Department of Obstetrics and Gynecology, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia.
University of Gondar, Gondar, Ethiopia
BMJ Open. 2022 Aug 2;12(8):e059372. doi: 10.1136/bmjopen-2021-059372.
The study aims to determine discontinuation among long-acting reversible contraceptive users at 3, 6, 9 and 12 months after initiation and its associated factors among new long-acting reversible contraceptive (LARC) users.
A facility-based multicentre prospective cohort study was conducted with a sample size of 1766 women.
The study was conducted in five large cities of Ethiopia (Addis Ababa, Gondar, Mekelle, Jimma and Harar) between March 2017 and December 2018. Various referral hospitals and health centres that are found in those cities are included in the study.
The study population was all women who were new users of LARCs and initiated LARCs in our selected public health facilities during the enrolment period.
A pretested structured questionnaire was administered at enrolment and at 6 and 12 months to determine discontinuation proportion and factors associated with discontinuation.
From the total of 1766 women sampled for the study only 1596 (90.4%) participants completed all the questionnaires including the 12-month follow-up study. The overall proportion of discontinuation of LARCs at 12 months was 21.8% (95% CI 19.8 to 23.9). The overall discontinuation proportions at 3, 6, 9 and 12 months were 2.94%, 8.53%, 3.94% and 6.36%, respectively. Location of method initiation (adjusted HR (aHR)=5.77; (95% CI 1.16 to 28.69)) and dissatisfaction with the method (aHR=0.09; (95% CI 0.03 to 0.21)) were found to be the predictors of discontinuation among intrauterine contraceptive device users. Being satisfied with the method (aHR=0.21; (95% CI 0.15 to 0.27)), initiation after post abortion (aHR=0.48; (95% CI: 0.26, 0.89)) and joint decision with partner for method initiation (aHR=0.67; (95% CI: 0.50, 0.90)) were inversely associated with implant discontinuation.
The majority of LARC users discontinue the method in the first 6 months after insertion and dissatisfaction with the method increased the likelihood of removal during the first year of LARC use.
本研究旨在确定长效可逆避孕（LARC）使用者在开始使用后 3、6、9 和 12 个月的停药率，并分析其相关因素。
这是一项基于设施的多中心前瞻性队列研究，样本量为 1766 名女性。
这项研究在埃塞俄比亚的五个大城市（亚的斯亚贝巴、贡德尔、梅克尔、吉马和哈拉尔）进行，时间为 2017 年 3 月至 2018 年 12 月。研究纳入了这些城市中的各种转诊医院和保健中心。
研究人群为所有在选定的公立保健机构初次使用 LARC 的新使用者。
在登记时以及 6 个月和 12 个月时使用经过预测试的结构化问卷，以确定停药比例和与停药相关的因素。
在总共抽样的 1766 名女性中，只有 1596 名（90.4%）参与者完成了所有问卷，包括 12 个月的随访研究。LARC 在 12 个月时的总体停药率为 21.8%（95%CI 19.8 至 23.9）。LARC 在 3、6、9 和 12 个月时的总体停药比例分别为 2.94%、8.53%、3.94%和 6.36%。放置方法的位置（调整后的 HR（aHR）=5.77；95%CI 1.16 至 28.69）和对方法的不满（aHR=0.09；95%CI 0.03 至 0.21）被发现是宫内节育器使用者停药的预测因素。对方法满意（aHR=0.21；95%CI 0.15 至 0.27）、流产后放置（aHR=0.48；95%CI：0.26，0.89）和与伴侣共同决定放置方法（aHR=0.67；95%CI：0.50，0.90）与植入物停药呈负相关。
大多数 LARC 用户在插入后 6 个月内停止使用该方法，并且对该方法的不满增加了 LARC 使用第一年取出的可能性。
