Introducing the hormonal Intrauterine Device in Madagascar, Nigeria, and Zambia: results from a pilot study

Abstract Background The hormonal Intrauterine Device (IUD) is a highly effective contraceptive option growing in popularity and availability in many countries. The hormonal IUD has been shown to have high rates of satisfaction and continuation among users in high-income countries. The study aims to understand the profiles of clients who choose the hormonal IUD in low- and middle-income countries (LMICs) and describe their continuation and satisfaction with the method after 12 months of use. Methods A prospective longitudinal study of hormonal IUD acceptors was conducted across three countries—Madagascar, Nigeria, and Zambia—where the hormonal IUD had been introduced in a pilot setting within the of a broad mix of available methods. Women were interviewed at baseline immediately following their voluntary hormonal IUD insertion, and again 3 and 12 months following provision of the method. A descriptive analysis of user characteristics and satisfaction with the method was conducted on an analytic sample of women who completed baseline, 3-month, and 12-month follow-up questionnaires. Kaplan–Meier time-to-event models were used to estimate the cumulative probability of method continuation rates up to 12 months post-insertion. Results Each country had a unique demographic profile of hormonal IUD users with different method-use histories. Across all three countries, women reported high rates of satisfaction with the hormonal IUD (67–100%) and high rates of continuation at the 12-month mark (82–90%). Conclusions Rates of satisfaction and continuation among hormonal IUD users in the study suggest that expanding method choice with the hormonal IUD would provide a highly effective, long-acting method desirable to many different population segments, including those with high unmet need.

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Introducing the Hormonal Intrauterine Device in Madagascar, Nigeria, and Zambia: Results From a Pilot Study

10.21203/rs.3.rs-606544/v1 ◽

2021 ◽

Author(s):

Kendal Danna ◽

Grace Jaworski ◽

Bakoly Rahaivondrafahitra ◽

Francia Rasoanirina ◽

Anthony Nwala ◽

...

Keyword(s):

Intrauterine Device ◽

Descriptive Analysis ◽

Unmet Need ◽

User Characteristics ◽

Middle Income ◽

Prospective Longitudinal Study ◽

Highly Effective ◽

Estimate Method ◽

Long Acting ◽

Prospective Longitudinal

Abstract Background: The hormonal Intrauterine Device (IUD) is a highly effective contraceptive option growing in popularity and availability in many countries. The hormonal IUD has been shown to have high rates of satisfaction and continuation among users in high-income countries. The study aims to understand the profiles of clients who choose the hormonal IUD in low-and middle-income countries (LMICs) and describe their continuation and satisfaction with the method after 12 months of use. Methods: A prospective longitudinal study of hormonal IUD acceptors was conducted across three countries—Madagascar, Nigeria, and Zambia—where the hormonal IUD had been introduced in a pilot setting within the context of a broad mix of available methods. Women were interviewed at baseline immediately following their voluntary hormonal IUD insertion, and again three and 12 months following provision of the method. A descriptive analysis of user characteristics and satisfaction with the method was conducted on an analytic sample of women who completed baseline, three-month, and 12-month follow-up questionnaires. Kaplan-Meier cumulative hazard models were used to estimate method continuation rates up to 12 months post-insertion.Results: Each country had a unique demographic profile of hormonal IUD users with different method use histories. Across all three countries, women reported high rates of satisfaction with the hormonal IUD (67-100%) and high rates of continuation at the 12-month mark (91-93%).Conclusions: Rates of satisfaction and continuation among hormonal IUD users in the study suggest that expanding method choice with the hormonal IUD would provide a highly effective, long-acting method desirable to many different population segments, including those with high unmet need.

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Follow-up of copper intrauterine device insertion by nurses: a prospective longitudinal study

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2020-0156 ◽

2020 ◽

Vol 73 (suppl 4) ◽

Author(s):

Tatiane Herreira Trigueiro ◽

Jerferson Cleiton Ferrari ◽

Silvana Regina Rossi Kissula Souza ◽

Marilene Loewen Wall ◽

Rute Barbosa

Keyword(s):

Intrauterine Device ◽

Descriptive Analysis ◽

Maternity Hospital ◽

Prospective Longitudinal Study ◽

Irregular Bleeding ◽

One Year ◽

Nursing Training ◽

Prospective Longitudinal ◽

Copper Intrauterine Device

ABSTRACT Objective: to assess the complications, acceptability and causes of discontinuation of women who inserted copper intrauterine devices at a usual risk maternity for one year. Methods: a longitudinal-prospective study, lasting 12 months. Eighty-three women who received the device by a doctor or nurse in a maternity hospital between September and October 2017 participated. Data were collected at one, six and 12 months after insertion and underwent descriptive analysis. Results: most were inserted by nurses and 71 continued with the device. Women chose IUD use because there is no risk of forgetfulness, it is non-hormonal and effective. The 12 who discontinued use reported dysmenorrhea, menorrhagia, irregular bleeding, fall out, and endometrium perforation. Conclusion: the method was continued by most of participants and the complications found are common to the literature. There is a need to expand nursing training to increase the offer to the population.

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Factors influencing satisfaction with oral contraceptive pills and injectables among past users in Kenya

Journal of Biosocial Science ◽

10.1017/s0021932018000299 ◽

2018 ◽

Vol 51 (4) ◽

pp. 491-504 ◽

Cited By ~ 3

Author(s):

George Odwe ◽

Joyce Mumah ◽

Francis Obare ◽

Marylene Wamukoya ◽

Kazuyo Machiyama ◽

...

Keyword(s):

Family Planning ◽

Unmet Need ◽

Multivariate Logistic Regression Analysis ◽

Ease Of Use ◽

Rural Site ◽

Urban Site ◽

Baseline Survey ◽

Prospective Longitudinal Study ◽

Prospective Longitudinal

AbstractThis study examines factors associated with satisfaction with oral pills and injectables among past users in Kenya based on a baseline survey for the 2-year prospective longitudinal study Improving Measurement of Unintended Pregnancy and Unmet Need for Family Planning conducted in 2016. Married women aged 15–39 years were interviewed using a structured questionnaire that captured information on reproduction, contraceptive knowledge and beliefs and attitudes towards contraception in general and towards specific methods. A multivariate logistic regression analysis was used to examine factors that influenced satisfaction with oral pills and injectables among past users in one urban site (Nairobi slums) and one predominantly rural site (Homa Bay in western Kenya). Results showed that dissatisfaction with pills and injectables is common among past users in both rural and urban Kenya (ranging from 39% to 56%). The distinctive contribution of the study lies in its ability to relate method-specific beliefs to overall satisfaction. Perception of effectiveness, ease of use and safety for long-term use had statistically significant influences on satisfaction with pills in both urban and rural sites while partner’s approval was only important in Nairobi. For injectables, the perception of safety for long-term use was significant in the urban but not the rural site. Unlike pills, the belief that members of a woman’s social network had used a method and found it satisfactory was a particularly powerful influence on satisfaction (AOR=2.8 in rural and 3.2 in urban). Perception of accessibility and fears about infertility were not found to be statistically associated with satisfaction for either pills or injectables. Surprisingly, the effects of all perceived contraceptive attributes were the same for major socio-demographic strata of the populations. The findings underscore the need for targeted counselling and community-based communication interventions to address negative and erroneous perceptions about family planning methods.

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Postpartum long-acting contraception uptake and service delivery outcomes after a multilevel intervention in Kigali, Rwanda

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2020-200741 ◽

2020 ◽

pp. bmjsrh-2020-200741

Author(s):

Julie Espey ◽

Rosine Ingabire ◽

Julien Nyombayire ◽

Alexandra Hoagland ◽

Vanessa Da Costa ◽

...

Keyword(s):

Supply And Demand ◽

Intrauterine Device ◽

Unmet Need ◽

Secondary Analysis ◽

Stakeholder Involvement ◽

Primary Objective ◽

Published Data ◽

National Priority ◽

Long Acting ◽

Multilevel Intervention

IntroductionPostpartum family planning (PPFP) is critical to reduce maternal–child mortality, abortion and unintended pregnancy. As in most countries, the majority of PP women in Rwanda have an unmet need for PPFP. In particular, increasing use of the highly effective PP long-acting reversible contraceptive (LARC) methods (the intrauterine device (IUD) and implant) is a national priority. We developed a multilevel intervention to increase supply and demand for PPFP services in Kigali, Rwanda.MethodsWe implemented our intervention (which included PPFP promotional counselling for clients, training for providers, and Ministry of Health stakeholder involvement) in six government health facilities from August 2017 to October 2018. While increasing knowledge and uptake of the IUD was a primary objective, all contraceptive method options were discussed and made available. Here, we report a secondary analysis of PP implant uptake and present already published data on PPIUD uptake for reference.ResultsOver a 15-month implementation period, 12 068 women received PPFP educational counselling and delivered at a study facility. Of these women, 1252 chose a PP implant (10.4% uptake) and 3372 chose a PPIUD (27.9% uptake). On average providers at our intervention facilities inserted 83.5 PP implants/month and 224.8 PPIUDs/month. Prior to our intervention, 30 PP implants/month and 8 PPIUDs/month were inserted at our selected facilities. Providers reported high ease of LARC insertion, and clients reported minimal insertion anxiety and pain.ConclusionsPP implant and PPIUD uptake significantly increased after implementation of our multilevel intervention. PPFP methods were well received by clients and providers.

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Establishing dental recall interval for Pakistani children: a longitudinal study

Journal of the Pakistan Medical Association ◽

10.47391/jpma.137 ◽

2021 ◽

pp. 1-13

Author(s):

Muhammad Taqi ◽

Jaffar Abbas Zaidi ◽

Hafeez Shaikh ◽

Adnan Sukkurwalla

Keyword(s):

Longitudinal Study ◽

Response Rate ◽

Descriptive Analysis ◽

Repeated Measure ◽

Progression Rate ◽

Prospective Longitudinal Study ◽

Recall Interval ◽

Caries Increment ◽

Prospective Longitudinal

Abstract Objective: This study aims to determine the caries increment rate in children of 12 years of age after 6, 12 and18 months to establish appropriate dental recall interval. Subjects and Methods: Prospective longitudinal study of 18 months duration was conducted from May 2016 to October 2017 in the Bhakkar city of Punjab, Pakistan. School children of 12-years-old were selected in this study using convenience sampling. The caries progression rate was measured using Modified Beck’s method or adjusted caries increment. Descriptive analysis was conducted to estimate the response rate at baseline and at each follow-up, to estimate the number of children who attended the examinations, mean DMFT/DMFS scores and mean caries increments. Repeated measure ANOVA with post hoc test using Bonferroni correction was used to compare baseline mean caries increment with caries increment on 6, 12 and 18 months. Results: In the last follow-up, 183 children were present, giving a response rate of 81%. Significantly high caries increment among cavitated lesions was observed at 6 months (0.49±1.45, p=0.0001), 12 months (0.66±2.35, p=0.0001), and 18 months (0.86±2.39, p=0.0001) when compared with baseline caries increment. Continuous...

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Factors affecting uptake of the levonorgestrel-releasing intrauterine device: A mixed-method study of social franchise clients in Nigeria

PLoS ONE ◽

10.1371/journal.pone.0257769 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257769

Author(s):

Aurélie Brunie ◽

Anthony Adindu Nwala ◽

Kayla Stankevitz ◽

Megan Lydon ◽

Kendal Danna ◽

...

Keyword(s):

Qualitative Data ◽

Contraceptive Use ◽

Intrauterine Device ◽

Middle Income ◽

Method Choice ◽

Social Franchise ◽

The Government ◽

Long Acting ◽

Depth Interviews ◽

Copper Iud

Background Despite the positive characteristics of the levonorgestrel-releasing intrauterine device (IUD)–a long-acting, highly effective contraceptive with important non-contraceptive attributes–the method has not been widely available in low- and middle-income countries. This study of hormonal IUD, copper IUD, implant and injectable users in Nigeria compares their characteristics, reasons for method choice, and experiences obtaining their method. Methods We conducted a phone survey with 888 women who received a hormonal IUD, copper IUD, contraceptive implant or injectable from 40 social franchise clinics across 18 states in Nigeria. We analyzed survey data descriptively by method and assessed factors associated with hormonal IUD use through multivariate logistic regression models. Follow-up in-depth interviews conducted with 32 women were analyzed thematically. Results There were few differences by method used in the socio-demographic profiles and contraceptive history of participants. Among users choosing a long-acting, reversible method, the top reasons for method choice included perceptions that the method was “right for my body,” long duration, recommended by provider, recommended by friends/family, few or manageable side effects, and high effectiveness. Among hormonal IUD users, 17% mentioned reduced bleeding (inclusive of lighter, shorter, or no period), and 16% mentioned treatment of heavy or painful periods. Qualitative data supported these findings. Among survey respondents, between 25% and 33% said they would have chosen no method if the method they received had not been available. Both quantitative and qualitative data indicated that partner support can affect contraceptive use, with in-depth interviews revealing that women typically needed partner permission to use contraception, but men were less influential in method choice. Conclusions Expanding access to the hormonal IUD as part of a full method mix provides an opportunity to expand contraceptive choice for women in Nigeria. Findings are timely as the government is poised to introduce the method on a wider scale.

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Expanding contraceptive choice in Ethiopia: a comparative analysis of method mixes in post-abortion contraception versus routine family planning

Gates Open Research ◽

10.12688/gatesopenres.13030.1 ◽

2019 ◽

Vol 3 ◽

pp. 1518

Author(s):

Melaku Samuel ◽

Samuel Muluye ◽

Tewodros Tolossa ◽

Ashenafi Alemayehu

Keyword(s):

Family Planning ◽

Service Delivery ◽

Trend Analysis ◽

Intrauterine Device ◽

Descriptive Analysis ◽

Unmet Need ◽

Maternal Health Services ◽

Delivery Strategies ◽

Post Abortion ◽

Method Mix

Background: In Ethiopia, a low contraceptive prevalence and high unmet need coupled with skewed method mix clearly signify the need for comprehensive family planning delivery strategies. Ipas implemented problem-focused intervention to improve service delivery standards and provide accessible, high-quality family planning services. This analysis seeks to compare the contraceptive method mix in routine and post-abortion contraception services and to suggest how multifaceted service delivery approaches can help address the unmet family planning need. Methods: The intervention was implemented in 127 public health facilities providing both routine and post-abortion contraception services, from 2010 to 2017. The intervention focused on service delivery and program management gaps identified during the baseline assessment. Service data regularly collected from intervention facilities and entered into a Microsoft Excel database to conduct descriptive analysis, review trends, and monitor progress. Results: Trend analysis of method choice patterns revealed that the share of method mix for long-acting reversible contraceptives(LARCs) rose from 3% in 2010 to 40% in 2017 in routine family planning service, whereas in the post-abortion contraception service, the share for LARCs climbed from 2% in 2010 to 62% in 2017(P<0.001). Trend analysis of LARC uptake in post-abortion contraception revealed that implant use rose from 2% in 2010 to 54% in 2017, while intrauterine device (IUD) use increased from 0.1% in 2010 to 9% in 2017. In routine program, proportion of implant acceptors increased from 3% in 2010 to 35% in 2017, while IUD acceptance increased far more slowly, from only 0.07% to 5% over the same period. Conclusions: Comprehensive contraceptive service delivery strategies, such as integration of family planning with other maternal health services can help the service to reach clients with a variety of needs, a key factor for a higher uptake of LARCs by abortion clients as compared to routine family planning program.

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Real-World Effectiveness of Inhalation Therapy Among Patients With Symptomatic COPD in China: A Multicenter Prospective Study

Frontiers in Pharmacology ◽

10.3389/fphar.2021.753653 ◽

2021 ◽

Vol 12 ◽

Author(s):

Wei Cheng ◽

Jiaxi Duan ◽

Aiyuan Zhou ◽

Yiyang Zhao ◽

Rong Yi ◽

...

Keyword(s):

Real World ◽

Minimum Clinically Important Difference ◽

Inhalation Therapy ◽

Chronic Obstructive ◽

Severe Exacerbation ◽

Prospective Longitudinal Study ◽

Copd Patients ◽

Long Acting ◽

Prospective Longitudinal

Purpose: This real-world study evaluated the effectiveness of different inhalation therapies in patients with symptomatic chronic obstructive pulmonary disease (COPD) in China and also explored the relevant factors that influence the effectiveness of inhalation therapy.Patients and Methods: We conducted a multicenter prospective longitudinal study that was carried out in 12 hospitals in China from December 2016 to June 2021. A face-to-face interview was conducted to collect data. Baseline data were collected at the first visit. Minimum clinically important difference (MCID) was defined as attaining a COPD assessment test (CAT) decrease ≥2. We mainly assessed the MCID and the incidence of exacerbations at the 6 months follow-up.Results: In 695 patients, the mean age was 62.5 ± 8.2 years, with a mean CAT score of 15.1 ± 6.0. Overall, 341 (49.1%) patients attained the MCID of CAT and the incidence of exacerbation during follow-up was 22.3%. Females were significantly more likely to attain MCID than male in COPD patients (adjusted odd ratio (aOR) = 1.93, adjusted 95% confidence interval (a95%CI) = 1.09–3.42, p = 0.024). Patients treated with LABA/LAMA or ICS/LABA/LAMA (ICS, inhaled corticosteroid; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist) were more likely to attain MCID than patients treated with LAMA (aOR = 3.97, a95%CI = 2.48–6.35, p < 0.001; aOR = 3.17, a95%CI = 2.09–4.80, p < 0.001, respectively). Patients treated with LABA/LAMA had a higher incidence of severe exacerbation than patients treated with ICS/LABA/LAMA (aOR = 1.95, a95%CI = 1.04–3.66, p = 0.038).Conclusion: The incidence of MCID in symptomatic COPD patients treated with inhalation therapy was nearly 50%. Patients treated with LABA/LAMA or ICS/LABA/LAMA were more likely to attain MCID than patients treated with LAMA. Patients treated with LABA/LAMA had a higher incidence of severe exacerbations than with ICS/LABA/LAMA.

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