Case records and long commentaries in Obstetrics and Gynaecology
Norplant is one of the safest hormonal contraceptive methods in use currently. Norplant may be safely used in conditions for which other hormonal contraceptives have been contraindicated. Its use in Kenya has been on the rise especially in urban areas. However, in Central Province of Kenya, an area where the overall contraceptive use is high, Norplant use remains low. A descriptive cross-sectional study was conducted between 1/5/2001 and 15/8/2001 to establish the causes oflow prevalence of Nor plant use in the Central Province of Kenya. Twenty-eight family planning clinics were visited. They included 9 hospitals, 4 subdistrict hospitals and 15 health centers. A total of 110 family planning providers were interviewed using self-administered questionnaires. Fifty nine percent had worked for • more than 8 years after their basic qualification. Seventeen percent had post-basic training in reproductive health. All the clinics reported a shortage of personnel. Using a checklist of known conditions and side effects associated with Norplant use, the knowledge on Norplant was low with 73.4% having below average knowledge on Norplant. Nurses in the family planning clinics had a positive attitude towards Norplant but were not able to offer the service due to lack of knowledge and skill on Norplant insertion and removal techniques. 90.4% of the respondents believed that Norplant was an effective method of family planning. Seventy seven percent (77%) were also promoting its use. Eighteen percent (18%) of the respondents could not advocate use of Norplant to breast-feeding mothers and 68% did not advocate use of Norplant to adolescent. The waiting period for Norplant insertion was as long as three months hence clients change to another more easily accessible and available method. Only doctors were inserting and removing Norplant implants. In the thirteen centers offering the Norplant services, supplies and instruments were adequate but there was a lack of trained personnel. Training of more personnel especially nurses on Norplant may improve its usage in the region.