Reasons for early discontinuation of Subdermal levonorgestrel contraceptive Implants in family health options of Kenya clinics In Nairobi
Abstract
Premature removal and discontinuation of contraceptive implants is a cause
of a sizeable expenditure in Kenya.
Evaluation 0f the factors that influence the decision to remove the implants
and being able to predict which users are likely to discontinue prematurely
could provide useful information for counseling patients as they are
considering contraceptive implants and enormous savings in terms of
manpower and finance, not only for the health facilities but the country at
large.
Objective
The objective of the study was to determine the reasons for removal and
discontinuation of implants among users as seen in Family Health Option of
Kenya clinics in Nairobi.
Study design
This was a retrospective cross-section descriptive study.
Study popula tion
The family planning clients who had implants removed in the Family Health
Option of Kenya clinics situtated in Nairobi, within the first three years of
insertion.
Study Hypothesis
_Can early discontinuation of implants be reduced in our set up?
Study Period
The data was collected from March 2008 to July2008 and involved the
collection of data from records of clients, dating from January 2003 to July
2008, this being the period when the implants wer removed.
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Method
Scrutiny of the records of clients who had implants removed in.these clinics
prior to and during the study, until the required sample size of 138 in total
was achieved. Earlier, the principal investigstor, had done test study with a
questionnaire and ten records of the clients to ascertain the suitability of the
data.
Main Outcome Measures
These include the demographic characteristics such as marital status, age,
parity, number of living children, education level and reasons for removal
and whether se If in itiated or health provider initiated.
Results
The majority ofthe clients were married (63%) and (26%) were divorced
while 30/0were widows. Most of them were of the age group 20-30 years
(53.8%). Those of parity of 3-5 constituted 83.3% of the users while those of
parity greater than 5 constituted only 3.7%.Most of them had atleast primary
education (98.7 %).
The commonest reason for removal within the first twelve months was
menstrual changes (38.4 0/0)followed by plan to conceive (28.30/0).Acne and
complexion changes was a reason in 13.8% of those who discontinued
during the first one year.
Conclusion
The most common reason for discontinuation at 12 months was menstrual
disturbances but by 24 months and later on it was intent to conceive. At low
parity thus 3 and below, the main reason was intent to conceive. Majority of
those who discontinued had family sizes of 2 - 3 and had attained at least
primary education.
Recommendations
• Good counseling prior to insertion, during use and on removal.
• Good medical support during use to alleviate the side effects should
be mandatory.
Citation
Master of medicine in obstetrics and gynaecologySponsorhip
University of NairobiPublisher
Department of Obstetrics and Gynaecology University of Nairobi