Incidence and determinants of Implanon discontinuation: Findings from a prospective cohort study in three health zones in Kinshasa, DRC

Abstract

Background Kinshasa is Africa's third largest city and one of the continent's most rapidly growing urban areas. PMA2020 data showed that Kinshasa has a modern contraceptive prevalence of 26.5% among married women in 2018. In Kinshasa's method mix, the contraceptive implant recently became the dominant method among contraceptive users married and in union. This study provides insight into patterns of implant use in a high-fertility setting by evaluating the 24-month continuation rate for Implanon NXT and identifying the characteristics associated with discontinuation. Methodology This community-based, prospective cohort study followed 531 Implanon users aged 18-49 years at 6, 12 and 24 months. The following information was collected: socio-demographic characteristics, Method Information Index (MII) and contraceptive history. The main outcome variable for this study was implant discontinuation. The incidence rate of discontinuation is presented as events per 1000 person/months (p-m), from the date of enrolment. The Cox proportional hazards modelling was used to measure predictors of discontinuation. Results A total of 9158.13 p-m were available for analysis, with an overall incidence rate of 9.06 (95% CI: 9.04-9.08) removals per 1000 p-m. Of nine possible co-variates tested, the likelihood of discontinuation was higher among women who lived in military camps, had less than three children, never used injectables or implants in the past, had experienced heavy/ prolonged bleeding, and whose MII score was less than 3.

Early implanon discontinuation and associated factors among women ever used implanon in Mettu district, Oromia regional state, southwest Ethiopia, 2021

“…This finding is found to be consistent with study in Kinshasa as this study implies those women who developed heavy menstrual bleeding had a positive association with early discontinuation of implanon when compared to their counter parts [ 20 ]. Similarly study in Hawassa revealed that women who suffered from abnormal bleeding were more likely to discontinue implanon early when compared to their other part [ 15 ].…”

Determinants of implanon discontinuation among women who ever used implanon in Shashamane district, West Arsi zone, Southern Ethiopia: Case-control study

“…Women who had no side effects after insertion of implanon were 65 % less likely to discontinue their implanon use as compared to women who had experienced side effects after insertion of implanon. This result is in line with the study conducted in Buffalo City of South Africa (34), Kinshasa, DRC (35), Upper Egypt(36), O a District(18), Debre Markos(37), Andabet District (32), Mekelle town (20), Ambo Town(38). This might be due to women not informed about possible side effects during counselling by providers; they may be concerned and frightened by unanticipated changes in their mood, menstruation patterns, or weight.…”

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

“…The sample size was calculated using the double population formula via stat calc menu of Epi info version 7 by considering the following assumptions: 95% CI; 80% power; 1:1 ratio of unexposed to exposed; the anticipated proportion of Implanon discontinuation among women with poor counseling (p1, Exposed) = 25.95%; Implanon discontinuation among women who got adequate counseling (p2, unexposed) = 14.97%; adjusted hazard ratio (AHR) =1.81 [ 34 ]. The sample size for the study was determined to be 458 based on the assumptions above.…”

“…A data abstraction checklist was developed by reviewing different literature in the area of interst [ 31 , 34 ]. Data from the family planning service registration, Implanon removal record book and clients’ medical records were also used to develop a data abstraction checklist.…”

“…Rather than striving to enroll a large number of acceptors at once, programs should focus on a small number of annual acceptors and focus on providing quality care to improve their satisfaction which reduces discontinuation [ 33 ]. Although Implanon is becoming more known among contraceptive users, little is known regarding the rates and reasons for discontinuation by using relatively strong study designs [ 34 ]. Those studies in Ethiopia were mostly focused on assessing early discontinuation in the first year, with the overall time to discontinuation not being evaluated rigorously.…”