Incidence and determinants of Implanon discontinuation: Findings from a prospective cohort study in three health zones in Kinshasa, DRC

Autor: Philip Anglewicz, Pierre Akilimali, K P Kayembe, Jane T. Bertrand, Julie H. Hernandez
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
Medical Implants
Social Sciences
Pathology and Laboratory Medicine
Vascular Medicine
Cohort Studies
Underserved Population
Families
0302 clinical medicine
Sociology
Medicine and Health Sciences
Medicine
030212 general & internal medicine
Prospective Studies
Young adult
Prospective cohort study
Contraception Behavior
Children
030219 obstetrics & reproductive medicine
Multidisciplinary
Schools
Incidence (epidemiology)
Obstetrics and Gynecology
Drugs
Contraceptives
Prostheses and Implants
Middle Aged
Contraception
Research Design
Democratic Republic of the Congo
Engineering and Technology
Female
Contraceptive implant
Cohort study
Research Article
Biotechnology
Adult
Adolescent
Science
Hemorrhage
Bioengineering
Research and Analysis Methods
Education
03 medical and health sciences
Young Adult
Nursing Science
Signs and Symptoms
Diagnostic Medicine
Humans
Female Contraception
Pharmacology
business.industry
Proportional hazards model
Biology and Life Sciences
Discontinuation
Health Care
Age Groups
People and Places
Women's Health
Medical Devices and Equipment
Population Groupings
business
Demography
Zdroj: PLoS ONE, Vol 15, Iss 5, p e0232582 (2020)
PLoS ONE
ISSN: 1932-6203
Popis: Background Kinshasa is Africa's third largest city and one of the continent’s most rapidly growing urban areas. PMA2020 data showed that Kinshasa has a modern contraceptive prevalence of 26.5% among married women in 2018. In Kinshasa’s method mix, the contraceptive implant recently became the dominant method among contraceptive users married and in union. This study provides insight into patterns of implant use in a high-fertility setting by evaluating the 24-month continuation rate for Implanon NXT and identifying the characteristics associated with discontinuation. Methodology This community-based, prospective cohort study followed 531 Implanon users aged 18–49 years at 6, 12 and 24 months. The following information was collected: socio-demographic characteristics, Method Information Index (MII) and contraceptive history. The main outcome variable for this study was implant discontinuation. The incidence rate of discontinuation is presented as events per 1000 person/months (p-m), from the date of enrolment. The Cox proportional hazards modelling was used to measure predictors of discontinuation. Results A total of 9158.13 p-m were available for analysis, with an overall incidence rate of 9.06 (95% CI: 9.04–9.08) removals per 1000 p-m. Of nine possible co-variates tested, the likelihood of discontinuation was higher among women who lived in military camps, had less than three children, never used injectables or implants in the past, had experienced heavy/prolonged bleeding, and whose MII score was less than 3. Conclusion In addition to four client characteristics that predicted discontinuation, we identified one programmatic factor: quality of counseling as measured by the Method Information Index. Community providers in similar contexts should pay more attention to clients having less than three children, new adopters, and to clients living military camps as underserved population, where clients have less access to health facilities. More targeted counselling and follow-up is needed, especially on bleeding patterns.
Databáze: OpenAIRE
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