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

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.

Discontinuation of long acting reversible contraceptive use and its determinants among women in Ethiopia: Systematic review and meta-analysis

“…As a result, 156 fulltext articles were assessed for eligibility criteria, with 136 studies being excluded due to various factors. Finally, for this systematic review and meta-analysis study, 20 publications (23,(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) were used as presented by PRISMA diagram (Figure 1). The cross-sectional study type was used in seventeen studies, whereas the retrospective cohort study approach was used in three.…”

“…Both community and institutional studies were equally represented (10 studies in each). Nine studies conducted in Southern Nations Nationalists and Peoples Region (23,27,31,32,(34)(35)(36)(37)39), five in Amhara (26, 28-30, 41), three in Tigray (40, 42, 43), and three in Oromia (33,38,44). The sample sizes ranged from 222 to 1050.…”

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

“…10 According to South African Family Practice, up to 43% of women discontinued their Implanon before the 3 years were completed. 11 According to studies conducted in Ethiopia, 12 Nigeria and Kenya, 11%, 19.0% and 30.0% of Implanon users discontinued use within the first year, respectively. 13 , 14…”

“…10 According to South African Family Practice, up to 43% of women discontinued their Implanon before the 3 years were completed. 11 According to studies conducted in Ethiopia, 12 Nigeria and Kenya, 11%, 19.0% and 30.0% of Implanon users discontinued use within the first year, respectively. 13,14 Implant discontinuation before the recommended effective duration leads women at risk of unintended pregnancies and unsafe abortions, along with negative health consequences such as miscarriage and stillbirth.…”