Early discontinuation of implanon and its associated factors among women who ever used implanon in Ofla District, Tigray, Northern Ethiopia

Background: Contraceptive use plays an important role in minimizing unintended pregnancies, reduce maternal mortality, and improve child survival. Hence family planning programmes must motivate women to begin using contraception and must encourage women who are already using family planning not to discontinue. The decision to continue or discontinue use of a contraceptive involves multiple factors. Objective: The objective of the study was to determine early discontinuation rate of Implanon and to identify its associated factors among women who ever used implanon in 2012/2013 in Northern part of Ethiopia. Methods: a community based cross sectional study was conducted in 244 participants from January 20-March 09, 2014. All women who ever used implanon in 2012/2013 were included in the study .The data was entered and cleaned in Epi Info and analyzed using SPSS. Multivariate logistic regression was used to identify factors associated with early discontinuation of implanon. Result: The overall early implanon discontinuation rate was 16% .the mean (±SD) duration of implanon use in months was 6.6±2.8. The main reason for early discontinuation was health concerns followed by desire to have more children. Women who have developed side effects, who were not appointed for follow up and who were not satisfied by the service given during the implanon insertion were the predictors of early implanon discontinuation. Conclusions: Early implanon discontinuation rate was considerable and a health concern was the main reason for discontinuation. Pre insertion counseling, close monitoring and follow up of implanon users should be made to increase implanon continuation rate. Key words; Implanon, discontinuation rate, Tigray, Ethiopia Introduction Early implanon discontinuation is defined as discontinuation at less than 2.5 years after insertion of implanon. Contraceptive use, as proximate determinant of fertility, plays an important role in minimize unintended pregnancies, reduce maternal mortality, and improve child survival. Hence family planning programmes must motivate women to begin using contraception and must encourage women who are already using family planning not to discontinue. Quality of family planning services is an important determinant of contraceptive use because it is likely to affect contraceptive adoption and, more significantly, contraceptive continuation . The decision to continue or discontinue use of a contraceptive involves multiple factors. High rates of contraceptive discontinuation for reasons other than the desire for pregnancy are a public health concern because of their association with negative reproductive health outcomes. Many experts believed implanon to have higher continuation rates as compared to other methods of contraceptives but evidences from different studies indicated that implanon discontinuation rates within the first one year of use ranges from 2% in Nigeria to 23% in UK, Malaysia, Australia and Egypt 1, 5-7 and despite well tolerance and effectiveness, many women discontinue implanon use within one year of initiating a method. The major reasons that women discontinue use of implanon method are side effects, and health concerns, and a desire to become pregnant. Menstrual disturbance is the most common reason for discontinuation of implanon use. Other less frequent reasons also include, spouse disapproval, and switching to another method . Early discontinuation of the implant heightens the risk of unintended pregnancy that end in miscarriage, stillbirth or abortion . Kalayu Birhane et al. / International Journal of Pharma Sciences and Research (IJPSR) ISSN : 0975-9492 Vol. 6 No.3 Mar 2015 544 Despite its proven safety, and effectiveness, the sub dermal implant is not widely used in Ethiopia .Only 3.4% of women who were taking contraceptives between the ages of 15 -49 years used Implants. Early discontinuation and reasons of discontinuation among women’s of Implanon users in Ethiopia has received little study. The purpose of this study was to assess early discontinuation rate of implanon and identify its determinants. The findings of the study would help health managers to understand the extent of the early implanon discontinuation and hence improve future national family planning programs in Ethiopia in general, in Ofla Tigray in particularly. METHODS AND MATERIALS A community based cross-sectional study design was conducted from January to March, 2014 in Ofla district. Based on the 2007 National Census conducted by Central Statistical Agency of Ethiopia (CSA), projection the district has a total population of 144,217 of whom 70, 666 (49%) male and 73,550 (51%) women. 96.6% of the population of the district is Orthodox Christians’, and 3.38% Muslim. The district has 6 Health centers, 22 Health post with 47 Health Extension Workers (HEW). Review of family planning registration book of health institutions revealed that 264 women used implanon in the period July 8, 2012 to July 07, 2013. All those women in the district were included in the study and the data was collected house to house by taking the list of the women from the Family planning registration book of the respective health institutions. A structured and pretested interview based questionnaire with both open ended and closed ended questions was used to collect the data. The questionnaire comprises socioeconomic and demographic, past contraception history and Knowledge on Implanon, partner involvement, counseling status, future intention and Information specific to the use of Implanon types of questions. The age, date of insertion and removal of implanon was taken from family planning registration book but again asked during the data collection process to ensure consistency data. The questionnaire was adopted from reviewing different literatures and scientific facts. Questionnaire was first prepared in English and translated to Tigrigna by RH specialist local language speaker to make it understandable by the study participants and to check whether the translation was consistent with the English version. The questionnaire was back retranslated to English by another person. Six female who have completed grade ten, as data collectors and two B.Sc Nurse as supervisors were recruited and trained on the objectives of the study, data collection tools and interview techniques for two days by the principal investigator. Before the actual data collection, the questionnaire was pre tested in 5 % of the total sample size. Based on the pretest, necessary modification was made on the questions. Data was entered and cleaned in EpiInfo version 3.5.4 by the principal investigator then exported to Statistical package for social sciences (SPSS) version 20.0 for analysis. Frequencies of the different variables were run to identify missing values. Means, standard deviation and proportions for the different variables were calculated and the data was presented in tables and figures. Bivariate analyses were done for the independent variables with the outcome variable (early implanon discontinuation) to select candidate variables for the multivariate analyses. Variables with P≤0.2 on the bivariate analysis were entered to multivariate binary logistic regression model to identify their independent effects on the outcome variable. Their respective odds ratios (OR) associated with these potential factors was reported as a measure of strength, together with the respective 95% confidence intervals. Ethical clearance was obtained from research and ethical committee (REC) of Addis Ababa University, School of Public Health. Permission for conducting the study was also obtained from the Tigray Regional Health Bureau and the Ofla district Health Office. Then official letter was written to each service delivery points. Information sheet that contains about the benefit and risk of participating of the respondents in this study with verbal informed consent was attached to each questionnaire. The study participants were asked after the data collectors explained the purpose of the study and obtaining verbal consent from each respondent RESULT Sociodemographic characteristics A total of two hundred forty four (244) participants responded to the questionnaires making a response rate of 92.4%. The age of study participants were between 16 and 45 years with the mean (+SD) age 26.9±6.9 years. More than half of the participants 168(68.9%) were married, 219(89.8%) Orthodox Christians and 199(81.6%) were farmer by occupation. One hundred eighty eight (77%) of the women had living children between one and nine at the time of insertion with a mean (+SD) number of living children. More than half of the study participants159 (65.2%) and more than three quarter of her husband’s 116(79.1%) educational status were illiterate (Table 1). Kalayu Birhane et al. / International Journal of Pharma Sciences and Research (IJPSR) ISSN : 0975-9492 Vol. 6 No.3 Mar 2015 545 Table 1 Sociodemographic status of women who used implanon in Ofla District, Tigray, Northern Ethiopia (n=244) Characteristics Number % Women’s Age at the time of Implanon insertion <20 39 16.0