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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Habte A, Wondimu M, Abdulkadir H. Survival time to Implanon discontinuation and its predictors among a cohort of Implanon users who enrolled in public hospitals of southern Ethiopia, 2021: a retrospective cohort study. Arch Public Health 2022; 80:89. [PMID: 35321741 PMCID: PMC8941807 DOI: 10.1186/s13690-022-00859-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/18/2022] [Indexed: 11/15/2022] Open
Abstract
Background Pieces of evidence strongly indicate that providing high-quality family planning services is accompanied by an increase in contraceptive uptake and a decrease in contraception discontinuation. Contraceptive, especially Implanon discontinuation is a global issue that could be linked to a summary outcome indicator of poor family planning service quality. Although Implanon is becoming more popular among Ethiopian contraceptive users, little is known regarding the survival and predictors of discontinuation. The study aimed at exploring the survival and predictors of Implanon discontinuation among women enrolled in family planning units of Public hospitals in southern Ethiopia, 2021. Methods A hospital-based retrospective cohort study was conducted among Implanon users who enrolled in family planning units of Public Hospitals. Five years of medical records, from January 1, 2016, to December 30, 2020, were reviewed. A total of 502 women were selected by using a random sampling technique. A standardized abstraction tool was used to collect data from medical records and registration books. The data were entered into Epidata Version 3.1 and then exported to STATA 14 for analysis. The median was calculated in the case of survival time. Across covariates, the Kaplan Meier survival curve was used to estimate time to Implanon discontinuation. To identify statistically significant predictors of Implanon discontinuation, a multivariable Cox proportional hazard model was fitted. Results The incidence rate of Implanon discontinuation was 1.87(95% CI = 1.63, 2.15) per 100 person-months of observation. The overall estimated survival probability at the end of 24 and 36 months was 67.4% (95%CI, 62.5, 71.8) and 25.9% (95%CI, 18.4, 34.1) months respectively. Residence [AHR = 1.50; 95%CI: 1.09, 2.08], parity [AHR = 2.02; 95%CI: 1.65, 3.67], pre-insertion counselling [AHR = 2.41; 95%CI: 1.72, 3.70], experiencing heavy vaginal bleeding [AHR = 3.91; 95%CI: 2.67, 5.32], post-insertion follow up [AHR = 3.15; 95%CI:2.11, 4.75] were identified as a significant predictors of Implanon discontinuation. Conclusion The risk Implanon of discontinuation was high, especially at 24 and 36 months. In family planning service delivery points, health care providers should pay special attention to clients who live in rural areas and do not have children. In addition, health care providers should provide pre-insertion counseling and post-insertion follow-up that focus on potential side effects. Finally, family planning units need to engage in early side effect management and reassurance to mitigate discontinuation. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00859-6.
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Affiliation(s)
- Aklilu Habte
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia.
| | - Merertu Wondimu
- School of nursing and midwifery, Faculty of health science, Institute of Health, Jimma University, Southwest, Jimma, Ethiopia
| | - Hanan Abdulkadir
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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