Reasons for early discontinuation of Subdermal levonorgestrel contraceptive Implants in family health options of Kenya clinics In Nairobi
Obago, Fredrick O
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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. 414 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.