Prevalence and factors associated with early discontinuation rate of Implanon utilization among women who ever used Implanon in Kucha District Gamo Gofa Zone, Southern Ethiopia

Abstract

Background The promotion of contraception in countries with high birth rates has the potential to reduce poverty, hunger, maternal, and childhood deaths. Every year in sub-Saharan Africa approximately 14 million unintended pregnancies occurred and a sizeable proportion was due to poor use of short-term hormonal methods. Contraceptive hormonal implants are highly effective and suitable for almost all women at any stage of their reproductive lives. On the other hand, early discontinuation of the Implanon contraceptive method utilization is one of the foremost problems amid the family planning program. Early discontinuation of the Implanon contraceptive method and reasons for such discontinuation lingers the most significant anxiety for family planning programs. In unindustrialized countries, contraceptive discontinuation due to health concerns is generally higher; these complaints are often related to service quality. Hence, this study aimed to assess the prevalence and factors associated with early discontinuation of Implanon among women who ever used Implanon in Kucha district, Gamo Gofa Zone, Southern Ethiopia. Methods Implanon contraceptive device users were selected from the Kucha district using a cross-sectional community-based survey from January to March 2018. A total of 430 women were selected and data were collected through face-to-face interviews by using a pre-tested structured questionnaire. Data were cleaned, coded, and entered into Epi-Info version 7statistical software. Factors that showed association in a bivariate analysis that has a p value of less than 0.25 were entered into multiple logistic regression models for controlling confounding factors. The strength of statistical association was measured by adjusted odds ratio, at 95% confidence intervals, and p value < 0.05 were considered as statistically significant variables. Result The result of this study revealed that the overall discontinuation rate of Implanon in the study was 34%. Variables having statistically significant association with Implanon discontinuation were women who never use a contraceptive method other than Implanon (AOR = 2.96, 95% CI 1.53–5.74), women who didn’t make discussion with a partner (AOR = 3.32, 95% CI 1.57–7.04), poor counseling and follow up (AOR = 9.23, 95% CI 4.7–18.13), fear of side effects (AOR = 0.12, 95% CI 0.058- 0.24) and poor satisfaction of service (AOR = 5.2, 95% CI 2.77- 9.76) Conclusion The overall early discontinuation rate of Implanon in the study area was high. The main factors associated with early discontinuation of Implanon were contraceptive ever use, discussion with partner, poor follow-up of counseling, fear of side effects, and un-satisfaction by the services given during the insertion rate of Implanon.

The prevalence of Implanon discontinuation and associated factors among Ethiopian women: A systematic review and meta-analysis

“…46 This high rate of discontinuation might be due to inadequate pre-insertion counseling and post-insertion follow-up, as well as minimal male partner involvement before insertion, as seen in the majority of the included studies in this systematic review and meta-analysis. 31,35,37 Also, this could be due to a decreased need for contraception, dissatisfaction with the current methods, or poor management of side effects. 42 This high rate of discontinuance could also be due to the good/cheap access to implant removal services in Ethiopia, as compared to other countries where women may not have this option.…”

“…A total of 11 cross-sectional studies were included in this systematic review and meta-analysis. [28][29][30][31][32][33][34][35][36][37][38] A total of 4320 Implanon users were considered in the meta-analysis. In all of the studies, data were collected by a face-to-face interview using a pre-tested, interviewer-administered questionnaire.…”

“…The minimum and the maximum sample sizes were 132 and 711, which were obtained from studies conducted in Amhara 34 and South Nations, Nationalities, and Peoples' Region (SNNPR), 36 respectively. Regarding the distribution of studies across the geographic region of the country, four were from the Amhara region, 28,34,35,37 three were from the Oromia region, 28,29,33 two were from Tigray, 32,38 and two were from SNNPR 31,36 (Table 1).…”

Prevalence of contraceptive implant discontinuation among women who used implant in Ethiopia: Systemic review and meta-analysis

“…17 From 13 articles included in this systematic review and meta-analysis, only four regions of Ethiopia were identified. Of the total studies included, four were conducted in Amhara; 16,[18][19][20] four in South Nations Nationalities and Peoples of Ethiopia national (SNNPR), 17,[21][22][23] three studies in Oromia [24][25][26] and two in Tigray. 27,28 Six studies were conducted in urban areas and the rest seven were conducted in rural areas.…”

“…To date, the prevalence of implant discontinuation rate in Ethiopia ranges from 16% to 66%. [16][17][18][19][20][21][22][23][24][25][26][27][28] However, those studies offered district-level information and there is no updated national representative evidence regarding the overall discontinuation rate about all types of implant contraceptives. So it is practical to work on synthesizing the evidence.…”