1
|
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.
Collapse
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
| | | |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|