FACTORS ASSOCIATED WITH EARLY DISCONTINUATION OF CONTRACEPTIVE IMPLANTS AMONG WOMEN OF REPRODUCTIVE AGE IN WAKISO DISTRICT, A FACILITY BASED CROSS-SECTIONAL STUDY

Abstract

Introduction: Over the recent years, there has been a gradual increment in the number of women using contraceptive implants in Uganda. In Wakiso district, the number of implant insertions increased from 6,344 in the FY 2015/16 to 14,389 in FY 2017/2018. However, there was also an increasing trend in the number of implants discontinued by women in the district. Studies on contraceptive discontinuation did not focus on implants and the critical interval of 18 months from the time of insertion. This study intended to contribute to the body of knowledge needed to improve retention of contraceptive implants among users. Therefore, the study estimated the proportion of women who discontinue implants early, established factors associated with early discontinuation of implants and determined factors that influence the duration of use of implants among women 15 – 49 years in Wakiso district. Methods: This is a facility-based cross-sectional study involving 397 women of reproductive age 15 – 49 years, who had discontinued contraceptive implants from 42 health facilities in Wakiso district. Sampling was by stratified technique and I analyzed data with STATA 14. I used modified Poisson and quantile regression analysis techniques using a significance level (α) of 0.05 for test statistics. Results: The proportion of early implant discontinuation was 31%. Early discontinuation was determined by; side effects [adjusted PR = 1.20; 95% CI = 1.05 – 1.37] and incurring costs on retention of implants [adjusted PR = 1.15; CI = 1.04 – 1.28]. Overall duration of use of implants was influenced by discontinuation due to side effects [β = -9.63; CI = -16.6 - -2.63], insertions during breastfeeding [β = -5.00; CI = -8.95 - -1.05], incurring costs on retention of an implant [β = -7.38; CI = -13.3 - -1.47] and not counseling a woman [β = -6.47; CI = -12.1 - -0.86]. Conclusion: The proportion of early discontinuation was considerably high at 31 percent. Addressing side effects and costs on retention would help prevent early discontinuation. In addition, ensuring counseling before implant insertions would improve retention of implants. Recommendations: A proportion of 19 percent should be set as a target for early discontinuation. FP programs should focus on managing side effects, mitigating costs on retention and counseling to improve retention of implants.