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Bezabih T, Agidew SD, Kebede SS, Belay MM, Siyoum E, Ashenafi E, Birhane M. Determinants of implanon discontinuation among women in Gedeo Zone, South Ethiopia: a case-control study. Contracept Reprod Med 2024; 9:22. [PMID: 38741215 DOI: 10.1186/s40834-024-00263-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 01/13/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The main public health problem that has a significant impact on the high fertility rate, unintended pregnancies, and induced abortion is Implanon cessation. In addition to Implanon being underutilized in Ethiopia, the rate of cessation is higher among women who started using it. Nevertheless, little is known about the factors that lead to Implanon cessation. OBJECTIVES The study was aimed to determine the factors that led women to discontinue Implanon in Gedeo Zone, Southern Nation Nationalities and Peoples Region, southern Ethiopia, 2019. METHOD A community-based unmatched case-control study design was carried out. Cases and controls were selected by a multi-stage sampling with a 1:2 case-to-control ratio. Data was entered into EPi-data version 3.1 and exported to Statistical Package for Social Sciences (SPSS) version 20 for analysis. A bivariate and multivariable logistic regression was used to identify the factors affecting Implanon discontinuation. The adjusted odd ratio (AOR) with 95% Confidence Interval (CI) was used to determine the precision of estimates, and statistical significance was declared at a p-value of 0.05. RESULT From 516 women included in to the study, 495 (cases = 166 and controls = 329) women have responded to the questionnaires making a response rate of 96%. Monthly income 500-1000 birr [AOR: 0.3; 95% CI (0.2-0.5)], above 1000 birr [AOR: 0.2; 95% CI (0.1-0.4)], history of abortion [AOR: 2.0; 95% CI (1.0-4.1)], birth spacing [AOR: 0.6; 95% CI (0.3-0.9)], partner objection [AOR: 2.4; 95% CI (1.4-4.2)] were significantly associated factors. CONCLUSION This study identified that monthly income, having abortion history, birth spacing, partner objection were the factors that affect Implanon discontinuation. To reduce implanon discontinuation, reducing abortion, involving partner and increasing the birth spacing, appropriate counseling before the insertion and appropriate follow-up by a health care practitioner are highly recommended.
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Affiliation(s)
- Tihtina Bezabih
- Department of Reproductive Health, School of Public Health, College of Medical and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Selamawit Dires Agidew
- Department of Reproductive Health, School of Public Health, College of Medical and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Selamawit Semagn Kebede
- Department of Reproductive Health, School of Public Health, College of Medical and Health Sciences, Dilla University, Dilla, Ethiopia.
| | - Moges Mareg Belay
- Department of Reproductive Health, School of Public Health, College of Medical and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Ever Siyoum
- Department of Reproductive Health, School of Public Health, College of Medical and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Eden Ashenafi
- Department of Reproductive Health, School of Public Health, College of Medical and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Mahlet Birhane
- Department of Nutrition, School of Public Health, College of Medical and Health Sciences, Dilla University, Dilla, Ethiopia
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Ayele SG, Mekonnen B, Deribe L, Tsige AW. Prevalence of modern contraceptive discontinuation and associated factors among married reproductive age group women in Debre Berhan town, Ethiopia: a community-based cross-sectional study. BMJ Open 2024; 14:e066605. [PMID: 38684273 PMCID: PMC11086279 DOI: 10.1136/bmjopen-2022-066605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 03/20/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE To assess the prevalence of modern contraceptive discontinuation and associated factors among married reproductive age (15-49 years) group women. STUDY DESIGN, SETTING AND PARTICIPANTS A community-based cross-sectional study was conducted in Debre Berhan town among 500 reproductive age group women. Study participants were selected using two-stage sampling procedures. Data were collected using a semistructured face-to-face interview questionnaire. The data were entered in EpiData V.4.2.0 and then exported to SPSS V.25 software for data analysis. Descriptive statistics such as mean, per cent and frequency were used to summarise women's characteristics. Binary logistic regression analysis was used to identify predictors' variables with modern contraceptive discontinuation and p<0.05 was used to declare association. RESULTS The prevalence of modern contraceptive discontinuation among married reproductive age group women was 35.2% with a mean duration of use of 2.6±2.1 months. This study also revealed that the discontinuation rate was 12.6% within the first year of use. In the current study, those living with their husband (adjusted OR (AOR)=3.81, p<0.001), experiencing side effects while using modern contraceptives (AOR=2.45, p=0.02), getting counselling service (AOR=5.51, p<0.001) and respondent husband acceptance of her modern contraceptive use (AOR=3.85, p=0.01) were significantly associated with modern contraceptive discontinuation. CONCLUSION The findings of this study showed that the prevalence of modern contraceptive discontinuation rate of all methods among married reproductive age group women was 35.2%. To reduce modern contraceptive discontinuation, mutually, it is important to create community awareness about the importance of the continued use of modern contraceptives, improve the quality of family planning service in the health institution, strengthen family planning counselling service and give adequate counselling on details of effectiveness and side effects.
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Affiliation(s)
| | - Baze Mekonnen
- Department of Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Leul Deribe
- Department of Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
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Ntimani JM, Randa MB. Experiences of women on the use of Implanon NXT in Gauteng province, South Africa: A qualitative study. Health SA 2024; 29:2237. [PMID: 38445029 PMCID: PMC10913096 DOI: 10.4102/hsag.v29i0.2237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 09/21/2023] [Indexed: 03/07/2024] Open
Abstract
Background Maternal-related illnesses and pregnancy-related deaths could be averted using contraceptives, particularly long-acting methods because they improve overall access to family planning because of their benefits, such as fewer visits to the healthcare facility, higher effectiveness and value for money. The introduction of Implanon NXT in the South African health system raised great concern about the number of women who returned to healthcare facilities for its early removal within a few months of insertion. Aim This article focussed on exploring the experiences of women regarding early removal of Implanon NXT insertion. Setting The study was conducted in four selected clinics in Region E sub-district, city of Johannesburg. Methods A qualitative exploratory approach was followed using semi-structured individual interviews to collect data. Data were analysed using the content analysis method. Results The most cited reasons for its discontinuity were that women experienced unpleasant side effects such as amenorrhoea, excessive bleeding and headaches, whilst other women found it to be reliable and convenient. Conclusion Contraceptive methods empower women to take control of their lives and to decide on the right time for them to have children. It is, therefore, important to equip women with relevant information about the contraceptive methods so that they can make informed decisions and choices. Contribution The study calls for health promoters to periodically conduct information sessions with women as guided by the National Contraception Policy Guidelines to ensure up-to-date practice.
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Affiliation(s)
- Junior M Ntimani
- Department of Nursing Science, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Moreoagae B Randa
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Ejeta Chibsa S, Bayisa K, Adem Hussen M, Tefera Kefeni B. Determinant of Implanon discontinuation among women in southwest Ethiopia: unmatched case control study. Contracept Reprod Med 2023; 8:54. [PMID: 37919819 PMCID: PMC10623863 DOI: 10.1186/s40834-023-00253-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/16/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Over 4.5 million women worldwide have used Implanon. It plays an important role in reducing unwanted conceptions, lowering maternal mortality, and enhancing child survival. As a result, the availability of family planning programmes encourages women to begin using contraception and encourages women who are already using family planning to continue using it. The purpose of this study was to investigate the factors that lead to implanon cessation among women in southwest, Ethiopia. METHODS A facility-based unmatched case-control study was conducted from February 01 to March 02, 2023. It included 348 participants, 174 cases, and 174 controls. The cases were selected consecutively, and the controls were selected using a systematic random sampling method. Data was collected through a structured, face-to-face interview and entered into Epi-data version 4.6 and SPSS version 25.0 for analysis. The confidence interval (CI) of 95 and the strength of the association were measured using an adjusted odds ratio. A p-value of less than 0.05 was considered statistically significant. RESULT Women whose husbands have formal education [AOR = 0.33, 95% CI (0.121-0.0944)], women who have been counseled individually [AOR = 3.403 (1.390-8.3.32)], women who have been counseled for less than 5 min [AOR = 3.143, 95% CI (1.303-8.046)], and women who discuss Implanon insertion with their partner [AOR = 0.289, 95% CI (0.143-0.585)] were significantly associated with Implanon discontinuation. CONCLUSION Implanon discontinuation was predicted by the husband's education, the number of women counselled alone, the length of counselling, a conversation with the spouse, satisfaction with the service, and implanon side effects. The health care provider should increase counselling services, especially the length of implanon pregnancy, in accordance with the national family planning recommendations, to reduce early implanon removal.
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Affiliation(s)
- Samuel Ejeta Chibsa
- Department of Midwifery, College of Health Sciences, Mattu University, Mettu, Ethiopia.
| | - Kenbon Bayisa
- Department of Midwifery, College of Health Sciences, Mattu University, Mettu, Ethiopia
| | - Mustefa Adem Hussen
- Department of Midwifery, College of Health Sciences, Mattu University, Mettu, Ethiopia
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Mgobhozi LN, Mchunu GG, Mbeje P. Women's perceptions with use of Implanon ® contraceptive device at a primary healthcare facility in KwaZulu-Natal. Health SA 2023; 28:2016. [PMID: 37927943 PMCID: PMC10623499 DOI: 10.4102/hsag.v28i0.2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 02/22/2023] [Indexed: 11/07/2023] Open
Abstract
Background Early 2014, subdermal contraceptive implant was introduced in South Africa, Implanon® NXT, aiming to expand the method mix, increase effectiveness and availability to long-acting contraceptives. The initial uptake was extremely high, but concerns have been raised with treatment failure and high number of removals reported. Aim The study focuses on describing women's perceptions with use of Implanon® at a primary health care (PHC) facility in KwaZulu-Natal. Setting This study was conducted at a selected primary health care (PHC) facility in KwaZulu-Natal. Methods A quantitative, descriptive study design was used. Through purposive sampling, a sample of 60 women from 15 to 50 years old were recruited. Data were gathered through a structured questionnaire and analysed using SPSS 24 software. Results Study findings show that slightly above half of respondents, 32 or 58.1% expressed satisfaction towards the implant, 20 or 40.9% had stopped using the implant as a result of its major implications. It was found that an edge above half of respondents continued using the implant 28 or 50.9%, while close to half had abandoned it (27 or 49.1%). Some respondents reported that they were experiencing heavy menstrual bleeding and low sex drive as serious unwanted side effects forcing them to stop using Implanon®. Conclusion Side-effects and poor screening, counselling and support are major reasons for early removal. It is imperative to develop an effective screening tool and to re-train healthcare workers on Implanon® NXT. Contributions This article contributes to increase awareness of women's perceptions about Implanon® contraceptive.
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Affiliation(s)
- Lucky N Mgobhozi
- Department of Nursing, Faculty of Health Sciences, Walter Sisulu University, uMthatha, South Africa
- Department of Nursing, Faculty of Science, Agriculture and Engineering, University of Zululand, eMpangeni, South Africa
| | - Gugu G Mchunu
- Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
- Department of Nursing, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Pretty Mbeje
- Department of Nursing, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Lencha B, Daba SG, Ahmed JA, Washo A, Beressa G, Yalew A, Ganfure G. Determinants of implanon discontinuation among women who ever used implanon in Shashemene district, west Arsi zone, Southern Ethiopia: unmatched case control study. Contracept Reprod Med 2023; 8:46. [PMID: 37789494 PMCID: PMC10548583 DOI: 10.1186/s40834-023-00248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Despite tremendous work has been done on demand creation, capacity building and ensuring the logistics of Implanon; its discontinuation rate remained high in Ethiopia; the prevalence is reported to be 31% in Shashemene District. However, the factors contributing to the high prevalence of early Implanon discontinuation were not well understood in our study setting. OBJECTIVE This study aimed to identify the determinants of implanon discontinuation among women who had ever used Implanon in Shashemene District, Southern Ethiopia. METHODS A community-based unmatched case-control study was conducted among randomly selected 264 women (88 cases and 176 controls) in Shashemene District, Southern Ethiopia, from April 12 to May 18, 2021. A systematic random sampling technique was used to select the respondents. Cases were women who discontinued Implanon before 3 years and controls were those who used implanon for 3 full years. A pre-tested, interviewer-administered structured questionnaire was used to collect data. Bivariable and multivariable binary logistic regression analyses were performed to identify determinants of Implanon discontinuation. An odds ratio (OR) with a 95% confidence interval (CI) was used to estimate the strength of the association, and significance was declared at a P value of less than 0.05. RESULT The mean age of the respondents was 28.23 (± 5.46) years: 27.27 (± 5.38) years for cases and 28.70 (± 5.5) years for controls. Women with no formal education [AOR = 3.09, 95% CI: (1.20, 8.00)], fewer than four children [AOR = 2.47, 95% CI: (1.20, 5.08)], no history of abortion [AOR = 2.84, 95% CI: (1.25, 6.46)], being new acceptors [AOR = 2.14, 95% CI: (1.02, 4. 49)], being counseled for less than fifteen minutes [AOR = 2.47, 95% CI: (1.29, 4.70)], not discussing it with a partner [AOR = 2.88, 95% CI: (1.42, 5.84)] and experiencing side effects [AOR = 0.35, 95% CI: (0.17, 0.71)] were significantly associated with discontinuation of implanon. CONCLUSION Women with no formal education, having less than four children, history of abortion, new acceptors, duration of counseling, discussion with partner, and side effects were determinants of Implanon discontinuation among women. There is a need to ensure adequate pre-implantation counseling and appropriate management of side effects. Furthermore, interventions should target new acceptors and those without formal education.
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Affiliation(s)
- Bikila Lencha
- Department of Public Health, Madda Walabu University, Shashemene, Oromia, Ethiopia.
| | | | | | - Asefa Washo
- Paradise Valley College, Shashemene, Oromia, Ethiopia
| | - Girma Beressa
- Department of Public Health, Madda Walabu University, Bale Goba, Oromia, Ethiopia
| | - Aster Yalew
- Department of Nursing, Madda Walabu University, Shashemene, Oromia, Ethiopia
| | - Gemechu Ganfure
- Department of pediatrics, Ambo University, Ambo, Oromia, Ethiopia
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Kebede SD, Sebastian Y, Yeneneh A, Chanie AF, Melaku MS, Walle AD. Prediction of contraceptive discontinuation among reproductive-age women in Ethiopia using Ethiopian Demographic and Health Survey 2016 Dataset: A Machine Learning Approach. BMC Med Inform Decis Mak 2023; 23:9. [PMID: 36650511 PMCID: PMC9843668 DOI: 10.1186/s12911-023-02102-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Globally, 38% of contraceptive users discontinue the use of a method within the first twelve months. In Ethiopia, about 35% of contraceptive users also discontinue within twelve months. Discontinuation reduces contraceptive coverage, family planning program effectiveness and contributes to undesired fertility. Hence understanding potential predictors of contraceptive discontinuation is crucial to reducing its undesired outcomes. Predicting the risk of discontinuing contraceptives is also used as an early-warning system to notify family planning programs. Thus, this study could enable to predict and determine the predictors for contraceptive discontinuation in Ethiopia. METHODOLOGY Secondary data analysis was done on the 2016 Ethiopian Demographic and Health Survey. Eight machine learning algorithms were employed on a total sample of 5885 women and evaluated using performance metrics to predict and identify important predictors of discontinuation through python software. Feature importance method was used to select top predictors of contraceptive discontinuation. Finally, association rule mining was applied to discover the relationship between contraceptive discontinuation and its top predictors by using R statistical software. RESULT Random forest was the best predictive model with 68% accuracy which identified the top predictors of contraceptive discontinuation. Association rule mining identified women's age, women's education level, family size, husband's desire for children, husband's education level, and women's fertility preference as predictors most frequently associated with contraceptive discontinuation. CONCLUSION Results have shown that machine learning algorithms can accurately predict the discontinuation status of contraceptives, making them potentially valuable as decision-support tools for the relevant stakeholders. Through association rule mining analysis of a large dataset, our findings also revealed previously unknown patterns and relationships between contraceptive discontinuation and numerous predictors.
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Affiliation(s)
- Shimels Derso Kebede
- Department of Health Informatics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
| | - Yakub Sebastian
- Department of Information Technology, College of Engineering, IT and Environment, Charles Darwin University, Darwin, Australia
| | - Abraham Yeneneh
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Ashenafi Fentahun Chanie
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mequannent Sharew Melaku
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Agmasie Damtew Walle
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, Mettu University, Mettu, Ethiopia
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Chekole MS, Zikie DT, Wogie Fitie G, Taye BT, Kibiret DM, Silesh Zerihun M, Moltot Kitaw T, Ali MA, Legasu TD, Assefa KT, Lemma Demisse T. Determinants of Implanon discontinuation among women who use Implanon at Debre Berhan town public health institutions in Northeast Ethiopia: a case-control study. Front Glob Womens Health 2023; 4:961364. [PMID: 36875719 PMCID: PMC9977160 DOI: 10.3389/fgwh.2023.961364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 01/13/2023] [Indexed: 02/17/2023] Open
Abstract
Background Discontinuation of the most effective methods of contraception such as Implanon has now become a worldwide problem, which is significantly associated with mistimed and unwanted pregnancies and unsafe abortion, leading to an increased risk of maternal and child mortality and morbidity. However, studies on factors associated with Implanon discontinuation in Ethiopia, particularly in the area under this study, are limited. Therefore, this study aims to identify the determinants of Implanon discontinuation among women who used Implanon at Debre Berhan town public health institutions. Methods and materials A facility-based unmatched case-control study was conducted among 312 study participants (78 cases and 234 controls) from February 1, 2021, to April 30, 2021. The study participants were selected by using a systematic random sampling method for controls, and cases were selected consecutively until the required sample size was reached, during the data collection period. The data were collected by using a structured face-to-face interviewer-administered questionnaire and entered into Epidata version 4.6 and transferred to SPSS version 25 for analysis. Variables with a p-value of <0.25 in the bivariable analysis were entered into the multivariable logistic regression model. In the final model variables, a p-value of <0.05 was considered statistically significant at a 95% confidence interval (CI) and the strength of association was measured using an adjusted odds ratio (AOR). Results In this study, the determinants of Implanon discontinuation were the following: women who had no formal education (AOR: 3.57; 95% CI, 1.62-7.87), who had no children (AOR: 2.8; 95% CI, 1.50-5.17), who had no counseling about side effects (AOR: 2.43;95% CI, 1.30-4.55), who had no discussion with their partner (AOR: 2.7; 95% CI, 1.34-5.46), who had no follow-up appointment (AOR:2.81; 95% CI, 1.54-5.12), and who had side effects (AOR:1.91; 95% CI, 1.13-3.53). Conclusion and Recommendations Women's educational status, having no children during the insertion of Implanon, received no counseling about the side effects of insertion, no follow-up appointment, experiencing side effects, and no discussion with a partner were determinants of Implanon discontinuation. Hence, healthcare providers and other health sector stakeholders should provide and strengthen pre-insertion counseling, and follow-up appointments to increase the retention rates of Implanon.
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Affiliation(s)
- Moges Sisay Chekole
- Department of Midwifery, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Delelegn Tsegaye Zikie
- Department of Midwifery, College of Medicine and Health Science School of Nursing and Midwifery, Wollo University, Wollo, Ethiopia
| | - Girma Wogie Fitie
- Department of Midwifery, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Birhan Tsegaw Taye
- Department of Midwifery, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Desta Mekete Kibiret
- Department of Midwifery, College of Medicine and Health Science, Metu University, Metu, Ethiopia
| | - Mulualem Silesh Zerihun
- Department of Midwifery, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Tebabere Moltot Kitaw
- Department of Midwifery, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Mohamed Ahmed Ali
- Department of Midwifery, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Temesegen Desalegn Legasu
- Department of Midwifery, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Kibir Temesgen Assefa
- Department of Midwifery, College of Medicine and Health Science School of Nursing and Midwifery, Wollo University, Wollo, Ethiopia
| | - Tesfanesh Lemma Demisse
- Department of Midwifery, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
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Factors Associated with Implanon Discontinuation among Women of Reproductive Age in Ethiopia: A Systematic Review and Meta-Analysis. Int J Reprod Med 2022; 2022:9576080. [PMID: 36035447 PMCID: PMC9410957 DOI: 10.1155/2022/9576080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Implanon is a long-acting contraceptive method that is extremely effective in preventing pregnancy with a clinical failure rate of less than 1%. Despite these, the rate of Implanon discontinuation is a common problem in various societies and exposes women to unwanted conception and its consequences. Objective. The current study sought to find and consolidate relevant literature on Implanon discontinuation and associated factors in Ethiopia. Methods. Medline, PubMed, Cochrane Library, EMBASE, and Google Scholar databases were systematically searched for studies published in English before December 2021. The included studies were critically appraised using the JBI instrument for observational studies. STATA version 16 was used for analysis. The presence of statistical heterogeneity was checked using Cochran’s
test, and its level was quantified using
statistics. A pooled estimate of the proportion of outcome variables was calculated. To measure the effect size, pooled odds ratios with 95% CI were computed. Results. The pooled prevalence of Implanon discontinuation in Ethiopia was 32.89%, 95% CI: 24.11%, 41.66%. Experiencing side effects (
, 95% CI 1.75, 3.65), having no children (
, 95% CI 1.15, 2.47), not having received preinsertion counselling (
, 95% CI 1.36, 2.00), having no postinsertion appointment (
, 95% CI 2.10, 4.21), and not satisfied with the service (
, 95% CI 2.47, 5.59) were significantly associated with Implanon discontinuation. Conclusion. The pooled prevalence of Implanon discontinuation in Ethiopia was high. Experiencing side effects, having no child, not receiving preinsertion counselling, having no follow-up appointment, and not being satisfied with the service were significantly associated with Implanon discontinuation. Therefore, healthcare providers should offer preinsertion counselling in accordance with national family planning guidelines, emphasizing the method’s advantages and side effects.
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Beyene GN, Assefa N, Mokonnon TM, Ejigu HB, Yadeta TA. Early Implanon discontinuation and associated factors among Implanon women users visiting public health facilities, in Kembata zone of Southern Ethiopia: An institution based cross-sectional study. Front Glob Womens Health 2022; 3:909411. [PMID: 36051576 PMCID: PMC9426357 DOI: 10.3389/fgwh.2022.909411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background Contraceptive practice is the basis of fertility and plays a significant role in minimizing maternal morbidity and mortality. Implanon is one of the most effective long-acting contraceptive methods that prevents pregnancy for 3 years. Early Implanon discontinuation can lead to many negative reproductive health consequences. Therefore, this study assessed the magnitude of early Implanon discontinuation among female Implanon users visiting public health facilities to discontinue Implanon in the Kembata zone of southern Ethiopia. Methods An institution-based cross-sectional study design was carried out from 1 March 2020 to 30 March 2020. Simple random sampling techniques were used to select 454 women who had discontinued Implanon. The data were collected using a pretested and structured questionnaire. The collected data were entered into Epi Data version-3.1 and then exported to STATA version-16 for analysis. A descriptive analysis along with bivariate and multivariate regression was performed to identify factors associated with early Implanon discontinuation. Statistical significance was declared at a p < 0.05 along with 95% confidence intervals (CIs). Results In the present study, 438 women were interviewed, which corresponds to a response rate of 96.48%. The magnitude of early Implanon discontinuation was 56.4%, 95%CI (51.6, 61.2). Primary educational status [adjusted odds ratio (AOR) = 2.92, 95%CI (1.56, 5.46)], rural residency [AOR = 1.76, 95%CI (1.06, 2.92)], women with no history of modern contraceptive use [(AOR = 2.14, 95%CI (1.14, 4.03)], those who experienced service dissatisfaction [AOR = 3.05, 95%CI (1.52, 6.12)], women who experienced as Implanon side effect [AOR = 3.36, 95%CI (2.09, 5.42)], and women who were not appointed after insertion [(AOR = 2.17, 95%CI (1.18, 4.79)] have shown an association with early Implanon discontinuation. Conclusion The present study indicated that the magnitude of early Implanon discontinuation was high. Educational level, rural residency, women who experienced side effects, those who experienced service dissatisfaction, women with no history of contraceptive use, and those who missed follow-up appointments were associated with Implanon discontinuation. Family planning service providers should focus on Implanon side effects during pre-insertion counseling. The recommended intervention is to recognize modifiable factors like improving client satisfaction with the service, appointing for follow up after insertion, and providing quality family planning services.
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Affiliation(s)
| | - Nega Assefa
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Taklu Marama Mokonnon
- School of Midwifery, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Habtamu Bekele Ejigu
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
- *Correspondence: Habtamu Bekele Ejigu
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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11
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Mihretie GS, Abebe SM, Abebaw Y, Gedefa L, Gure T, Alemayehu BA, Amenu D, Tadesse D, Fanta GA, Abubeker FA, Yemane A, G/Michael AD, Teklu AM, Damtew MH, Girma B. Factors associated with discontinuation among long-acting reversible contraceptive users: a multisite prospective cohort study in urban public health facilities in Ethiopia. BMJ Open 2022; 12:e059372. [PMID: 35918115 PMCID: PMC9351308 DOI: 10.1136/bmjopen-2021-059372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The study aims to determine discontinuation among long-acting reversible contraceptive users at 3, 6, 9 and 12 months after initiation and its associated factors among new long-acting reversible contraceptive (LARC) users. DESIGN A facility-based multicentre prospective cohort study was conducted with a sample size of 1766 women. SETTING The study was conducted in five large cities of Ethiopia (Addis Ababa, Gondar, Mekelle, Jimma and Harar) between March 2017 and December 2018. Various referral hospitals and health centres that are found in those cities are included in the study. PARTICIPANTS The study population was all women who were new users of LARCs and initiated LARCs in our selected public health facilities during the enrolment period. INTERVENTIONS A pretested structured questionnaire was administered at enrolment and at 6 and 12 months to determine discontinuation proportion and factors associated with discontinuation. RESULT From the total of 1766 women sampled for the study only 1596 (90.4%) participants completed all the questionnaires including the 12-month follow-up study. The overall proportion of discontinuation of LARCs at 12 months was 21.8% (95% CI 19.8 to 23.9). The overall discontinuation proportions at 3, 6, 9 and 12 months were 2.94%, 8.53%, 3.94% and 6.36%, respectively. Location of method initiation (adjusted HR (aHR)=5.77; (95% CI 1.16 to 28.69)) and dissatisfaction with the method (aHR=0.09; (95% CI 0.03 to 0.21)) were found to be the predictors of discontinuation among intrauterine contraceptive device users. Being satisfied with the method (aHR=0.21; (95% CI 0.15 to 0.27)), initiation after post abortion (aHR=0.48; (95% CI: 0.26, 0.89)) and joint decision with partner for method initiation (aHR=0.67; (95% CI: 0.50, 0.90)) were inversely associated with implant discontinuation. CONCLUSION The majority of LARC users discontinue the method in the first 6 months after insertion and dissatisfaction with the method increased the likelihood of removal during the first year of LARC use.
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Affiliation(s)
- Getasew Sisay Mihretie
- Department of Obstetrics and Gynecology, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Solomon Mekonnen Abebe
- University of Gondar, Gondar, Ethiopia
- University of Gondar, Gondar, Ethiopia
- Human Nutrition, Institute of Public Halth, Gondar, Ethiopia
| | - Yeshiwas Abebaw
- University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
- Obstetrics and Gynecology, School of Medicine, Gondar, Ethiopia
| | - Leta Gedefa
- Haramaya University, Dire Dawa, Ethiopia
- Obstetrics and Gynecology, College of health and Medical Sciences, Haromaya, Ethiopia
| | - Tadesse Gure
- Obstetrics and Gynaecology, Hiwot Fana Specialized University Hospital, Harar, Ethiopia
- Obstetrics and Gynaecology, Haramaya University College of Health and Medical Sciences, Haramaya, Oromia, Ethiopia
| | - Birtukan Asmare Alemayehu
- Department of Obstetrics and Gynecology, Menelik II Referral Hospital, Ethiopia, Addis Ababa, Ethiopia
| | | | - Daniel Tadesse
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
- Research and project unit, Addis Ababa, Ethiopia
| | - Girma Abraham Fanta
- Zewditu Memorial Hospital, Addis Ababa, Ethiopia
- Obstetrics and Gynecology, College of health and Medical Sciences, Addis Ababa, Ethiopia
| | - Ferid Abbas Abubeker
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Medical College, Addis Ababa, Ethiopia
| | - Awol Yemane
- Mekelle University, Mekelle, Ethiopia
- Obstetrics and Gynecology, College of health and Medical Sciences, Mekella, Ethiopia
| | - Amanuel Desta G/Michael
- Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
- College of Health Science, Mekelle, Ethiopia
| | - Alula M Teklu
- MERQ Consultancy PLC, Addis Ababa, Ethiopia
- Research, MERQ PLC LLC, Baltimore, Maryland, USA
- Research Unit, Addis Ababa, Ethiopia
| | - Mengistu Hailemariam Damtew
- University of Michigan Center for International Reproductive Health Training Ethiopia, Addis Ababa, Oromia, Ethiopia
- CIRHT, Addis Ababa, Ethiopia
| | - Bisrat Girma
- Jimma University, Jimma, Ethiopia
- College of health and Medical Sciences, Jimma, Ethiopia
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12
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Moeti DMP, Govender I, Bongongo T. Early removal of etonogestrel subcutaneous contraceptive implant at a community health centre in Pretoria. S Afr Fam Pract (2004) 2022; 64:e1-e6. [PMID: 35924618 PMCID: PMC9350465 DOI: 10.4102/safp.v64i1.5407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 04/04/2022] [Accepted: 03/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background The etonogestrel subcutaneous contraceptive implant offers efficacy for three years, but some women remove it earlier than prescribed. This study discusses factors associated with the early removal of these implants at a Pretoria community health centre between 01 January 2020 to 30 June 2020. Methods A cross-sectional study using a piloted and researcher assistant-administered questionnaire. Results Of the 124 participants who removed their etonogestrel subcutaneous contraceptive implant earlier than prescribed, most were single, unemployed, in the age group 30–39 years, Christian, with secondary level education and with parity one or more. Etonogestrel subcutaneous contraceptive implant pre-insertion counselling was given to all participants, most of whom had not previously used contraceptives. Those participants with previous contraceptive use had used injectables. Long-term contraception was the main reason for getting the etonogestrel subcutaneous contraceptive implant. Most participants did not attend post-insertion counselling. Heavy bleeding was the most common side effect and reason for early removal. Fifty-one participants kept the etonogestrel subcutaneous contraceptive implant in for a longer period of 12–23 months. From participants’ responses, it seems that Etonogestrel implants may be offered from as early as 15–20 years of age. Conclusion Women having etonogestrel subcutaneous contraceptive implants removed early at a Pretoria community health centre tended to be young, single, unemployed, Christian, with a secondary level education and with parity one or more. All participants attended the etonogestrel subcutaneous contraceptive implant pre-insertion counselling services but not the post-counselling services. Heavy bleeding was the main reason for the early removal of the etonogestrel subcutaneous contraceptive implant.
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Affiliation(s)
- Dikonketjo M P Moeti
- Department of Family Medicine and Primary Health Care, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria.
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13
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Yimer Y, Cherie N, Damtie Y. Determinants of early discontinuation of etonogestrel sub-dermal implant among reproductive-age women in Legambo district, Northeast Ethiopia: An unmatched case–control study. SAGE Open Med 2022; 10:20503121221088102. [PMID: 35371479 PMCID: PMC8969501 DOI: 10.1177/20503121221088102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: Etonogestrel sub-dermal implant discontinuation is very common in the study area. But evidence on the determinants was limited. So, this study aimed to identify determinants of early discontinuation of etonogestrel sub-dermal implant among reproductive-age women in Legambo district, Northeast Ethiopia. Methods: An institution-based unmatched case–control study was conducted on 252 reproductive-age women (84 cases and 168 controls) from 1 February up to 30 April 2020. Systematic random sampling was used to select women, and the data were collected by face-to-face interview using a structured, pretested, and interviewer-administered questionnaire. The collected data were entered into Epi Data version 3.1 and analyzed by SPSS version 23. A binary logistic regression model was used to identify determinants of early discontinuation of etonogestrel sub-dermal implant. Statistical significance was declared at a p value of less than 0.05, and adjusted odds ratio with a 95% confidence interval was used to identify determinants of early discontinuation of etonogestrel sub-dermal implant in the final model. Result: In this study, not receiving pre-insertion counseling (adjusted odds ratio = 3.19, 95% confidence interval: (1.61, 6.30)), having a history of abortion (adjusted odds ratio = 2.89, 95% confidence interval: (1.50, 5.54)), contraceptive side effects (adjusted odds ratio = 2.45, 95% confidence interval: (1.99, 3.91)), and not receiving an appointment for a follow-up visit at the time of insertion (adjusted odds ratio = 3.45, 95% confidence interval: (1.89, 5.99)) were determinants of early discontinuation of etonogestrel sub-dermal implant. Conclusion: Not receiving pre-insertion counseling, having a history of abortion, contraceptive side effects, and not receiving an appointment for a follow-up visit at the time of insertion were predictors of early discontinuation of etonogestrel sub-dermal implant. Thus, healthcare professionals should give an appointment for a follow-up visit at the time of insertion and provide detailed counseling for all women, not only for those who had had an abortion and contraceptive side effects.
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Affiliation(s)
- Yesuf Yimer
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Niguss Cherie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yitaysh Damtie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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14
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Obsu M, Hundessa B, Garoma S, Aman H, Merga H. Magnitude and associated factors of early Implanon discontinuation among rural women in public health facilities of central Ethiopia: a community-based cross-sectional study. BMC Womens Health 2022; 22:72. [PMID: 35287654 PMCID: PMC8922880 DOI: 10.1186/s12905-022-01651-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/28/2022] [Indexed: 01/08/2023] Open
Abstract
Background Advocating for and promoting contraception use is critical in reducing mother and child morbidity and mortality. Early Implanon discontinuation may result in unwanted pregnancies and induced abortions. Although there has been research in Ethiopia on long-acting reversible contraceptives, there has been none on early Implanon removal among rural women who have used and removed it. Hence, this study aimed to investigate the magnitude of Implanon discontinuation and related characteristics among women who had the Implanon removed in central Ethiopian public health facilities. Methods A community-based cross-sectional study was conducted among all women of the reproductive age group who had removed Implanon after using it. A simple random sampling technique was used to select 373 women after proportional allocation to each health facility. Data were collected using a pretested semi-structured interviewer-administered questionnaire adapted from previous studies. Data were entered using EpiInfo and exported to SPSS version 21 for analysis. A binary logistic regression model was used to determine the association between the outcome variable and independent variables. A p-value less than 0.25 was used as a cutoff point to select candidate variables for the final model. Then, a p value less than 0.05, AOR, and a 95% confidence level were used to declare statistical significance. Result A total of 360 participants responded to the questionnaires, making a response rate of 96.5%. In this study, the early discontinuation rate was 42% (95% CI 36.9–47.7). No formal education (AOR = 0.53 [95% CI 0.3–0.94], having medium monthly income (AOR = 3.02 [95% CI 1.38–6.6]), inadequate pre-insertion counseling (AOR = 0.55 [95% CI 0.31–0.98]), lack of appointment for follow up (AOR = 0.16 [95% CI 0.05–0.54]), didn`t satisfy with service provided (AOR = 0.067 [95% CI 0.015–0.29] and developed side effect (AOR) = 4.45 [95% CI 2.37–8.36] were significantly associated with Implanon discontinuation. Conclusion The discontinuation rate of Implanon among those who removed it after using it in this study was high. Lack of formal education, having a medium-income, inadequate pre-insertion counseling, lack of appointments for the follow-up, poor satisfaction, and problems with side effects were the factors associated with early discontinuation rate. Hence, quality family planning service provision is essential to reduce the discontinuation rate. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01651-y.
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Affiliation(s)
- Mekonnen Obsu
- South West Shewa Zone Health Department, Oromia Region, Ethiopia
| | | | - Sileshi Garoma
- Department of Public Health, Adama Hospital Medical College, Adama, Ethiopia
| | - Haji Aman
- Department of Public Health, Adama Hospital Medical College, Adama, Ethiopia
| | - Hailu Merga
- Department of Epidemiology, Institute of Health, Jimma University, Jimma, Ethiopia.
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15
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Dirirsa DE, Awol Salo M, Gudeta MB, kelbessa ME, Lammi MB. Determinants of early discontinuation of long-acting and reversible contraceptive methods among women within childbearing age attending health facilities in Ethiopia, 2019. SAGE Open Med 2022; 10:20503121221136763. [DOI: 10.1177/20503121221136763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: This study aimed to identify the determinants of early discontinuation of long-acting and reversible contraceptive methods among women within childbearing age in Ethiopia, 2019. Methods: The institutional-based case–control study design was implemented from June to August 2019. Eligible study participants were sampled using systematic random sampling technique. Data were collected using structured and pre-tested questionnaire and entered into Epi Info and exported to SPSS version 20 for further analysis. All variables with a p value of <0.05 at odds ratio of 95% confidence interval in multivariable logistic regression analysis were considered as determinants of early discontinuation of long-acting and reversible contraceptive methods. Results: A total of 825 study participants (206 cases and 619 controls) were included in the study. Decision-making on the use of contraception (adjusted odds ratio: 4.8, 95% confidence interval: 1.4–16.8 and adjusted odds ratio: 5.6, 95% confidence interval: 1.7–18.8), the women who got counseled about side effects of contraceptive methods being 84% less likely to discontinue long-acting and reversible contraceptive methods compared to the women of their counterpart (adjusted odds ratio: 0.16, 95% confidence interval: 0.15–0.4), having two or more children (adjusted odds ratio: 10, 95% confidence interval: 3.7–28), and desire to be pregnant (adjusted odds ratio = 0.15 95% confidence interval: 0.06–0.4) were determinants of early discontinuation of long-acting and reversible contraceptive methods. Conclusion: According to the findings of this study, decision-maker on utilization of contraceptive methods, being counseled on side effects of contraception, number of children, and desire of woman to be pregnant were found to be determinants of discontinuation of long-acting and reversible contraceptive methods. Health care providers should strengthen providing pre-insertion counseling in accordance with the national guideline for family planning services, with an emphasis on potential contraceptive side effects and consideration of counseling on decision-making.
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Affiliation(s)
- Dejene Edosa Dirirsa
- Department of Midwifery, College of Health and Medical Sciences, Salale University, Fiche, Ethiopia
| | - Mukemil Awol Salo
- Department of Midwifery, College of Health and Medical Sciences, Salale University, Fiche, Ethiopia
| | - Mogos Beya Gudeta
- Department of Midwifery, College of Health and Medical Sciences, Salale University, Fiche, Ethiopia
| | - Merga Eticha kelbessa
- Department of Midwifery, College of Health and Medical Sciences, Kotebe University of Education, Addis Ababa, Ethiopia
| | - Mengistu Bekele Lammi
- Department of Midwifery, College of Health and Medical Sciences, Kotebe University of Education, Addis Ababa, Ethiopia
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16
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Tesfaye H, Negara E, Bayisa K. Early implanon discontinuation and associated factors among women ever used implanon in Mettu district, Oromia regional state, southwest Ethiopia, 2021. Reprod Health 2021; 18:176. [PMID: 34454512 PMCID: PMC8401065 DOI: 10.1186/s12978-021-01222-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Implanon is an effective form of long-acting reversible contraceptive used to prevent conception with a clinical failure rate of less than one per 100 users. However, in sub-Saharan countries the utilization of implanon was very low. Regardless of low utilization; its early discontinuation is very common in most developing countries including Ethiopia. Objectives To assess the prevalence of early implanon discontinuation and associated factors among women ever used implanon in Mettu district. Methods A community based cross-sectional study design was conducted from October 11 to December 4, 2020 G C. A total of 430 women were included in the study by systematic random sampling technique. Data were entered into epi data version 3.1 and analyzed by SPSS version 25.0. Descriptive analysis was computed to describe descriptive results. Logistics regression was computed to see the relative effect of factors on the outcome variable. Adjusted odds ratio was calculated with 95% confidence intervals to show strength of association and p-value < 0.05 was used to declare statistical significance. The finding of the study was presented using narrations, tables and chart. Result The total proportion of early implanon discontinuation among 430 mothers was 19.3%. Women who did not counseled about the presence of alternatives methods [AOR = 2.28: 95% CI (1.22–4.26)], women who experienced dizziness after insertion of implanon [AOR = 1.90: 95% CI (1.06–3.43)] and being having menstrual disturbance after insertion of implanon [AOR = 2.17: 95% CI (1.16–4.08)] were significantly associated with early implanon discontinuation. Women who were counseled about the advantage of implanon [AOR: 0.49: 95% CI (0.28–0.87)] were protective from early implanon discontinuation. Conclusion and recommendation Early implanon discontinuation among mothers was found to be high. Hence, effective counseling on advantages and side effects of implanon and proper management of the side effects should be made to increase implanon retention. Worldwide, a large number of women become exposed to the risk of conception after contraceptive discontinuation. Besides its low utilization, the discontinuation rate of implanon in developing country was high including Ethiopia. There is no study conducted in south western Ethiopia which shows the magnitude and associated factors of early implanon discontinuation. Therefore, this article provides level of early implanon discontinuation and factors associated with early discontinuation within 1 year’s duration. In this study, a cross-sectional design and interviewer administered questionnaire was employed among 430 women’s of ever used implanon in Mettu district woreda Ilu Aba Bor Zone. The finding of this study revealed that, Women who did not counseled on the presence of alternatives methods, women who experienced dizziness after insertion of implanon and being having menstrual disturbance after insertion of implanon were significantly associated with early implanon discontinuation. Women who were counseled about the advantage of implanon were protective from early implanon discontinuation. In conclusion, the finding of this study reported a high magnitude of early implanon discontinuation as compared to other previous studies.
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Affiliation(s)
- Hana Tesfaye
- Midwifery Department, College of Public Health and Medical Science, Mettu University, Metu, Ethiopia
| | - Ebissa Negara
- Public Health Department, College of Public Health and Medical Science, Mettu University, Metu, Ethiopia
| | - Kenbon Bayisa
- Midwifery Department, College of Public Health and Medical Science, Mettu University, Metu, Ethiopia.
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Level and Timing of Implanon Discontinuation and Associated Factors among Women Who Used Implanon in Andabet District, Public Health Facilities, North-West Ethiopia. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6647660. [PMID: 34395623 PMCID: PMC8363448 DOI: 10.1155/2021/6647660] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/28/2021] [Accepted: 07/26/2021] [Indexed: 12/02/2022]
Abstract
Background Implanon discontinuation is unacceptably high in developing countries, including Ethiopia. Furthermore, there is an observed problem of high unintended pregnancy after method discontinuation that strides to program failure. Therefore, the purpose of this study was to assess the level and determinants of Implanon discontinuation among women who used Implanon in Andabet district, public health facilities, North-West Ethiopia, 2017. Methods Facility-based cross-sectional study design was employed among 537 women from Feb. 03 to April 28, 2017. Study participants were selected using a systematic random sampling technique. A face-to-face interview was employed to collect data. Epi-Info version 7 was used for data entry and SPSS version 20 for analysis. Both descriptive and analytical statistical analysis was computed. On multivariable binary logistic regression, a p value of less than 0.05 was used to declare statistical significance. Results About 37% of Implanon users have discontinued the method before the intended time. About 86% of them discontinued Implanon before two years of insertion. Women who had no live child (AOR = 2.17, 95% CI: 1.25-3.77), women who did not receive preinsertion counseling (AOR = 1.85, 95% CI: 1.15-2.97), women who developed Implanon-related side effect (AOR = 5.17, 95% CI: 3.18-8.40), and women who did not satisfy by the service provided (AOR = 5.40, 95% CI: 3.04-9.57) had higher odds of Implanon discontinuation. On the other hand, women who received appointment follow-up (AOR = 0.23, 95% CI: 0.13-0.41) had lower odds of Implanon discontinuation. Conclusions The level of Implanon discontinuation before its intended time was high in the district. Hence, strengthening preinsertion counseling and appointment follow-up as well as improving the clients' level of service satisfaction could increase Implanon's continuation.
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Obsa MS, Takiso KT, Ayele TT, Chare Koyra H, Tafesse Hidoto K, Getahun Molla Shanka G, Kelbiso Hanfore L, Arba MA, Anjulo AA, Worku Kercho M, Zema Z. Lived Experience of Women Who Underwent Early Removal of Long-Acting Family Planning Methods in Bedesa Town, Wolaita Zone, Southern Ethiopia: A Phenomenological Study. Int J Womens Health 2021; 13:645-652. [PMID: 34239332 PMCID: PMC8259935 DOI: 10.2147/ijwh.s307142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background Long-acting family planning method (LAFP) is a low-cost yet effective method of reducing maternal mortality, limiting and spacing childbirth. In Ethiopia, the family planning prevalence rate rises from 15% in 2005 to 36% in 2016. However, the discontinuation rate of LAFP is still high in the region. Therefore, the aim of this study was to explore the lived experiences of women who underwent early removal of long-acting family planning methods in Bedesa town, Southern Ethiopia. Methods An interpretative phenomenological study design was employed. Women aged 15–49 years who removed LAFP therapy in the past 12 months were our sampled population. Data were collected through in-depth interviews (IDIs) by using open-ended structured interview guide. Purposive sampling technique was used to select 10 participants from the family planning logbook registration of Bedesa health center. The interview continued until information saturation was reached. Open code version 4.03 was used to code and facilitate analysis. Transcripts were read and re-read separately to identify emerging themes. A thematic analysis technique was used. Results This study revealed that the side effects, seeking more children and the husband’s opposition were the main reason for early removal of LAFP. Amongst side effects, heavy and irregular menses were occurred most frequently. Besides, there were various myths and misconceptions about family planning methods. It also noted that the counseling services provided by health professionals were not adequate. Conclusion Side effects, desired to have more children, and the husband’s opposition are the most important reason of early removal of LAFP methods. Furthermore, there were misunderstanding, fear and rumors raised by women about each method. Hence, greater public awareness on family planning should be delivered to change community perception on LAFP methods.
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Affiliation(s)
| | | | | | - Hailu Chare Koyra
- Department of Pharmacy, Wolaita Soddo University, Wolaita Soddo, Ethiopia
| | | | | | | | | | | | | | - Zewde Zema
- Department of Pharmacy, Wolaita Soddo University, Wolaita Soddo, Ethiopia
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Amare Abebe B, Reda Terefe M. Discontinuation of implants use and associated factors among women attending health facility clinics in Hawassa City, Southern Ethiopia, 2019; cross sectional study. Contracept Reprod Med 2020; 5:29. [PMID: 33110625 PMCID: PMC7583256 DOI: 10.1186/s40834-020-00128-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/17/2020] [Indexed: 11/29/2022] Open
Abstract
Background Despite improving the availability and use of Implants, discontinuation is becoming a public health concern. A significant proportion of women discontinuing the service before its due date, which is of concern in the health system and its consequence may lead to a program failure. This might have also social and economic consequences for users. Only 8% of married women in Ethiopia use implants. Apart from its low utilization, premature removal is common for unknown reasons. However, there is paucity of information on discontinuation of implants use and associated factors in the study area. Objective The study was aimed to assess discontinuation of implants use and associated factors among women attending health facility clinics in Hawassa city, southern Ethiopia, from March, 01-April, 01/2019. Methods Facility based cross sectional study design was used. Out of 16 health facilities, 9 of them were selected for this study using simple random sampling. Total sample size of this study was determined to be 351. Data were collected from study subjects using pretested, structured questionnaire through a face-to-face interview. Data was analyzed using descriptive statistics and logistic regression. The result is presented using the Crude Odds ratio as well as Adjusted Odds Ratio with the corresponding 95% confidence level. Result Out of 351 study participants, the overall proportion of implants discontinuation was 49.3%(95% CI: 44.2–55.0). Lack of counseling about side effects (AOR = 2.394; 95% CI: 1.422–4.030), developing side effects (AOR = 6.325; 95% CI: 3.719–10.757) and lack of post insertion follow-up (AOR = 2.241; 95% CI: 1.186–4.234) the major factors associated with discontinuation of Implants. Conclusion and recommendation In this study, the overall proportion of discontinuation of Implants among women who were using Implants was high. Health professionals could give pre-insertion counseling about side effects and post insertion dates for follow-up to improve of utilization of implants.
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Affiliation(s)
- Belay Amare Abebe
- Department of Midwifery, College Medicine and Health Sciences, University of Hawassa, PO Box-1560, Hawassa, Ethiopia
| | - Mulu Reda Terefe
- Department Statistics, College of Natural and Computational Science, University of Hawassa, PO Box-1560, Hawassa, Ethiopia
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Determinants of Implanon Discontinuation among Women Who Use Implanon at Bahir Dar Town Health Institutions, Northwest Ethiopia, 2019: A Case-Control Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:9048609. [PMID: 33029180 PMCID: PMC7532418 DOI: 10.1155/2020/9048609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 11/18/2022]
Abstract
Background Implanon is a long-acting reversible contraceptive method that is 99% effective in preventing unintended pregnancy. Despite its effectiveness, the rate of Implanon discontinuation is high. In Ethiopia, there is limited information about determinants of Implanon discontinuation. Therefore, this study aimed to identify the determinants of Implanon discontinuation among women who used Implanon at Bahir Dar town health institutions. Methods We employed an unmatched case-control study to find out the determinants of Implanon discontinuation at Bahir Dar town health institutions from March to June 2019 using the multistage stratified sampling technique to select study participants. Cases were women who had discontinued Implanon before completion of 3 years, and controls were women who had removed Implanon at the date of appointment (3 years). A pretested, structured questionnaire with face-to-face interviews was used. Binary logistic regression was performed to identify determinants of Implanon discontinuation. In the final model, variables with a p value of <0.05 were considered significant at 95% confidence interval and the strength of association was measured using odds ratio. Results Primary education (AOR = 0.104, 95% CI (0.02–0.48)), secondary education (AOR = 0.48, 95% CI (0.24–0.952)), women who have no child (AOR = 2.04, 95% CI (1.2–3.4)), women who had no discussion with their partner (AOR = 2.2, 95% CI (1.39–3.57)), mass counseling (AOR = 3.5, 95% CI (1.75–7.01)), women who had no counseling about side effects (AOR = 1.7, 95% CI (1.07–2.07)), women who experienced side effects (AOR = 2.2, 95% CI (1.4–3.4)), and purpose of family planning use (AOR = 2.5, 95% CI (1.14–4.8)) were determinants of Implanon discontinuation. Conclusion Implanon discontinuation is attributed by multifactorial involvement. Women's educational status, nulliparity, no counseling, not informed of side effects, and no partner discussion are significant factors. Health sector stakeholders need to tailor counseling services at individual level to bolster family planning utilization until the desired time.
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Abebe BA, Assefa N, Mengistie B. Discontinuation of Reversible Long-Acting Contraceptive and Associated Factors among Female Users in Health Facilities of Hawassa City, Southern Ethiopia: Cross-Sectional Study. Open Access J Contracept 2020; 11:113-123. [PMID: 32943951 PMCID: PMC7480761 DOI: 10.2147/oajc.s259978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background Despite improvement in the availability and use of reversible long-acting contraception, discontinuation is becoming a public health concern. A significant proportion of women discontinuing the service before its due date, which is of concern in the health system with regard to its consequences, may lead to a program failure. In addition, there is a paucity of information on discontinuation of reversible long-acting contraceptives and associated factors in the study area. Therefore, this study aimed to assess discontinuation of reversible long-acting contraceptives and associated factors among female users in health facilities of Hawassa city, southern Ethiopia, 2019. Methods Institution-based cross-sectional design was used. Systematic sampling was used to select study participants. Women who were users of long-acting contraceptives and had come to selected health facilities for method-related reasons were included in the study. Data collectors approached and recruited participants before they contacted their care providers. Data were collected from study subjects using a pretested, structured questionnaire through face-to-face interviews after participants had contacted care providers. Results are presented using the crude and adjusted ORs with corresponding 95% CIs. Results The overall proportion of reversible long-acting contraceptive discontinuation was 56.6% (95% CI 52.30%, 61.10%). Maternal education at primary level (AOR 2.33, 95% CI 1.15–4.74), lack of counseling (AOR 2.50, 95% CI 1.01–6.18), side effects (AOR 2.10, 95% CI 1.31–3.34), and desire to be pregnant (AOR 2.22; 95CI 1.50–3.30) were the major factors in discontinuation. Conclusion In this study, the overall proportion of discontinuation of reversible long-acting contraceptives was high. Maternal education at primary level, lack of counseling, side effects, and desire to be pregnant were the key factors associated with discontinuation of the contraceptives. Health professionals should provide counseling on the side effects before insertion.
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Affiliation(s)
- Belay Amare Abebe
- Department of Midwifery, College Medicine and Health Sciences, University of Hawassa, Hawassa, Ethiopia
| | - Nega Assefa
- School of Public Health, College of Health and Medical Sciences, University of Haramaya, Harar, Ethiopia
| | - Bezatu Mengistie
- School of Public Health, College of Health and Medical Sciences, University of Haramaya, Harar, Ethiopia
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Fekadu GA, Omigbodun AO, Roberts OA, Yalew AW. Factors associated with early long-acting reversible contraceptives discontinuation in Ethiopia: evidence from the 2016 Ethiopian demographic and health survey. Arch Public Health 2020; 78:36. [PMID: 32626577 PMCID: PMC7329387 DOI: 10.1186/s13690-020-00419-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Ethiopia is struggling to achieve the 2020 family planning target. But the current contraceptive prevalence uptake is low and dominated by short-acting methods. Contraceptive discontinuation rate is also high. This analysis was done to identify the reasons and factors associated with long-acting and reversible contraceptives (LARC) discontinuation in Ethiopia. Methods The unit of analysis was LARC-use episodes in the 5 years preceding the survey, generated from the 2016 Ethiopian Demographic and Health Survey data. A total of 1385 LARC episodes were included. Data analysis was done using STATA 15. The event file generated from the contraceptive calendar was merged to the original data set to identify factors associated with LARC discontinuation. Univariate, bivariate and inferential analyses were done for 12 months LARC discontinuation. Result Approximately 82% of LARC episodes were implants. About 45% of intrauterine device (IUD) and 61% of implant episodes were discontinued by 36 months. Side effects and the desire to become pregnant were the main reasons for discontinuation. Women aged 25–34 (HR = 0.26; 95% CI: 0.20–0.35) and those aged 35–49 (HR = 0.17; 95%CI: 0.11–0.26), women who participated in decision-making partially (HR = 0.53; 95%CI: 0.37–0.78), or fully (HR = 0.55; 95%CI: 0.40–0.74) and primiparous women (HR = 0.53, 95%CI: 0.33–0.86) had a lower hazard of discontinuing LARCs. On the other hand, women who had only primary education (HR = 1.32; 95%CI: 1.02–1.72) and women who were not sure about their fertility intention (HR = 2.11; 95%C: 1.28–3.46) had a higher likelihood of discontinuing these methods. Conclusion Majority of LARC episodes were discontinued early, mainly due to the desire for pregnancy or experience of side effects. Older women, particularly those involved in household decision-making, and primipara were less likely to discontinue LARC. Women with only primary education and those uncertain about their fertility intention had a higher likelihood of discontinuation. Family planning service providers should focus on fertility intention and side effects when counseling women for contraceptive choice. Improving women’s participation in household decision-making may decrease LARC discontinuation in Ethiopia.
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Affiliation(s)
- Gedefaw Abeje Fekadu
- Pan African University, Institute of Life and Earth Sciences (including Health and Agriculture), University of Ibadan, Ibadan, Nigeria.,College of Medicine and Health Sciences, School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | | | | | - Alemayehu Worku Yalew
- School of Public health, College of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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A qualitative study on reasons for early removal of Implanon among users in Arba Minch town, Gamo Goffa zone, South Ethiopia: a phenomenological approach. BMC WOMENS HEALTH 2020; 20:2. [PMID: 31896349 PMCID: PMC6941265 DOI: 10.1186/s12905-019-0876-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/27/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Implanon is one of the cost - effective long acting reversible contraceptive methods used for spacing and limiting births in Ethiopia. Despite the scaling up initiative undertaken by the Ethiopian Government, Implanon uptake is very low compared to short acting contraceptive methods. There is low utilization of Implanon with high level of discontinuation in Ethiopia. Therefore, this study was conducted to explore the reasons for early removal of Implanon among users in Arba Minch town, South Ethiopia. METHODS A community-based qualitative exploratory study using phenomenological approach was conducted. In-depth and key informant interviews were used to collect data from April 20-27, 2018 in Arba Minch town. Convenient sampling was employed to recruit participants from the households of targeted villages. A total of 10 in-depth interviews with women who recently removed Implanon and 5 key informant interviews with health extension workers were conducted. The sample size was determined based on the concept of saturation. The collected data were analyzed using thematic content analysis technique. Data coding and analysis were facilitated by using Open code version 4.0 software. RESULTS This study revealed that majority of participants were able to mention at least three types of contraceptive methods available in the nearby health facilities. The study underlined that side effect of the method, husband opposition, seeking more children, and method failure were the common reasons for early removal of Implanon, in which side effect of the method was the main reason. Among various forms of side effects of Implanon identified by users, heavy and irregular bleeding was mentioned as the most frequently occurring side effect. CONCLUSION Our result indicated that heavy and irregular bleeding was the main reason for early removal of Implanon. Therefore it suggests improvement in the service delivery system. Improving client's education and counseling service program could contribute much to avoid unreasonable and untimely removal of Implanon.
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Nageso A, Gebretsadik A. Discontinuation rate of Implanon and its associated factors among women who ever used Implanon in Dale District, Southern Ethiopia. BMC Womens Health 2018; 18:189. [PMID: 30453931 PMCID: PMC6245529 DOI: 10.1186/s12905-018-0678-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/01/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Early discontinuation of the Implanon contraceptive method and reasons for such discontinuation remains a major concern for family planning programs. In less developed countries, contraceptive discontinuation due to health concerns is generally higher, these complaints are often related to service quality. Significant numbers of women become exposed to conception after discontinuation and accidental pregnancies that end up with abortion & stillbirth. The aim of this study was to assess the early discontinuation rate of Implanon and identify its associated factors among women who ever used Implanon in 2016 in Dale district, Southern Ethiopia. METHODS Community based cross-sectional study design was conducted from January to February, 2017. A total number of 711 women who ever used Implanon in 2016 were selected using multistage sampling. The data were entered and cleaned in Epi Info and analyzed using SPSS. Multivariate logistic regression analysis was used to determine the effect of factors on the outcome variables. Finally, the results were presented using adjusted odds ratio (AOR) & confidence interval of 95%. RESULT Early Implanon discontinuation rate in this study was 160 (23.4%) with a mean duration of Implanon use of 9.6 ± 2.5 months. The main reasons for discontinuation of Implanon were 55 (34.4%) the facing of side effects. Factors for discontinuation of Implanon were women age 20-24 years (AOR =. 44 (95% CI: 23-. 85), 25-29 years (AOR =. 52 (95% CI: 27-. 96), 35+ years, (AOR =. 08 (95% CI: 02-. 41), less likely to discontinue. Women who weren't counseled about the side effects during Implanon insertion were 1.93 times (AOR = 1.93 (95% CI: 1.27-2.93), women who didn't satisfied by the service (AOR = 2.55(CI: 95%: 1.63-3.97), women who didn't appointed for follow up (AOR = 3.13 (CI: 95%: 2.0-4.95), women who didn't choose the method by themselves (AOR = 1.83 (CI: 95%: 1.18-2.83) and women who didn't have information on family planning before Implanon insertion (AOR = 1.52 (CI: 95%: 1.1-2.28) were the predictors of Implanon discontinuation. CONCLUSIONS Implanon discontinuation rate in this study area was high. Appropriate counseling prior to insertion and proper follow up, autonomous choice will improve the continuation rate of Implanon.
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Affiliation(s)
- Abreham Nageso
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia
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