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Bande AD, Handiso TB, Hanjelo HW, Jena BH. Early discontinuation of long-acting reversible contraceptives methods and its associated factors in Hosanna town, central Ethiopia: a cross-sectional study. Sci Rep 2024; 14:11841. [PMID: 38782935 PMCID: PMC11116486 DOI: 10.1038/s41598-024-61648-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Long-acting reversible contraceptive (LARC) method use is an ideal strategy for longer protection against unintended pregnancies, unsafe abortions, maternal morbidities, and mortalities related to pregnancies and childbirth. Despite low utilization of LARC methods in Ethiopia, early discontinuation remains a problem. This study aimed to assess prevalence of early discontinuation of LARC methods and associated factors in Hossana town. A community-based cross-sectional study was conducted among 433 adult women of reproductive age who had a history of LARC use. Logistic regression model was considered for the analysis. Proportion of LARC methods discontinuation within one year was 24.5%, 95% CI (20.6, 26.8%). Women whose age ≥ 30 years (AOR = 3.16, 95% CI: 1.27, 7.89), who had < 3 live children (AOR = 5.17, 95% CI 2.30, 11.61), who had a desire for pregnancy (AOR = 2.35, 95% CI 1.14, 4.85), who did not get pre-insertion counseling on the benefits of LARC methods (AOR = 1.79, 95% CI 1.01, 3.21) and who experienced side effects (AOR = 3.63, 95% CI 2.07, 6.38) were more likely to discontinue LARC methods early than their counterparts. Nearly one-fourth of clients discontinued using the LARC methods within the first year of insertion, highlighting the need to promote longer use for improved protection and success of family planning programs.
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Affiliation(s)
| | - Tilahun Bayene Handiso
- Department of Epidemiology, School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Habtamu Wude Hanjelo
- Department of Health Service Management, School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Belayneh Hamdela Jena
- Department of Epidemiology, School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia.
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Letose F, Tusa A, Sahlu D, Miherite Y. Discontinuation of long-acting reversible contraceptive methods and associated factors among reproductive-age women in Shashemene town, Oromia, Ethiopia. Front Glob Womens Health 2024; 5:1269302. [PMID: 38774251 PMCID: PMC11106469 DOI: 10.3389/fgwh.2024.1269302] [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: 08/01/2023] [Accepted: 04/11/2024] [Indexed: 05/24/2024] Open
Abstract
Background The early termination of long-acting reversible contraceptives (LARCs) raises issues for the healthcare system and has the potential to affect public health. Long-acting reversible contraception has now become more widely available and used, although a sizable percentage of women still do not use it. Therefore, this study aims to assess the factors associated with the discontinuation of the LARC method among female users of health facilities in Shashemene town in Oromia, Ethiopia. Methods A facility-based cross-sectional study was conducted in Shashemene town involving 410 study participants from nine facilities. The study participants were selected by using a systematic sampling method. The data were collected by using structured interviewer-administered questionnaires, entered into EpiData version 4.6.0.2, and exported to SPSS version 25 for analysis. Bivariate and multivariable logistic regressions were used to examine the association between independent variables and LARC discontinuation. The results were presented using the odds ratio at 95% CI. p < 0.05 was used to indicate statistical significance. Result The overall prevalence of women who discontinued the LARC method before the due date was 57.2%. Having an occupation as a housewife, desire for pregnancy, unwarned side effects, effectiveness, and dissatisfaction with the service provided were the factors positively associated with the discontinuation of the contraception. Conclusion The prevalence of the discontinuation of LARCs was high. Pre-insertion, effective counseling about the benefits, follow-up care, management of side effects, and client reassurance are recommended.
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Affiliation(s)
- Fikru Letose
- Amref Health Africa in Ethiopia, Gambella Field Office, Gambela, Ethiopia
| | - Alemtsehay Tusa
- Department of Maternal and Child Health, Melk Oda G/Hospital, Shashemene, Ethiopia
| | - Degemu Sahlu
- Department of Public Health, College of Health Science, Salale University, Fiche, Ethiopia
| | - Yohannis Miherite
- Department of Public Health, College of Health Science, Salale University, Fiche, Ethiopia
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Budu E, Okyere J, Osei MD, Seidu AA, Ahinkorah BO. Determinants of contraceptive continuation among women in sub-Saharan Africa. BMC Womens Health 2023; 23:447. [PMID: 37620922 PMCID: PMC10463526 DOI: 10.1186/s12905-023-02578-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Contraceptive continuation is an important factor that has significant implications on total fertility rates and reproductive health outcomes, like unintended pregnancies. Therefore, it is imperative to understand the factors that influence women's decision to continue the use of contraceptives. The present study examined the determinants of contraceptive continuation among women in sub-Saharan Africa (SSA). METHODS Data for the study were extracted from the most recent Demographic and Health Surveys (DHS) of twenty-four (24) countries in SSA. Descriptive and multivariable binary logistic regression analysis were conducted. Frequencies, percentanges, and an adjusted odds ratio with 95% confidence intervals were used to present the results. RESULTS Compared to adolescents, adult women aged 45-49 years [aOR: 1.24; CI: 1.13-1.37] had higher odds of contraceptive continuation. The odds of contraceptive continuation were lower among those working [aOR: 0.96; CI: 0.93-0.98] compared to those not working. Also, the study shows that the likelihood of contraceptive continuation was lower among those exposed to family planning messages compared to those not exposed [aOR: 0.91; CI: 0.88-0.93]. Compared to women who used LARCs, women who used pills [aOR: 0.34; CI: 0.33-0.36], injectable [aOR: 0.42; CI: 0.40-0.43], other modern contraceptives [aOR: 0.72; CI: 0.68-0.75] or traditional methods [aOR: 0.50; CI: 0.478-0.523] were less likely to continue with their contraception. Women with one birth [aOR: 0.86; CI: 0.83-0.90] and those with 2 + births in the last five years [aOR: 0.54; CI: 0.512-0.56] reported lower odds of contraceptive continuation as compared to those with no births. Compared to women with no children living, those with 4 + children living had lower odds of contraceptive continuation [aOR: 0.62; CI: 0.57-0.67]. The study also found that the likelihood of contraceptive continuation was higher among those with secondary education [aOR: 1.08; CI: 1.04-1.12] as compared to those with no formal education. Contraceptive continuation was also higher among those who have information on choice [aOR: 3.91; CI: 3.82-4.01], and also higher among those who were undecided about having an additional child [aOR: 1.39; CI: 1.33-1.46]. Compared to West AfricaAngola, women from all other sub-regions were less likely to continue using contraceptives Comoros were more likely to continue with contraception [aOR: 1.49; CI: 1.24-1.78]. CONCLUSION To improve contraceptive continuation among women of reproductive age, countries in SSA must invest heavily in advocacy and dissemination of family planning messages, and information of choice. Also, much commitment should be directed towards enhancing the use of long-acting reversible contraceptive use.
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Affiliation(s)
- Eugene Budu
- Korle Bu Teaching Hospital, P. O. Box, 77, Accra, Ghana
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Mary Dansoah Osei
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Centre For Gender and Advocacy, Takoradi Technical University, P.O.Box 256, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Sisay A, Teshome A, Bizuneh H, D Compton S. Early discontinuation of long-acting reversible contraceptives at four government hospitals, Addis Ababa, Ethiopia. Contracept Reprod Med 2023; 8:38. [PMID: 37480045 PMCID: PMC10360256 DOI: 10.1186/s40834-023-00238-8] [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: 01/13/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023] Open
Abstract
OBJECTIVE Given high unmet need for contraception in Ethiopia, this study aimed to determine prevalence and factors associated with early discontinuation of long-acting reversible contraceptives (LARC). METHODS This institution-based cross-sectional study was conducted with 389 participants using exit interviews with clients presenting for removal of LARC at the family planning clinic of four government hospitals in Addis Ababa. SPSS version 26 was used for analysis. Descriptive statistics, bivariate, and multivariate logistic regression were computed. RESULT Among the 389 clients, 236 (60.7%) discontinued early. In multivariate regression, lack of pre-insertion counseling on side effects (AOR = 3.5, p = 0. 000; 95% C.I = 1.8-6.8), presence of side effects (AOR = 1.9, p = 0. 017; 95% C.I = 1. 1- 3.4), history of abortion (AOR = 3.5, p = 0. 001; 95% C.I = 1. 6- 7.4); and no prior contraception use (AOR = 2.9, p = 0. 000; 95% C.I = 1. 6- 5.3) were positively associated with early discontinuation. Whereas insertion outside of Saint Paul's Hospital Millennium Medical College (AOR = 0.4, p = 0. 000; 95% C.I = 0. 2- 0.6), and influence on choice of contraceptives by others (AOR = 0.2, p = 0. 000; 95% C.I = 0. 2- 0.4) were negatively associated with early discontinuation. CONCLUSION Early discontinuation of LARC was high among study participants. Counseling about possible side effects and giving women the opportunity to decide their own choice of contraception might help in reducing early discontinuation.
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Affiliation(s)
- Adane Sisay
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abel Teshome
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Hailemichael Bizuneh
- School of Public Health, Department of Epidemiology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Sarah D Compton
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
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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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Gebeyehu NA, Tegegne KD, Biset G, Sewuyew DA, Alemu BW, Yitayew AM. Discontinuation of long acting reversible contraceptive use and its determinants among women in Ethiopia: Systematic review and meta-analysis. Front Public Health 2022; 10:979231. [PMID: 36561863 PMCID: PMC9763286 DOI: 10.3389/fpubh.2022.979231] [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: 06/27/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Contraception discontinuation is a major public health issue that leads to unwanted pregnancies and unsafe abortions. Therefore, this systematic review and meta-analysis aimed to estimate discontinuation of contraceptives and its determinants in Ethiopia. Methods PubMed, Google Scholar, Scopus, Science Direct, and Addis Ababa University online library were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (v. 14). Publication bias was checked by forest plot, Begg's rank test, and Egger's regression test. To look for heterogeneity, I2 was computed, and an overall estimated analysis was carried out. Subgroup analysis was done by region, study setting, and publication. The pooled odds ratio for associated factors was also computed. Results Out of 654 studies assessed, 20 met our criteria and were included in the study. The total number of study participants was 8,780. The pooled prevalence of discontinuation of long acting reversible contraceptive use was 36.94% (95% CI: 28.547-45.326). According to sub-group analysis, Amhara region (45%) and institution-based studies (47.9%) had the highest prevalence. The most common reason for contraceptive discontinuation was negative side effect (42.3%).Women experienced side effects (AOR = 2.833:95% CI:2.005-4.003), didn't receive counseling on side effects (AOR = 2.417; 95% CI: 1.591-3.672), didn't appoint follow up (AOR = 2.820; 95% CI: 2.048-3.881), dissatisfied with the given service (AOR = 5.156; 95% CI: 3.644-7.296), and a desire to be pregnant (AOR = 2.366; 95% CI: 1.760-3.182) were predictors of discontinuation of contraceptives. Conclusion In Ethiopia, the pooled prevalence of long acting contraceptive discontinuation was high. Side effects, not being informed about side effects, dissatisfaction with the provided service, no insertion follow-up, and a desire to become pregnant were all associated factors. Healthcare professionals should focus on the client's reproductive goals, proper management of side effects, counseling, and post-insertion visits. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022347860, identifier CRD42022347860.
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Affiliation(s)
- Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia,*Correspondence: Natnael Atnafu Gebeyehu
| | - Kirubel Dagnaw Tegegne
- Department of Comprehensive Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Gebyaw Biset
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Dagne Addisu Sewuyew
- Department of Midwifery, College of Medicine and Health Science, Debretabore University, Debre Tabor, Ethiopia
| | - Biresaw Wassihun Alemu
- Department of Midwifery, College of Medicine and Health Science, Injbara University, Injbara, Ethiopia
| | - Alemker Mola Yitayew
- School of Medicine, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
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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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