DETERMINANTS OF IMPLANON DISCONTINUATION AMONG WOMEN WHO EVER USED IMPLANON IN DUGUNA FANGO WOREDA, WOLAYTA ZONE, SOUTHERN ETHIOPIA

Abstract

Introduction: There is paucity of information on the determinants of implanon discontinuation in low income countries like Ethiopia. Encouraging contraceptive continuation has been less of a priority than encouraging new adopters in the country. Inspite of significant scale up of implanon program in health facilities including health posts at community, significant numbers of women make implanon as their first choice of contraception and then discontinue their implanon before it’s expire date at all health facilities of the study Woreda. Objectives: The objective of this study was to identify the determinants of implanon discontinuation among women who ever used implanon in Duguna Fango Woreda, Wolayta Zone, Southern Ethiopia. Methods: A community based unmatched case control study design was used from March 20 to April 20, 2017. Sampling frame was obtained from implanon registration book of the selected kebele Health centers and Hospital. A total of 340 (85 cases and 255 controls) were randomly selected. Cases were implanon discontinuers before 3 years and controls were those used implanon for 3 years. Data were collected by using a pretested structured questionnaire through face to face interview by diploma nurses. Backward stepwise likelihood ratio method was used in multivariable analysis to identify determinants of implanon discontinuation. The strength of the association was assessed using adjusted odds ratio along with 95% CI. Level of statistical significance was declared at p-value less than 0.05. Result: Of the total of 340 eligible women (85 cases and 255 controls) requested for interview, all were participated yielding the response rate of 100% for both cases and controls. Provision of pre-insertion counseling and follow-up appointment were major determinants of implanon discontinuation, AOR=0.36(0.20-0.64) and 0.35(0.20-0.62) respectively. The other factors to be found significant association with implanon discontinuation were age at insertion less than 20 years (AOR= (95%CI) = 3(1.16-7.80), lack of maternal formal education (AOR (95%CI) = 2.8(1.31-6.11), having less than or equal to 4 living children (AOR (95%CI) = 1.8(1.01-3.21) and previous history of abortion AOR (95%CI = 2.3(1.10-4.63). Conclusion: Pre-insertion counseling, follow-up appointment, age at insertion, lack of maternal formal education, having less than or equal to 4 living children, and previous history of abortion were found to be the major determinants of implanon discontinuation. Thus, health professionals and health extension workers must take in to consideration on determinants of implanon discontinuation of these factors for future intervention in an attempt to improve the up-take of implanon including informed choice for all clients after implanon insertion.