Pattern of Implanon uptake in a tertiary hospital in Niger Delta, Nigeria.
Osegi Nkencho1, Makinde Olakunle I1*, Ozori Ebiogbo S1, Biakolo Akpobome1
1Department of Obstetrics and Gynaecology, Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria.
*Correspondence: Dr. Olakunle I. Makinde; +234 803 213 6315; firstname.lastname@example.org
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Background: Implants are the most eﬀective of the contraceptive options currently available with 99.95% eﬀectiveness. Implanon is a subdermal implant, which consists of single 4cm x 2mm ethylene-vinyl acetate (EVA) rod embedded with 68mg of etonogestrel. Experience with Implanon at the Federal Medical Centre, Yenagoa has not been documented since its introduction.
Objective: To determine Implanon uptake, socio-demographic characteristics of Implanon users, Implanon discontinuation rate, reasons for discontinuation, and the eﬀectiveness of Implanon.
Method: A retrospective descriptive study of clients that used Implanon at the Federal Medical Centre, Yenagoa from January 2014 to December 2018. A Proforma was used to obtain data from client cards and record books at the contraception and family planning clinic. Statistical analysis was done using IBM SPSS Statistics version 22.
Results: Of the 2,701 women who used a modern contraceptive within the study period, 253 women had Implanon insertion, giving an Implanon uptake of 9.4%. Majority of Implanon users (38.1%) were aged 30-34 years. The mean age was 32.3 ± 5.4 years. Most (81.5%) had secondary education, were Christians (97.4%) and multiparous (70.5%). Most (69.5%) of them used Implanon for child spacing, and 63.1% had never used any modern contraceptive previously. Injectable contraceptives were the most common (31.9%) among previous users. Implanon discontinuation rate was 14.6%. Majority (45.5%) discontinued after two years of use, 36.4% within two years of use, 35.7% discontinued to have another child, and 32.1% because of abnormal menstrual bleeding patterns. Implanon failure rate was 0.2% per 100 women years.
Conclusion: Implanon is eﬀective as a long-acting reversible contraceptive but its uptake is low. Cost of insertion services, level of education of the women and prevalence of family planning myths are possible factors limiting uptake of Implanon. Out-of-pocket cost reduction, awareness programmes and counselling in local dialects are recommended.
Keywords: Modern contraceptive, Implanon, Implanon uptake, Implanon discontinuation rate, Implanon failure rate.
Cite this article: Osegi N, Makinde OI, Ozori ES, Biakolo A. Pattern of Implanon uptake in a tertiary hospital in Niger Delta, Nigeria. Yen Med J. 2020;2(1):119-129.
- Mutihir JT, Emuveyan EE. Advances in Contraception. In: Kwawukume EY, Ekele BA, Danso KA, Emuveyan EE, eds. Comprehensive Gynaecology in the Tropics. 2nd ed. Ghana: G-Pak Limited publishers; 2017:305-316.
- Cameron ST, Glasier A. Contraception and Sterilization. In: Keith Edmonds D, ed. Dewhurst’s Textbook of Obstetrics & Gynaecology. 8th ed. West Sussex, UK: John Wiley and Sons, Ltd; 2012:495-512.
- Graesslin O, Korver T. The contraceptive efficacy of Implanon: a review of clinical trials and marketing experience. Eur J Contracept Reprod Health Care. 2008;13 Suppl(s1):4-12. doi: 10.1080/13625180801942754.
- Sundaram A, Vaughan B, Kost K, Bankole A, Finer L, Singh S, et al. Contraceptive failure in the United States: estimates from the 2006-2010 National Survey of Family Growth. Perspect Sex Reprod Health. 2017;49(1):7-16. doi: 1363/psrh.12017.
- Ladipo AO, Akinso SA. Contraceptive Implants. Afr J Reprod Health. 2005;9(1):16-23.
- Kolawole OO, Sowemimo OO, Ojo OO, Fasuba OB. Contraceptive Implants: a review and current perspective in southwest Nigeria. Trop J Obstet Gynaecol. 2018;35(2):108-112. doi: 10.4103/TJOG.TJOG_6_18.
- Mazza D, Bateson D, Frearson M, Goldstone P, Kovacs G, Baber R. Current barriers and potential strategies to increase use of long-acting reversible contraception (LARC) to reduce the rate of unintended pregnancies in Australia: an expert roundtable discussion. Aust N Z J Obstet Gynaecol. 2017;57(2):206-212. doi: 10.1111/ajo.12587.
- Joshi R, Khadilkar S, Patel M. Global trends in use of long-acting reversible and permanent methods of contraception: seeking a balance. Int J Gynaecol Obstet. 2015;131 Suppl(s1):S60-S63. doi: 10.1016/j.ijgo.2015.04.024.
- Darroch JE, Singh S. Trends in contraceptive need and use in developing countries in 2003, 2008, and 2012: an analysis of national surveys. Lancet. 2013;381(9879):1756-1762. doi: 10.1016/S0140-6736(13)60597-8.
- National population commission (NPC) [Nigeria], ICF International. Nigeria Demographic and Health Survey. 2013. Abuja, Nigeria and Rockville, Maryland, USA: NPC and ICF International; 2014.
- National population commission (NPC) [Nigeria], ICF. Nigeria Demographic and Health Survey. 2018. Abuja, Nigeria and Rockville, Maryland, USA: NPC and ICF; 2019.
- Elias B, Hailemariam T. Implants contraceptive utilization and factors associated among married women in the reproductive age group (18 – 49 Years) in southern Ethiopia. J Women’s Health Care. 2015;4(7):281. doi: 10.4172/2167- 0420.1000281.
- Moodley A, Mahomed O. Prevalence and predictors of Implanon uptake in Ugu (Ugu north sub district) 2016/17. S Afr Fam Pract. 2019;61(2):48-52. doi: 10.1080/20786190.2018.1548725.
- Gueye A, Speizer IS, Corroon M, Okigbo CC. Belief in family planning myths at the individual and community levels and modern contraceptive use in urban Africa. Int Perspect Sex Reprod Health. 2015;41(4):191-199. doi: 10.1363/4119115.
- Nageso A, Gebretsadik A. Discontinuation rate of Implanon and its associated factors among women who ever used Implanon in Dale District, Southern Ethiopia. BMC Womens Health. 2018;18(1):189. doi: 10.1186/s12905-018-0678-x.
- Ojule JD, Oranu EO, Enyindah CE. Experience with Implanon in Southern Nigeria. J Med Med Sci. 2012;3(11):710-714. Available from: http://www.interesjournals.org/JMMS. Accessed 28 November 28, 2019.
- Roberts AO, Morhason-Bello IO, Okunlola MA, Adekunle AO. Profile of Implanon acceptors and pattern of side effects. J Reprod Contracept. 2015;26(1):46-52. doi: 10.7669/j.issn.1001-7844.2015.01.0046.
- Balogun OR, Olaomo N, Adeniran AS, Fawole AA. Implanon sub-dermal implant: an emerging method of contraception in Ilorin, Nigeria. J Med Biomed Sci. 2014;3(1):1-5. doi: 10.4314/jmbs.v3i1.1.
- Gebre-Egziabher D, Medhanyie AA, Alemayehu M, Tesfay FH. Prevalence and predictors of Implanon utilization among women of reproductive age group in Tigray Region, Northern Ethiopia. Reprod Health. 2017;14:62. doi: 10.1186/s12978-017-0320-7.
- Amo-Adjei J, Mutua M, Athero S, Izugbara C, Ezeh A. Improving family planning services delivery and uptake: experiences from the “Reversing the Stall in Fertility Decline in Western Kenya Project”. BMC Res Notes. 2017;10(1):498. doi:10.1186/s13104-017-2821-4.
- Broecker J, Jurich J, Fuchs R. The relationship between long-acting reversible contraception and insurance coverage: a retrospective analysis. Contraception. 2016;93(3):266–272. doi:10.1016/j.contraception.2015.11.006.
- G/Medhin T, Gebrekidan KG, Nerea MK, Gerezgiher H, Haftu M. Early Implanon discontinuation rate and its associated factors in health institutions of Mekelle City, Tigray, Ethiopia 2016/17. BMC Res Notes. 2019;12(1):8. doi:10.1186/s13104-018-3992-3.
- Tadesse A, Kondale M, Agedew E, Gebremeskel F, Boti N, Oumer B. Determinant of Implanon discontinuation among women who ever used Implanon in Diguna Fango District, Wolayita Zone, Southern Ethiopia: a community-based case control study. Int J Reprod Med. 2017;2861207,8. doi.org/10.1155/2017/2861207.
- Siyoum M, Zerfu M, Abuhay M, Habtamu K. Implanon discontinuation rate and associated factors among women who ever used Implanon in the last three years in Debre Markos town, Northwest Ethiopia,2016, cross sectional study. ARC J. Public Health Community Med. 2017;2(1):8-16. doi: 10.20431/2456-0596.0201003.
- Ezegwui H, Ikeako L, Ishiekwene C, Oguanua T. The discontinuation rate and reasons for discontinuation of Implanon at the family planning clinic of University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria. Niger J Med. 2010;20(4):448–50.
- Wondie AG. Implanon discontinuation rate and its associated factors in Debre Tabor Town, North Central Ethiopia. Sci J Clin Med. 2010;8(2):6-12. doi:10.11648/j.sjcm.20190802.11.
- Asaye MM, Nigussie ST, Ambaw WM. Early Implanon discontinuation and associated factors among Implanon user women in Debre Tabor Town, Public Health facilities, Northwest Ethiopia, 2016. Int J Reprod Med. 2018;2018:3597487. doi:10.1155/2018/3597487.
- Robinson JA, Jamshidi R, Burke AE. Contraception for the HIV-positive woman: a review of interactions between hormonal contraception and antiretroviral therapy. Infect Dis Obstet Gynecol. 2012;2012:890160. doi:10.1155/2012/890160.
- Shelton JD. Reduced effectiveness of contraceptive implants for women taking the antiretroviral efavirenz (EFV): still good enough and for how long? Glob Health Sci Pract. 2015;3(4):528-531. doi.org/10.9745/GHSP-D-15-00356.