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ORIGINAL ARTICLE
Year : 2018  |  Volume : 21  |  Issue : 3  |  Page : 137-140

Subdermal contraceptive implants: Experience at a tertiary health institution in Southwestern Nigeria


1 Department of Obstetrics and Gynaecology, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
2 Department of Obstetrics and Gynaecology, College of Health Sciences, Bowen University, Iwo, Nigeria

Date of Web Publication4-Oct-2018

Correspondence Address:
Dr. Adewale Samson Adeyemi
Department of Obstetrics and Gynaecology, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso
Nigeria
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DOI: 10.4103/smj.smj_7_18

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  Abstract 


Background: Norplant, a six-rod implant, was the first-generation subdermal contraceptive implant containing levonorgestrel. This had been replaced with the second-generation Implanon® and Jadelle®, which contain one rod and two rods, respectively. These second-generation implants have been shown to be as effective as the first-generation Norplant, but with less cumbersome insertion and removal techniques. The aim of this study is to evaluate the prevalence and use of subdermal contraceptive implants and the side effects among contraceptive method acceptors. Materials and Methods: A retrospective review of the case notes of clients who chose subdermal implants as a contraceptive method at Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso between 1 January 2014 and 31 December 2016. Mean and standard deviation were used to summarize continuous variables whereas frequency and percentage were used for categorical variables. Level of significance was set at a value of P < 0.05. Results: One hundred and forty-two clients made Implanon (115) and Jadelle (27) their contraceptive method of choice during the study period, accounting for 15.3% of the 928 contraceptive acceptors. Most of the acceptors were married (93.7%), and child spacing was mostly the reason for their choice (55.6%). The duration of the use of the method ranged between 6 and 49 months, and only 25 (17.6%) discontinued the method during the study period. The reason to discontinue the method was mostly to conceive (80%). Subdermal implants were well tolerated by the clients as 112 (78.9%) reported no unwanted side effects, and irregular vaginal bleeding was the most unwanted side effect in those that had them (59.3%). Conclusion: Subdermal implant contraceptives were well tolerated by the clients, and most clients did not report any side effects.

Keywords: Acceptability, complications, continuation, discontinuation, subdermal implants


How to cite this article:
Adeyemi AS, Owonikoko KM, Adekanle DA, Aworinde O. Subdermal contraceptive implants: Experience at a tertiary health institution in Southwestern Nigeria. Sahel Med J 2018;21:137-40

How to cite this URL:
Adeyemi AS, Owonikoko KM, Adekanle DA, Aworinde O. Subdermal contraceptive implants: Experience at a tertiary health institution in Southwestern Nigeria. Sahel Med J [serial online] 2018 [cited 2018 Dec 14];21:137-40. Available from: http://www.smjonline.org/text.asp?2018/21/3/137/242747




  Introduction Top


Subdermal contraceptive implants are said to have the highest effectiveness of any contraceptive method with only 0.05% of typical and perfect users expected to experience an unintended pregnancy in the 1st year of use.[1] About 1% of women using a modern contraceptive, use implants.[2] Norplant, a six-rod subdermal implant is the first-generation implant, while Jadelle, a two–-rod and Implanon, a one-rod, are second-generation subdermal implants. The second-generation implants have the advantage of ease of insertion and removal over the first-generation Norplant. Each rod of Jadelle contains 75 mg of levonorgestrel and is effective for 5 years. The single rod of Implanon contains 68 mg of etonogestrel which is less androgenic than levonorgestrel so that acne, weight gain and perhaps other side effects would be less common.[3],[4]

The primary mode of action of all subdermal implants is to prevent ovulation.[5] Secondary modes of action include the prevention of sperm penetration of the cervical mucus and prevention of implantation by thinning the endometrium.[6]

The side effects of subdermal contraceptive implants are similar to other progestogen-only contraceptives of which menstrual disruption is the most common and is the most common reason for discontinuation of the method, and presents a major obstacle to its widespread use.[6]

Ovulation returns within 3 weeks of implant removal in 90% of women; therefore, women can be advised that there is no delay in return of fertility after implant removal.[7]

The second-generation subdermal contraceptive implants were introduced to Nigeria contraceptive market in 2006,[8] and since then, several studies from the country have explored the acceptability and continuation rates of the method.[8],[9],[10],[11] These studies showed a low acceptance rate, but good continuation rate.[9],[10],[11] The present study is to determine the use, prevalence, and continuation rate of subdermal contraceptive implants at Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, a growing teaching hospital in Southwestern Nigeria.


  Methods Top


A retrospective review of the clients' case notes who had subdermal contraceptive implants (Implanon and Jadelle) as modern contraceptive method during the study period, from 1 January 2014 to 31 December 2016. Data retrieved from the patient case notes were as follows: client's age, number of living children, educational and marital status, duration of use of the method, reasons for discontinuation of the method, and complications experienced with the method. Data were analyzed using SPSS version 17 (SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc. 2008). Mean and standard deviation were used to summarize continuous variables while frequency and percentage were used for categorical variables. The Kaplan–Meier survival analysis was performed to determine the continuation rate of the implants by the clients, whereas Cox regression analysis was performed to determine factors influencing the continuation rate. Level of significance was set at a value of P < 0.05%.


  Results Top


One hundred and forty-two clients made subdermal contraceptive implants their method of choice during the study period, accounting for 15.3% of the 928 modern contraceptive acceptors. Of the 142 acceptors, 115 (81%) chose Implanon, whereas 27 (19%) chose Jadelle. Most of the acceptors were married 133 (93.7%), whereas 9 (6.3%) were single. Seventy-nine of the clients (55.6%) used the method for child spacing, whereas 63 (44.4%) used the method to limit the size of the family. The duration of use of the method was between 6 and 49 months with a mean of 22.1 ± 8.94. The age of the clients ranged between 20 and 48 years with a mean of 32.9 ± 5.70. Other sociodemographic characteristics of the clients are shown in [Table 1]. Their weight ranged between 41.70 and 124.10 kg with a mean of 66.3 ± 14.00. Thirty (21.1%) of the client experienced some side effects of the methods, of which irregular vaginal bleeding 19 (63.4%) was the most common; other side effects experienced were excessive menstrual flow 6 (20%), and weight gain 5 (16.7%). Of the clients that discontinued the method 25 (17.6%), the most common reason was to get pregnant 20 (80%); other reasons for discontinuation were menorrhagia 3 (12%), and irregular vaginal bleeding 2 (8%).
Table 1: Sociodemographic characteristics of the clients

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There was no report of accidental pregnancy by any of the clients during the study period. Using the Kaplan–Meier survival analysis, more than 50% of the clients will be on a method for at least 39 months [Figure 1]. Using the Cox regression analysis, combining number of living children with educational status, clients having tertiary education stayed longer on the method compared with those with lower education (odds ratio [OR]: 2.02:95% confidence interval [CI]: 1.345–3.05) [Figure 2]. However, number of living children did not significantly affect the continuation rate of subdermal contraceptive implants (P = 0.789) [Figure 3].
Figure 1: Continuation rate of subdermal contraceptive implants

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Figure 2: Educational groups (P = 0.001). 1-Below tertiary education. 2-Tertiary education

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Figure 3: Number of living children. The two lines are close (P = 0.789)

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  Discussion Top


The prevalence of subdermal contraceptive implants in this study is 15.3%. This is higher than the 4.3% from Port Harcourt,[10] 4.3% from Ibadan,[11] 7% from Zaria,[8] and 13.4% from Jos.[9] However, it is a lower rate than the 18.6% from Uyo,[12] and 31.9% from Abakaliki.[13] The higher prevalence rate may be explained by the more awareness of subdermal contraceptive implants, as many of the studies with the low prevalence rates were done in the first few years of the introduction of the second-generation subdermal implants into Nigeria contraceptive market.

The side effects of the subdermal contraceptive implants experienced by the clients in this study were irregular vaginal bleeding, menorrhagia, and weight gain. These were the side effects of the method that had been documented from other studies.[8],[9],[10],[11],[12] These side effects are those that had been documented to be associated with progestogen-only contraceptives generally.[6],[14],[15] There was a good continuation rate of the method by the clients as more than 50% were still using the method 39 months after insertion. Only 17.6% of the clients discontinued the method, and the reason for discontinuation was mostly to conceive (80%), and only 20% of those that discontinued, did so because of the side effects. This is at variance with the study of Madugu et al.[8] in which there was a high discontinuation rate of subdermal implants and those that discontinued did so as a result of side effects.[8] Studies from Port Harcourt,[10] Ibadan,[11] and Uyo[12] showed a good continuation rate of subdermal implants as it is in the present study. Ojule et al.[10] and Igwe et al.[13] also found that the most common reason for discontinuation was to get pregnant.

Education was found to be a significant factor (OR: 2.02:95% CI: 1.345–3.05) for the high continuation rate of subdermal contraceptive implants by the clients in this study. Formal education had been shown to positively influence the use of contraceptives generally.[16]

There was no report of accidental pregnancy by the clients in this study. This confirms the high efficacy of the method as documented by previous studies.[8],[9],[10],[11],[12] Therefore, the subdermal contraceptive implant will be a good option for terminal fertility control in our environment where there is great aversion for surgical sterilization.[16],[17]


  Conclusion Top


Subdermal contraceptive implants are well tolerated, long lasting reversible methods with good continuation rate among our clients, and will be a good alternative in our population that has aversion to female surgical sterilization.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Trussell J. Contraceptive failure in the United States. Contraception 2011;83:397-404.  Back to cited text no. 1
    
2.
Jacobstein R, Polis CB. Progestin-only contraception: Injectables and implants. Best Pract Res Clin Obstet Gynaecol 2014;28:795-806.  Back to cited text no. 2
    
3.
Oloto E, Mascarentas L. Subdermal contraceptive implants. Br J Fam Plann 2000;26:171-4.  Back to cited text no. 3
    
4.
Darney PD. Hormonal implants: Contraception for a new century. Am J Obstet Gynecol 1994;170:1536-43.  Back to cited text no. 4
    
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Damey PD. Hormonal implants: Contraception for a new century. Am J Obstet Gynecol 1994;170:1536-43.  Back to cited text no. 5
    
6.
Baird DT, Glasier AF. Menstrual bleeding patterns and contraception. IPPF Med Bull 1991;25:1-2  Back to cited text no. 6
    
7.
Glasier A. Implantable contraceptives for women: Effectiveness, discontinuation rates, return of fertility, and outcome of pregnancies. Contraception 2002;65:29-37.  Back to cited text no. 7
    
8.
Madugu NH, Abdul MA, Bawa U, Kalawole B. Uptake of hormonal implant contraceptives in Zaria, Northern Nigeria. Open J Obstet Gynaecol 2015;5:268-73.  Back to cited text no. 8
    
9.
Mutihir JT, Nyango DD. One-year experience with implanon subdermal Implants in Jos Nigeria. Nig J Clin Pract 2010;13:28-31.  Back to cited text no. 9
    
10.
Ojule JD, Oranu EO, Enyindah CE. Experience with implanon in Southern Nigeria. J Med Med Sci 2012;3:710-4.  Back to cited text no. 10
    
11.
Roberts AO, Morhason-Bello IO, Okunlola MA, Adekunle AO. Profile of implanon acceptors and pattern of side effects. J Reprod Contracept 2015;26:46-52.  Back to cited text no. 11
    
12.
Abasiattai AM, Utuk NM, Inyang-Etoh EC. Subdermal contraceptive implants: Profile of acceptors in a tertiary hospital in Southern Nigeria. Int J Gynaecol Obstet Neonatal Care 2014;1:9-13.  Back to cited text no. 12
    
13.
Igwe NW, Nnamdi EB, Jude AJ. A 5-year clinical evaluation of subdermal implants among abakaliki acceptors. J Basic Clin Reprod Sci 2016;5:1-5.  Back to cited text no. 13
  [Full text]  
14.
Adeyemi AS, Adekanle DA. Progestogen-only injectable contraceptive: Experience of women in Osogbo, Southwestern Nigeria. Ann Afr Med 2012;11:27-31.  Back to cited text no. 14
[PUBMED]  [Full text]  
15.
Akadri AA, Odelola OI. Progestogen-only injectable contraceptive: Acceptor prevalence and client experience at Sagamu, Nigeria. Niger Postgrad Med J 2017;24:178-81.  Back to cited text no. 15
[PUBMED]  [Full text]  
16.
Adeyemi AS, Adekanle DA, Komolafe JO. Pattern of contraceptives choice among the married women attending the family planning clinic of a tertiary health institution. Niger J Med 2008;17:67-70.  Back to cited text no. 16
    
17.
Adekanle DA, Afolabi AF, Adeyemi AS. Terminal fertility control: Clients own reason for the choice of the contraceptive method. Open J Obstet Gynaecol 2013;3:706-9.  Back to cited text no. 17
    


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