哪些避孕副作用最为重要？来自肯尼亚西部当前及过往使用注射式避孕法和植入式避孕法者的证据。
Which contraceptive side effects matter most? Evidence from current and past users of injectables and implants in Western Kenya.
作者信息
Odwe George, Obare Francis, Machiyama Kazuyo, Cleland John
机构信息
Population Council, Kenya, Third Floor, Avenue 5, Rose Avenue, P.O. Box 17643-00500, Nairobi, Kenya.
Faculty of Epidemiology and Population Health, London, School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
出版信息
Contracept X. 2020 Jun 20;2:100030. doi: 10.1016/j.conx.2020.100030. eCollection 2020.
OBJECTIVES
The objectives were to assess experiences of menstrual bleeding and nonbleeding side effects among current and past users of injectables and implants and the associations between side effects and method evaluations by women - satisfaction, perceived suitability, the likelihood of future use and intended duration of use.
STUDY DESIGN
We used data on past and current users of injectables and implants from a survey of 1866 married or cohabiting women who participated in the third round of a 2-year prospective longitudinal study conducted in Homa Bay County, Western Kenya. Descriptive and bivariate analysis with tests was used to assess statistically significant associations between experience of bleeding/nonbleeding side effects and method-specific attitudes.
RESULTS
Self-reported method-related bleeding problems were high among current and past users of injectables (range 69%-79%) and implants (range 55%-60%) and much more common than nonbleeding side effects. For both methods, experience of either bleeding or nonbleeding side effects reduces positive evaluations, but the conjunction of both types had particularly pronounced consequences. Heavy bleeding was more strongly related to method evaluation (satisfaction and the likelihood of future use; p < .001) among past users than other forms of menstrual bleeding disorders. Even among current users, about one third regarded bleeding side effects as very serious. Care-seeking from a healthcare provider for management of contraceptive-related side effects was low among current users (less than 40%) and modest among past users (range 53%-63%).
CONCLUSIONS
The results underscore the need to strengthen programs on counseling and information on contraceptive side effects including menstrual bleeding disturbances to improve method satisfaction and reduce discontinuation.
IMPLICATION
The experience of contraceptive-related menstrual bleeding and nonbleeding side effects reduces positive evaluation of the method and deters past users from future use of the method.
目的
评估注射剂和植入剂的现使用者和既往使用者的月经出血及非出血副作用经历，以及副作用与女性对方法的评价之间的关联——满意度、感知适用性、未来使用可能性和预期使用期限。
研究设计
我们使用了对1866名已婚或同居女性进行调查的数据，这些女性参与了在肯尼亚西部霍马湾县进行的一项为期两年的前瞻性纵向研究的第三轮调查，她们为注射剂和植入剂的既往使用者和现使用者。采用描述性和双变量分析及检验来评估出血/非出血副作用经历与特定方法态度之间的统计学显著关联。
结果
注射剂现使用者和既往使用者（范围为69%-79%）以及植入剂现使用者和既往使用者（范围为55%-60%）中，自我报告的与方法相关的出血问题发生率较高，且比非出血副作用更为常见。对于这两种方法，出血或非出血副作用的经历都会降低积极评价，但两种副作用同时出现的影响尤为显著。在既往使用者中，大量出血与方法评价（满意度和未来使用可能性；p<0.001）的相关性比其他形式的月经出血紊乱更强。即使在现使用者中，约三分之一的人认为出血副作用非常严重。现使用者中因避孕相关副作用寻求医疗服务提供者帮助的比例较低（不到40%），既往使用者中这一比例适中（范围为53%-63%）。
结论
结果强调需要加强关于避孕副作用（包括月经出血紊乱）的咨询和信息项目，以提高方法满意度并减少停用情况。
启示
与避孕相关的月经出血和非出血副作用经历会降低对该方法的积极评价，并使既往使用者不再未来使用该方法。
Zotero 插件