Discontinuation of the five-year implant amongst women of reproductive age in selected health facilities of Nairobi County, Kenya
Gicheru, Francis Ng’ang’a
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Levels and trends in contraceptive use in Kenya underscore the need to examine the dynamics of contraceptive use in the country. The contraceptive prevalence rate has been on the increase from 7% in 1978 to 58% in 2014. Similarly, implant contraceptive prevalence rate has increased from 0% in 1993 to 9.9% in 2014. As the CPR increases, current and potential users of family planning are increasingly drawn from women with a past history of contraceptive use. This implies that a further increase in the CPR is more dependent on promotion of continuation rates and re-adoption of contraception among past users than it will be on promotion of new acceptance rates. As such, this study aimed at determining factors leading to the discontinuation of the 5-year two rod implant contraceptive amongst women of the reproductive age in Nairobi County in order to understand its effectiveness in enabling clients fulfill their reproductive goals. It was also to establish the average duration of use of such implants and determine the implant contraceptive switching trend. To achieve the objectives, a descriptive cross-sectional study was conducted with a desired sample size of 384 respondents employing quantitative parameters for a period of three months. The study determined exposure to the implant and simultaneously determined the main reason for its discontinuation in the target population. Simple random sampling was used to select Kamukunji, Njiru and Embakassi sub-counties of Nairobi. Convenient sampling was used to select seventeen health facilities in these sub-counties where the study was undertaken. Data was collected using a standardized interviewer guide which had been pre-tested in Kasarani sub-county of Nairobi. The data was then entered and analyzed using the Epi info computer program. Pearson’s Chi-square and logistic regression was computed to determine if there were relationships between the dependent and independent variables. At the end of the study, a total of 377 randomly selected respondents were interviewed. It was determined through bivariate analysis that spousal discussion with a p-value of 0.00039, number of living children a woman has with a p-value of 0.0003, duration of implant use with a p-value of 0.01 and number of years since her last delivery with a p-value of 0.0001 were significantly associated with implant discontinuation. The logistic regression analysis further determined that spousal discussion and a woman’s number of living children were the strongest predictors of the five-year implant discontinuation. The average duration of implant use was 19.3 months; short-term contraceptives were the most preferred contraceptives both prior to implant insertion and discontinuation and 74.5% of the respondents’ required further contraception after the discontinuation implying that the implant was unable to fulfill their reproductive goals. Thus, the factors identified as the major contributors of the discontinuations should be a key concern to family planning programmers and the Ministry of Health in general and should be addressed for strengthen continued implant use.