empowerment and ownership of knowledge of the native population, which was one of the core values of this research.
The interviewers were men and women, belonging to all ethnic groups. There was no matching between the sexes and the ethnic groups of interviewers/interviewees.
The overall sample consisted of 468 HCPs, including nurses, community nurses, public health nurses, nurse attendants, and midwives. All public health system facilities located in the four rural regions were covered, which included hospitals, dispensaries, and major and minor health centres.
The KAP questionnaire was designed by a medical anthropologist researcher with a thorough and extensive ethnographic background in The Gambia. This questionnaire was designed following the implementation of barrier analysis using focus group discussions among Gambian men and women of all ethnic groups. Questionnaires were in English, the official language in the country. Four open and 25 close-ended questions were used to collect socio-demographic data (name of institution, occupation, age, sex, ethnic group, and date of interview) and on information regarding the KAP of HCP. The specifics of KAP were as follows. Knowledge on FGM/C health consequences (including exposure), reasons given for performing this practice, and its mandatory character in relation to religion, were examined. Attitudes towards the continuation of FGM/C, possible strategies for preventing it (including the role that can be played by HCPs and Islamic leaders), its medicalisation, the discrimination of girls who do not undergo FGM/C, and the involvement of men in the debate were examined. Practices included assessing if FGM/C is practiced in the HCP's families/households, whether they would subject their own daughters to the practice, and whether they had ever performed FGM/C on girls.
The pilot study allowed testing of the consistency of the KAP questionnaire. The questionnaire was validated after being administered to 97 HCPs by medical students from the University of The Gambia.
The study was approved by The Gambia Government/Medical Research Council Laboratories Joint Ethics Committee (Ref: R08002), which is the ethical committee in The Gambia. All respondents signed an informed consent, which was kept under the custody of Wassu Gambia Kafo, a non-governmental organisation that supported the study. Rigorous confidentiality over participants' identity was maintained.
Once collected, the data were computerised via Epidata and analysed in SPSS Version 19. Univariate and bivariate analyses with chi square tests were conducted to detect differences in KAP among HCPS of various ethnic origins and both sexes. Intra-sex and inter-sex relationships were tested. Statistical significance was considered at p < 0.05.
Methods
Design of the Study
To achieve the proposed objective, a cross-sectional descriptive study was designed to examine the KAP of Gambian HCPs regarding FGM/C. A multiethnic approach was chosen because this practice is closely linked to ethnic identity. The survey was conducted in 2009. Following a pilot study carried out in Banjul and the West Coast Region, implementation of the survey took place in rural settings throughout four regions: North Bank Region, Lower River Region, Central River Region, and Upper River Region.
The questionnaires were administered, face to face, by 40 medical students of the Community-based Medical Programme, under the Cuban Medical Mission in The Gambia. This research was conceived as part of their practicum in the Biostatistics course. The medical students attended 1 week of training on FGM/C and social research skills (including data collection, entry and analysis, as well as proposal development) by a team consisting of a medical anthropologist, a biostatistician, and a medical doctor. The organisation and supervision of the fieldwork were performed by members of the Regional Health Teams, under the authority of the Ministry of Health and Social Welfare. Their committed collaboration was fundamental to the implementation of this research.
The involvement of native interviewers was important for this study. This contributed to reduce the distance between interviewers and interviewees because they were both living in rural areas and shared the same culture. The interviews were conducted in English and/or local languages, as agreed between the interviewer and the interviewee. The involvement of native interviewers promoted the empowerment and ownership of knowledge of the native population, which was one of the core values of this research.
The interviewers were men and women, belonging to all ethnic groups. There was no matching between the sexes and the ethnic groups of interviewers/interviewees.
Research Population
The overall sample consisted of 468 HCPs, including nurses, community nurses, public health nurses, nurse attendants, and midwives. All public health system facilities located in the four rural regions were covered, which included hospitals, dispensaries, and major and minor health centres.
Questionnaire and Variables Studied
The KAP questionnaire was designed by a medical anthropologist researcher with a thorough and extensive ethnographic background in The Gambia. This questionnaire was designed following the implementation of barrier analysis using focus group discussions among Gambian men and women of all ethnic groups. Questionnaires were in English, the official language in the country. Four open and 25 close-ended questions were used to collect socio-demographic data (name of institution, occupation, age, sex, ethnic group, and date of interview) and on information regarding the KAP of HCP. The specifics of KAP were as follows. Knowledge on FGM/C health consequences (including exposure), reasons given for performing this practice, and its mandatory character in relation to religion, were examined. Attitudes towards the continuation of FGM/C, possible strategies for preventing it (including the role that can be played by HCPs and Islamic leaders), its medicalisation, the discrimination of girls who do not undergo FGM/C, and the involvement of men in the debate were examined. Practices included assessing if FGM/C is practiced in the HCP's families/households, whether they would subject their own daughters to the practice, and whether they had ever performed FGM/C on girls.
The pilot study allowed testing of the consistency of the KAP questionnaire. The questionnaire was validated after being administered to 97 HCPs by medical students from the University of The Gambia.
Ethical Aspects
The study was approved by The Gambia Government/Medical Research Council Laboratories Joint Ethics Committee (Ref: R08002), which is the ethical committee in The Gambia. All respondents signed an informed consent, which was kept under the custody of Wassu Gambia Kafo, a non-governmental organisation that supported the study. Rigorous confidentiality over participants' identity was maintained.
Statistical Analyses
Once collected, the data were computerised via Epidata and analysed in SPSS Version 19. Univariate and bivariate analyses with chi square tests were conducted to detect differences in KAP among HCPS of various ethnic origins and both sexes. Intra-sex and inter-sex relationships were tested. Statistical significance was considered at p < 0.05.