A cross-sectional study was done from August 2019 to November 2019 in IMARET Mobile Clinic in Selayang, Selangor, Malaysia. The population included for this study was Rohingya female refugees of reproductive age group (15 - 52 years old) (Bustreo, 2015). Study subjects with any of the following exclusion criteria were not eligible to participate in this study. The exclusion criteria were as follows: individuals facing difficulty of understanding the questionnaire, individuals speaking other languages apart from the trained translators, elderly (60 years old and above), not consented or willing to participate in the study and individuals that failed to complete the whole questionnaire.

The study was approved by the appropriate institutional and/or national research ethics committee and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Ethical approval for conducting this study was obtained from the Medical Research Ethics Committee, University of Cyberjaya (CUCMS/CRERC/FR/032).

Subjects’ involvement in this study was voluntary and agreed to participate with both verbal and written consent form (Appendix: consent form). Participants were well-informed of all important information regarding the study including assured confidentiality with no adverse consequences arise if they declined participation. No identifying markers of any of the participants were revealed in the study and only relevant details related to the research were conveyed.

Quantitative information was collected using a validated questionnaire developed by Santoso & Surya (2017). It contains five domains such as socio-demographic background, reproductive health issues, knowledge, attitude and practice on family planning. Questions regarding sources of information and services of contraception were included under the knowledge domain. Each of the questions were verbally asked to each of the participants with the help of a trained translator in the preferred languages. One session took about 10 - 15 minutes to complete the questionnaire.

Total score for each domain was used to rank the level of knowledge, attitude and practice into specific categories as summarised in Table 1. For knowledge

domain, the total score was determined by summation of number of contraceptive methods known and knowledge on number of contraceptive methods that did not interfere with process of breastfeeding. The total score of attitude refers to summation of the use of contraception to control birth interval, the benefit of using contraception, the desire to use contraception postpartum, and family support to use of contraception. While the total practice score was the summation of history of using contraception and the desire to use contraception in the future (Salisbury et al., 2016). Other questions in the questionnaire apart from the stated were not included for scoring of KAP.

Data collected were analysed using the Statistical Package for Social Sciences (SPSS) Ver. 25 for Windows. Descriptive statistics were used to analyse the characteristics of study population. The categorical variables were tabulated as frequency and percentage while continuous variables were measured as mean ± standard deviation. Inferential statistics such as Mann-Whitney U test and Kruskal Wallis tests p < 0.05 were used to evaluate significance among study variables. p-value < 0.05 is considered statistically significant (Hameed et al., 2019). Meanwhile, correlations were interpreted using Pearson product-moment correlation.

Demographic characteristics of the 86 respondents included in the study were as shown in Table 2, in which age varied from 15 to 52 years old.

The most frequently encountered group was 15 to 19 years old (n = 16, 18.6%). More than half of the respondents did not have educational background (n = 44, 51.2%) and all the respondents (n = 86, 100%) were Muslims. About (n = 54, 62.8%) were housewives and most of them (n = 67, 77.9%) were married. A big percentage of them (n = 32, 42.7%) had early marriage age below 18 years old and majority (n = 45, 59.2%) had 1 - 3 children.

Table 3 showed only seven (8.1%), had experienced one or more reproductive health issues. Out of the seven people, five (71.4%) had gestational diabetes and another five (71.4%) had pre-eclampsia. Meanwhile, only one person had either miscarriage or pre-mature birth. Other reproductive health issues such as STDs that has high correlation with unmet use of contraception as mentioned by McCoy et al. (2014) was not found in the Rohingya female refugee community.

Table 8 showed small and negative correlation of reproductive health issue with all three domains of KAP. This indicates that the higher the KAP scores the lower the incidence of reproductive health issues among the respondents. However, it has no statistical significance with (r = −0.11, p = 0.322), (r = −0.22, p = 0.142) and (r = −0.18, p = 0.102) respectively. This was due to small number of reported cases of reproductive health issues found in this study. Out of the 86 respondents, none reported having sexually transmitted disease.

Multiple choices were allowed, so total was not 100%.

A study by Frank (2011) reported that the education among Rohingya children was being discouraged by the government, which explained low literacy rates. Thus, the language barrier may become one of the major factors limiting access of knowledge on family planning. About (n = 54, 62.8%) were housewives and most of them (n = 67, 77.9%) were married. A big percentage of them (n = 32, 42.7%) were married before they were 18 years old (UNICEF, 2017) and majority (n = 45, 59.2%) had 1 - 3 children. According to Hamid et al. (2011), women who are independently working, autonomous and free to make decision, had better provision in their married life and were more able to talk about their reproductive matters to their husbands.

Strong religious belief was found to be the factor for lack of STDs reported among the Rohingya refugees’ community who are mostly practicing Muslims. Similarly, Frank (2011) found that the presence of the community leader significantly affects the difference of lifestyle practiced by the Rohingya refugees living in Malaysia.