A fifteen-year review of female sterilization by minilaparotomy under local anesthesia in Kenya.
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This paper is a comprehensive review of literature concerning the Kenyan experience with female sterilization through minilaparotomy under local anesthesia (ML/LA). A composite picture from analysis of several studies that include some 12,000 clients since 1979 reveals an average Kenyan user to be 31-34 years old (SD 4.9) with 5.9-6.8 children (SD 1.7-1.8). In up to 96% of cases, the indication for choosing sterilization is personal socio-economic considerations. The majority of clients (97%-99%) report satisfaction with their choice of sterilization at the first follow-up visit, and 96-99% state that they would recommend the method to others. The operation takes an average of 14 min (SD 4.5-5.3) "skin-to-skin" through a 18.104.22.168 cm incision (SD 0.5). A mean of 18 cm3 of 1% lignocaine is used (SD 2.7). Most clients (76.4%) have no post-operative complaints; those who do have any complaints report minor transitory problems. Similarly, most clients (96%) have moderate, little, or no peri-operative pain, but 1.9%-5% report much pain. The intra-operative and early complication rate is 0.9%. Some 3.3% of clients suffer at least one complication, some multiple, and the complication rate at 6 weeks is 4.1%, with major complications occurring in 0.7% of cases, and minor complications in 3.4%. The crude failure rate is 0.4% in the first year and 0.1% in the second year, when corrected for luteal phase pregnancies, which account for 50% of all "failures," the actual failure rate is 0.2% in the first year and 0.1% in the second year both for interval and postpartum procedures. This literature review finds outpatient ML/LA to be a relatively safe, simple, effective, and well-accepted option for most Kenyan couples seeking contraception that is intended to be permanent. Counseling, adequate client assessment, and voluntarism have been shown to be essential elements, not only for client satisfaction and avoidance of possible future regret, but also for technical ease of the operative procedure. Recommendations that derive from the Kenya experience are made.