Facility readiness to remove subdermal contraceptive implants in 6 sub-Saharan African countries

Senderowicz, Leigh; Karp, Celia; Bullington, Brooke W.; Tumlinson, Katherine; Zimmerman, Linnea; OlaOlorun, Funmilola; Zakirai, Musa Sani; Guiella, Georges; Shiferaw, Solomon; Seme, Assefa; Gichangi, Peter; Thiongo, Mary; Omoluabi, Elizabeth; Makumbi, Fredrick; Kibera, Simon

doi:10.1016/j.xagr.2022.100132

Cited by 4 publications

(3 citation statements)

References 22 publications

(30 reference statements)

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“…Cost was also a persistent barrier across time in both countries. Our results confirm prior findings that women encounter substantial facility-level barriers to implant removal as well as unaffordable removal fees, including within public facilities 10 11 16–18…”

Section: Discussionsupporting

confidence: 88%

Assessing trends and reasons for unsuccessful implant discontinuation in Burkina Faso and Kenya between 2016 and 2020: a cross-sectional study

et al. 2023

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ObjectivesContraceptive implant use has grown considerably in the last decade, particularly among women in Burkina Faso and Kenya, where implant use is among the highest globally. We aim to quantify the proportion of current implant users who have unsuccessfully attempted implant removal in Burkina Faso and Kenya and document reasons for and location of unsuccessful removal.MethodsWe use nationally representative data collected between 2016 and 2020 from a cross-section of women of reproductive age in Burkina Faso and Kenya to estimate the prevalence of implant use, proportion of current implant users who unsuccessfully attempted removal and proportion of all removal attempts that have been unsuccessful. We describe reasons for and barriers to removal, including the type of facility where successful and unsuccessful attempts occurred.FindingsThe total number of participants ranged from 3221 (2017) to 6590 (2020) in Burkina Faso and from 5864 (2017) to 9469 (2019) in Kenya. Over a 4 year period, the percentage of current implant users reporting an unsuccessful implant discontinuation declined from 9% (95% CI: 7% to 12%) to 2% (95% CI: 1% to 3%) in Kenya and from 7% (95% CI: 4% to 14%) to 3% (95% CI: 2% to 6%) in Burkina Faso. Common barriers to removal included being counselled against removal by the provider or told to return a different day.ConclusionUnsuccessful implant discontinuation has decreased in recent years. Despite progress, substantial numbers of women desire having their contraceptive implant removed but are unable to do so. Greater attention to health systems barriers preventing implant removal is imperative to protect reproductive autonomy and ensure women can achieve their reproductive goals.

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Section: Discussionsupporting

confidence: 88%

Assessing trends and reasons for unsuccessful implant discontinuation in Burkina Faso and Kenya between 2016 and 2020: a cross-sectional study

et al. 2023

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“…Contrary to our expectations, user control, referring to the ability to initiate or discontinue a method on one's own, did not emerge as a key priority for AGYW in this study. The rapid scale-up of contraceptive implants in Kenya and many other countries in Africa over the past decade has significantly altered the method mix ( 35 ), and recent data suggest that many implant users face challenges and delays with respect to accessing timely and quality implant removal ( 36 , 37 ). While AGYW did not focus on concerns about autonomy related to discontinuation, and thus we chose to not select “ability to stop a method on your own” as an attribute, the related concept of duration of use was considered very important.…”

Section: Discussionmentioning

confidence: 99%

Priorities for contraceptive method and service delivery attributes among adolescent girls and young women in Kenya: a qualitative study

Harrington,

Hauber,

Ouma

et al. 2024

Front. Reprod. Health

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IntroductionDespite increasing global commitment to meeting the family planning needs of adolescent girls and young women (AGYW), there is limited research on how they prioritize contraceptive method and service delivery characteristics. In this qualitative study, we examine the specific elements that drive the contraceptive choices of Kenyan AGYW, and apply our findings to the development of attributes and levels for a discrete choice experiment (DCE).MethodsOur four-stage approach included data collection, data reduction, removing inappropriate attributes, and optimizing wording. Between June-October 2021, we conducted in-depth interviews with 30 sexually-active 15–24 year-old AGYW in Kisumu county, Kenya who were non-pregnant and desired to delay pregnancy. Interviews focused on priorities for contraceptive attributes, how AGYW make trade-offs between among these attributes, and the influences of preferences on contraceptive choice. Translated transcripts were qualitatively coded and analyzed with a constant comparative approach to identify key concepts. We developed and iteratively revised a list of attributes and levels, and pre-tested draft DCE choice tasks using cognitive interviews with an additional 15 AGYW to optimize comprehension and relevance.ResultsIn-depth interview participants' median age was 18, 70% were current students, and 93% had a primary sexual partner. AGYW named a variety of priorities and preferences related to choosing and accessing contraceptive methods, which we distilled into six key themes: side effects; effectiveness; user control; privacy; source of services; and cost. Bleeding pattern was top of mind for participants; amenorrhea was generally considered an intolerable side effect. Many participants felt more strongly about privacy than effectiveness, though some prioritized duration of use and minimizing chance of pregnancy above other contraceptive characteristics. Most AGYW preferred a clinic setting for access, as they desired contraceptive counseling from a provider, but pharmacies were considered preferable for reasons of privacy. We selected, refined, and pre-tested 7 DCE attributes, each with 2–4 levels.ConclusionsIdentifying AGYW preferences for contraceptive method and service delivery characteristics is essential to developing innovative strategies to meet their unique SRH needs. DCE methods may provide valuable quantitative perspectives to guide and tailor contraceptive counseling and service delivery interventions for AGYW who want to use contraception.

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“…Maintaining an adequate number of trained health professionals is crucial for achieving a balance between human and physical resources and ensuring the effectiveness of the healthcare system. Several studies have documented that the shortage of trained staff serves as a barrier to providing quality care [ 35 – 37 ]. Although guidelines for managing substance use disorders were present in most facilities, the number of staff trained in screening, diagnosing, and managing SUD was limited.…”

Section: Discussionmentioning

confidence: 99%

Health facility readiness to screen, diagnose and manage substance use disorders in Mbale district, Uganda

Aber-Odonga,

Nuwaha,

Kisaakye

et al. 2023

Subst Abuse Treat Prev Policy

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Background Substance use disorders (SUD) pose a significant public health problem in Uganda. Studies indicate that integrating mental health services into Primary Health Care can play a crucial role in alleviating the impact of SUD. However, despite ongoing efforts to integrate these services in Uganda, there is a lack of evidence regarding the preparedness of health facilities to effectively screen and manage SUD. Therefore, this study aimed to assess the readiness of health facilities at all levels of the health system in Mbale, Uganda, to carry out screening, diagnosis, and management of SUD. Methods A health facility-based cross-sectional study was carried out among all the 54 facilities in Mbale district. A composite variable adapted from the WHO Service Availability and Readiness Assessment manual (2015) with 14 tracer indicators were used to measure readiness. A cut-off threshold of having at least half the criteria fulfilled (higher than the cutoff of 7) was classified as having met the readiness criteria. Descriptive analyses were performed to describe readiness scores across various facility characteristics and a linear regression model was used to identify the predictors of readiness. Results Among all health facilities assessed, only 35% met the readiness criteria for managing Substance Use Disorders (SUD). Out of the 54 facilities, 42 (77.8%) had guidelines in place for managing SUD, but less than half, 26 (48%), reported following these guidelines. Only 8 out of 54 (14.5%) facilities had staff who had received training in the diagnosis and management of SUD within the past two years. Diagnostic tests for SUD, specifically the Uri stick, were available in the majority of facilities, (46/54, 83.6%). A higher number of clinical officers working at the health centres was associated with higher readiness scores (score coefficient 4.0,95% CI 1.5–6.5). Conclusions In this setting, a low level of health facility readiness to provide screening, diagnosis, and management for substance use disorders was found. To improve health facility readiness for delivery of care for substance use disorders, a frequent inventory of human resources in terms of numbers, skills, and other resources are required in this resource-limited setting.

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Facility readiness to remove subdermal contraceptive implants in 6 sub-Saharan African countries

Cited by 4 publications

References 22 publications

Assessing trends and reasons for unsuccessful implant discontinuation in Burkina Faso and Kenya between 2016 and 2020: a cross-sectional study

Assessing trends and reasons for unsuccessful implant discontinuation in Burkina Faso and Kenya between 2016 and 2020: a cross-sectional study

Priorities for contraceptive method and service delivery attributes among adolescent girls and young women in Kenya: a qualitative study

Health facility readiness to screen, diagnose and manage substance use disorders in Mbale district, Uganda

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